PRE2019-00051 1111
,TIGARD
City of Tigard
January 28,2020
Pipeline Plumbing
333 S State St,Ste V-108
Lake Oswego,OR 97034
Re: Permit No. PRE2019-00051
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 9780 SW Tigard St
Project Name: Pipeline Plumbing
Job No.:
Refund Method: ® Check#234497 in the amount of$341.00.
❑ Credit card"return"receipt in the amount of$
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): Pre-application was not required,only required a minor modification.
Refund 100%of application fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
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
71
I ' City of Tigard
r i c n i: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: Pipeline Plumbing DATE: 1/17/2020
1885 Crest Drive
Lake Owego, OR 97034 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 427116 Case#: PRE2019-00051
Date: 11/25/2019 Address/Parcel: 9780 SW Tigard St
Pay Method: CreditCard Project Name: Pipeline Plumbing
EXPLANATION: Pre-application was not required per Agnes Lindor and only required a minor
modification. Refund 100%of application fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Pre-Application Conference 100-0000-43116 $341.00
TOTAL REFUND: $341.00
APPROVALS: SIGN/ATU S/DATE:
If under$5,000 Professional Staff �/
If under$12,500 Division Manager --�tt"
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: 9/J/21 By: „Je
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
lig a
a ' 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Pipeline Plumbing
Site Address: 9780 SW TIGARD ST '
/��/u n
Receipt Number: 436207 - 09/03/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PRE2019-00051 $-341.00
Total: $-341.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 234497 DHOWSE 09/03/2021 $-341.00
Payor: Pipeline Plumbing
Total Payments: $-341.00
Balance Due: $341.00
Page 1 of 1
CITY OF TIGARD RECEIPT
g 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
T [GAR I)
Project Name: Pipeline Plumbing
Site Address: 9780 SW TIGARD ST
Receipt Number: 427116 - 11/25/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PRE2019-00051 Pre-Application Conference-Type II 100-0000-43116 /00 t' $341.00 E
Total: $341.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 02372D ALINDOR 11/25/2019 $341.00
Payor: Adam Faren
Total Payments: $341.00
Balance Due: $0.00
Page 1 of 1
VOID
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT l//e/Zc
_. r Request for Permit Action
ipl
T I G A R D 13125 SW Hall Blvd. • Tigard,Oregon 97223 • 503-718-2439 •www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPerrnits@tigard-or.gov
FROM: 0 Owner ra Applicant 0 Contractor VrCity Staff
Check(✓)one
REFUND OR Name: •
INVOICE TO: (Business or Individual) AAA rn I Vt p&h� plumb n5
Mailing Address: `eV S Cirevi n vG
City/State/Zip: [Ate 0Swed0 1 0 R on 0 3 4-
Phone No.: V3_(4/24. 1"!W
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
►� CANCEL/VOID PERMIT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). — (
0 INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). VV(VIICA
Permit#: F Zb i0 t9- (i��0o 51
Site Address or Parcel#: otuo SW -t-t iter
cri- •
Project Name: PI InL- P u i bi
Subdivision Name: Lot#:
EXPLANATION: ,
Prt'—rnpp was nO+- rr jotercl. T'_. pm*c..P- uv4-01ct 0 ..i I j be c., heli i.-
Signature: i- O 2t `� Date: i 2I ([b 1 1
Print Name: / �( (-(s i frr
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.
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date €7/3/y/ By „/ J
Refund Processed: Date./A ap By I Invoice Processed: Date By
Permit Canceled: Date //f /2.p 4 By 4 •arcel Tag Added: Date By
I:\Building\Forms\RegPemutAction_20518.doc