Permit 1 ' q
TIGARD
City of Tigard
July 16, 2015
Specialty Heating&Cooling Inc.
7500 SW Tech Center Dr. #130
Tigard, OR 97223
Re: Permit No. MEC2015-00351
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 13472 SW 107th Ave
Project Name: O'Dea
Job No.: N/A
Refund Method: ® Check#218022 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 customer cancelled job. Refund 80% of permit
fees. Please note that check was mailed separately by finance department.
If you have any questions please contact me at 503.718.2430.
Sincerely,
/ * . ---f,e.---
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
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 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: Specialty Heating&Cooling Inc. DATE: 7/9/2015
7500 SW Tech Center Dr. #130
Tigard, OR 97223 REQUESTED BY: Dianna Howse
• TRANSACTION INFORMATION:
Receipt#: 201153 Case #: MEC2015-00351
Date: 6/8/2015 Address/Parcel: 13472 SW 107th Ave.
Pay Method: CreditCard Project Name: Fantacy Hill D'd.Q.C-4---
EXPLANATION: Per applicant's request as customer cancelled job. 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: SIGNATURES/DATE:
If under$5,000 Professional Staff
If under 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 ON
Case Refund Processed: Date: 7//(w//S' I By:
I:\Building\Refunds\RefundRequest.doe x 09/01/2011)
From: 06/09/2015 14:15 #161 P.001/002
V O �
City f g Tigard • COMMUNITY DEVELOPMENT DEPARTMENT RECEIVED
r
'• a Request for Permit Action JUN 9 2015
TIGARD 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 •www.tigard-or.gov CITY OF TIGARD
ovILL)IN' / SION
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits @tigard-or.gov
FROM: ❑ Owner xi Applicant ® Contractor El City Staff
Check V)one �"
REFUND OR Name:
INVOICE TO: (Business or Individual)
—Specialty Heating&Cooling, Inc.
Mailing Address: 7500 SW Tech Center Dr.#130
Tigard,Or.97223
City/State/Zip:
— (503)620-5643
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
gCANCEL/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 CONTRAc.tOR ON PERMIT(do not cancel permit).
Permit#: rV( CCbrZo/I- - aD.? f- l
Site Address or Parcel#: /3 L/ 7SZ .SZe� /0 7
Project Name: Or/of c-4--
Subdivision Name: F<' fe'-c� �+ // Lot#:
EXPLANATION: C,Lt,04--0 tv*-r' CA..rLC-2-1 Q-cL- if U G..1y'--41
Signature: Date:
Print Name:
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. 940 r _ 7oZ ` C7Z7 -c ie. 0-0
/d .1-a ,-. ro ( r ,________L—
FOR OFFICE USE ONLY
Route to S s Admin: Date B Ro e to Records: Date MANIM :NZfAMI
Refund Processed: Date `.m B, Alai Invoice Processed: Date By
Permit Canceled: Date 7 f / :.:' Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_1 .31..doc