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Permit Support Document (59)
V 0 1 !;:). City of Tigard • COMMUNITY DEVELOPMENT D/P.AIr Xet.LENT RECEIVED IIIV = Request for Permit Action T i GA R n 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 • www.tigard-or.gov Al 10 201 CITY TIGARD TO: CITY OF TIGARDl'� a ��DIVISION Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: n Owner ❑ Applicant FR.Contractor ❑ City Staff Check(✓)one REFUND OR Name: ;� INVOICE TO: (Business or Individual) ��J y7L t 1n Mailing Address: I 0'9-00 5u A t j vol • City/State/Zip: 13-e Qr+frin cp q-7065 Phone No.: 5d 3 33--Oct 30 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): CANCEL/VOID PERMIT APPLICATION. REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE(attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit). Permit#: 'PLY r 1*ZDV -0o.,; ?-,,P, Site Address or Parcel#: t O 6 j Q 5 LO Peau:V'kICVV.ell L Project Name: N) Subdivision Name: Lot#: EXPLANATION: O )n - �1 d '-6 lis .4'ae.re,l Cif:WaVeilln, Signature: Ota(-0-4 Date: to i a--9 `( y Print Name: D,CGui„iinA ©ia.L..e Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. _ a 2 Cel, - /'. 1/ — .2, �.-s. /33 2 / O /, y7 0,2.,E FOR OFFICE USE ONLY Route to Sys Admin: Date By Route to Records: Date ti ;C By , Refund Processed: Date .// � By , - Invoice Processed: Date / By Permit Canceled: Date � By Parcel Tag Added: Date By I:\Building\Pons\RegPcnnitAction_0923 4.doc III TIGARD . City of Tigard August 9, 2018 ProDrain Attn: Deanna Oakley 10200 SW Allen Blvd. Beaverton, OR 97005 Re: Permit No. PLM2017-00500 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 10890 SW Fairhaven Way Project Name: Nutt Job No.: N/A Refund Method: ® Check#229418 in the amount of$106.47. ❑ Credit card "return" receipt in the amount of$ . Note: Please allow 2-5 days for this refund transaction to be credited to your account by the company that issued your card. ❑ Trust account"deposit" receipt in the amount of$ . Comment(s): Per applicant's request as owner used a different contractor. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, '621 ___, Dianna Howse Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov III City of Tigard T► Accela Refund Request • This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Request for PermitAction form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: ProDrain DATE: 8/3/2018 10200 SW Allen Blvd Beaverton, OR 97005 REQUESTED BY: Dianna Howse • TRANSACTION INFORMATION: Receipt#: 417265 Case#: PLM2018-00232 Date: 5/15/2018 Address/Parcel: 10890 SW Fairhaven Way Pay Method: CreditCard Project Name: Nutt EXPLANATION: Per applicant's request as owner used another contractor for the work. Refund 80%of permit fees. A r� �r a € t @ 64 Plumbin. Permit 230-0000-43101 $95.06 12%state surcha•.e 100-0000-24001 11.41 TOTAL REFUND: $106.47 APPROVALS: SIGNATURES ATE: If under$5,000 Professional Staff ‹..61 If under$12,500 Division Manager If under$25,500 Department Manager If under$50,000 City Manager If over$50,000 Local Contract Review Board I - NOri "', row ,i♦ ,, u >,K & '�:Si. 4` . .... 4:fir-; Case Refund Processed: Date: Y S" /J By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010