Permit Support Document IIIa
.
TIGARD
City of Tigard
April 3,2020
Sun Glow, Inc.
2428 SE 105th Ave
Portland, OR 97216
Re: Permit No. MEC2019-00898
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 11945 SW Katherine St
Project Name: Glen Lotka
Job No.: N/A
Refund Method: ® Check#235170 in the amount of$80.64.
❑ Credit card "return" receipt in the amount of$ .
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 this was a duplicate permit (see MEC2019-
00748). Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Aa/h/2.1
Dianna Ornelas
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
. ' City of Tigard
w
T c n R D 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 Permit Action 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: Sun Glow, Inc DATE: 3/20/2020
2428 SE 105th Ave
Portland, OR 97216 REQUESTED BY: Dianna Ornelas
TRANSACTION INFORMATION:
Receipt#: 427570 Case#: MEC2019-00898
Date: 12/30/2019 Address/Parcel: 11945 SW Katherine St
Pay Method: CreditCard Project Name: Glen Lotka
EXPLANATION: Per applicant's request as this was a duplicate permit;refund 80%of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Mechanical Permit 230-0000-43102 $72.00
12%State Surcharge 100-0000-24001 8.64
TOTAL REFUND: $80.64
APPROVALS: SIGN�, � ��,C
If under$5,000 Professional Staff • '�
If under$12,500 Division Manager
If under$25,000 Department Manager
If under$100,000 City Manager
If over$50,000 Local Contract Review Board
FOR ACCELA SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: V'/ By:
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
111 I 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Glen Lotka ��-
Site Address: 11945 SW KATHERINE ST
Receipt Number: 436219 - 09/03/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
M EC2019-00898 $-80.64
Total: $-80.64
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 235170 DHOWSE 09/03/2021 $-80.64
Payor: Sun Glow, Inc.
Total Payments: $-80.64
Balance Due: $80.64
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CITY OF TIGARD RECEIPT
111,e q
a 13125 SW Hall Blvd.,Tigard OR 97223
-- 503.639.4171
TIGARD
Project Name: Glen Lotka
Site Address: 11945 SW KATHERINE ST 0 4_ 6 / ", /-
Receipt Number: 427570 - 12/30/2019 'V
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2019-00898 Heat Pump 230-0000-43102 $61.06
MEC2019-00898 12%State Surcharge-Mechanical 100-0000-24001 $10.80
MEC2019-00898 Minimum Fee Adjustment-Mechanical 230-0000-43102 $28.94
Total: $100.80
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 5896237 PUBLICUSER33254112/30/2019 $100.80
Payor:jylishaf
Total Payments: $100.80
Balance Due: $0.00
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