Permit Support Document (2) • .
1111
n
TIGARD
City of Tigard
June 24, 2019
D &Sons Plumbing
16510 NE 199th St
Battleground, WA 98604
Re: Permit No. PLM2019-00055
Dear Applicant:
The City of Tigard has processed a refund for overpayment of permit fees on the above
referenced permit for the following:
Site Address: 7735 SW Gentle Woods Dr
Project Name: Gentle Woods
Job No.: N/A
Refund: ® Check#232403 in the amount of$33.62.
❑ Credit card "return"receipt in the amount of$
❑ Trust account"deposit"receipt in the amount of$
Notes: Refund 80% of permit fees paid for plumbing fixtures not installed (ice maker and
tub/shower) per applicant's request.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
Enc.
is\s wing\Refuna §rW0 M NY-Avel!abi E4kaiegon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
III
. City of Tigard
T I G A 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: D &Sons Plumbing DATE: 6/10/2019
16510 NE 199th St
Battleground, WA 98604 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 421490 Case#: PLM2019-00055
Date: 2/12/2019 Address/Parcel: 7735 sw Gentle Woods Dr
Pay Method: CreditCard Project Name: Gentle Woods
EXPLANATION: Refund 80%of plumbing permit fees paid for plumbing fixtures not installed(ice maker
and tub/shower)per applicant's request.
REFUND INFORMATION: _
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Plumbing Permit 230-0000-43101 $30.02
12% State surchage 100-0000-24001 3.60
TOTAL REFUND: $33.62
APPROVALS: SIGNATURES/DATE:
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 y■ yF} tj
f ` " :55 � �;�J�.^"2,.: ' ', �✓ ILI""� ,l.t° ; �,, k , mid?+ :. S
Case Refund Processed: Date: i 'zj By: C-
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
U
1111 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Gentle Woods
Site Address: 7735 SW GENTLE WOODS DR
Receipt Number: 434458 - 05/21/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PLM2019-00055 $-33.62
Total: $-33.62
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 232403 DHOWSE 05/21/2021 $-33.62
Payor: D&Sons Plumbing
Total Payments: $-33.62
Balance Due: $0.00
lftillJiflHtfiYtY.m . . .. -— .. W .. .. . . -. ._. ..... ...,,,... _..
Ili CITY OF TIGARD RECEIPT
. 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Gentle Woods
Site Address: 7735 SW GENTLE WOODS DR
Receipt Number: 421490 - 02/12/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PLM2019-00055 Dishwasher 230-0000-43101 $25.02
PLM2019-00055 Garbage Disposal 230-0000-43101 $25.02
PLM2019-00055 Ice Maker"-- 230-0000-43101 $12.51 —
PLM2019-00055 Sink 230-0000-43101 $25.02
PLM2019-00055 Lavatories 230-0000-43101 $50.04
PLM2019-00055 Tub/Shower/Shower Pan' 230-0000-43101 $25.02 (- -
PLM2019-00055 Water Closet, 230-0000-43101 $50.04
PLM2019-00055 12%State Surcharge-Plumbing 100-0000-24001 $25.52
Total: $238.19
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 09041D PUBLICUSER144 02/12/2019 $238.19
Payor: Daniil Akimenko
Total Payments: $238.19
Balance Due: $0.00
Page 1 of 1
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
INr
= Request for Permit Action
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www. ir-
r l r '
TO: CITY OF TIGARD APR 2 5 2019
Building Division CITY ° .ARU
13125 SW Hall Blvd.,Tigard,OR 97223 BUILDING DIVISION
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: 'Owner ❑ Applicant ❑ Contractor ❑ City Staff
Check(1)one -f o// ,
REFUND OR Name: /�/E7z -,
INVOICE TO: (Business or Individual) J / S r Fo (Z fir- 00ifs-2 _ So L-A l
P M1
Mailing Address: 7 ? S r,J 14, 4uu,„( o/.
City/State/Zip: ��` C � ",-Ope i 1., 6' rT ;
Phone No.: 2 'it .So v S Pe u r>,6/nl(�-
/45'fa ,c/c itY 9 r= S'T
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): a — - G, wo IA/4
❑ CANCEL/VOID PERMIT APPLICATION. 90P-e,d y
'REFUND"P RMIT FEES (attach copy of original receipt and provide explanation below).
OR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: pi evi 3 5_ i 55
Site Address or Parcel#: 7735 ,sc.,..) e /r Licjiflit /' SA.rt CV(....
Project Name: /
Subdivision Name: / Lot#:
EXPLANATION: A), Q /-o 2.�,,ou 'I
4.
k,.. 44. n� 7)b ;44411I
Signature: f Date: ti„7,6-1/,
Print Name: �...,....-- ;gc. `n j
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. /2r70
3. Please allow 3-4 weeks for processing refund requests. _ 25. S y
_37-52
?o 3. C. o = � __
-S�" -4- 0.s /= 7, S/ y.:1, 0.3 3 2 ' Z. ? <<f l -ge 2/,9 Z
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date-5/:4, / By .1
Refund Processed: Date (,.//o /f By Ga', Invoice Processed: Date By
Permit Canceled: Date h/ ej' By ..4►,' Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_1205 8.doc