Correspondence TI.GARD
City of Tigard
December 2, 2014
Tapani Plumbing
PO Box 2350
Battle Ground,WA 98604
Re: Permit No. PLM2014-00060
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: 8200 SW Pfaffle St
Project Name: Westside Christian High School
Job No.: N/A
Refund: ® Check #215739 in the amount of$11.20.
❑ Credit card"return" receipt in the amount of$
❑ Trust account"deposit" receipt in the amount of$
Notes: Per applicant's request as whirlpool tub was removed from scope of work resulting
in a refund of 80% of the plumbing permit fees for this fixture item.
If you have any questions please contact me at 503.718.2430.
Sincerely,
/bP-4/4-70-1-E.L.'---
Dianna Howse
Building Division Services Coordinator
Enc.
I:\Building\RefunalI ,ig o eke€alfomalsprdlle1 egon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
City of Tigard
TIGARD 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 forPermitAction 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: Tapani Plumbing DATE: 11/17/2014
PO Box 2350
Battle Ground,WA 98604 REQUESTED BY: Dianna Howse
DA
TRANSACTION INFORMATION:
Receipt#: 195231 Case #: PLM2014-00060
Date: 3/13/2014 Address/Parcel: 8200 SW Pfaffle St
Pay Method: CreditCard Project Name: Westside Christian High School
EXPLANATION: Remove (1)whirlpool tub from scope of work and refund 80% of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Plumbing permit fee 230-0000-43101 $10.00
12% State Surcharge 100-0000-24001 1.20
TOTAL REFUND: $11.20
APPROVALS: SIGNATURES/DATE:
If under$5,000 Professional Staff '"
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
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: /a/vt//y By: il
1:\Building\Refunds\RefundRequest.doc x 09/01/2010
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
III ■ Ill Request for Permit Action
1 1 t ;A RD 13125 S\V Hall Blvd. • Tigard,Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 S\V Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPertnits @tigard-or.gov
FROM: ❑ Owner n Applicant ❑ Contractor gi City Staff
Check(1)one
REFUND OR Name:
INVOICE TO: (Business or Individual) (.,Je) --r6.,-0 E__ C tit! 'r,A.ii /4r 6l.{ 6eH/10(---
Mailing Address: 4/5105 C.-CM t.K.)-73#2.4.t.)F
City/State/Zip: �� 05+.)L Go , 02 5'70 35-
Phone No.: 5-0-2)- 69-7 - d-71 (
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
1 1 ■ ._ _ 'SID PERMIT APPLICATION.
REFUND IIT FEES (attach copy of original receipt and provide explanation below).
�U _ r FOR FEES DUE (attach case fee schedule and provide explanation .- .w .
I REMOVE/REPLACE CONTRACTOR ON`(tPERMIT (do not - e permit).
Permit#: 3w Q-2O l ` OGY)( A /C)Lt'/ c2 i/ — //r - o
Site Address or Parcel#: p a-CC .t.v P A-f j LL-
Project Name: LE-,r r £ C4l a4.5-r-/4(J 41(mil-i *Cc L,
Subdivision Name: Lot#:
EXPLANATION: f.r ut r ckieL P.ay}-t �r Cif �f :€2, &DC rF
(h- i-tt -Ti) / /1C..cia2.c eLA-3 ,F Ie..4Tie,r`) e if. P;xelli ee� . (4) v�..��e_s
-7/fY 101/-1- ew .Jr.�us/A
6_,+5604-/t,-0 �s 2�6 �wf/14,f���Pc;x.-rs f-4- tJl�f,� „ .rs �rsr
I ?..q ' / 67-10 t/ / 'v' �/Ef,1 /0e.'P7 4 s:r)/e /7 ay •.
�f Signature: K j,j Date: /c,9////
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Print Name: / f�13/� 3k ° 2`'/-1-,")
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Puy: /. So — I.a o = : se
Refund Policy 7719/_')#7,4 eal 7 o'Z t a .i'/
I. The city's Community Development Director,Building Official or City 1;a, ---- we-the refun n:
• 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. .\ll refunds will be returned to the original paver in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests. cwA : A9-/ ?^t Spy.cre
Al if 6-Au o2+ 70,E 6k,F. c r7
tc%TS ,, C- /e-C-1-7.4 A.„� y Ps,o .eD
- ;
FOR OFFICE USE ONLY
Route to Sys Admin: Date eirfAmopm Route to Records: Date / By c •=
Refund Processed: DateAV.V/y By •' � Invoice Processed: Date By
Permit Canceled: Date 4, 9- By fe721 .. Parcel Tag Added: Date By
l:\Buil ding\Forms\RegPcrmit.\ction_u'-3I4.doc