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PFI2016-00117 N July 29, 2016 City of Tigard Parsons Excavating Inc. Attn: Greg Parsons PO Box 3607 Tualatin, OR 97062 Re: Permit No. PFI2016-00117 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: 15315 SW Bull Mountain Rd Project Name: Parsons Partition Job No.: N/A Refund: ® Check #221868 in the amount of$100.00. ❑ Credit card "return" receipt in the amount of$ ❑ Trust account "deposit" receipt in the amount of$ Notes: Refund overpayment by applicant. If you have any questions please contact me at 503.718.2430. Sincerely, rte_ Dianna Howse Building Division Services Coordinator Enc. 1:\Building\RefunINZn�' v 1kXd4),e'Q rdJjlQrpgon 97223 • 503.639.4171 TTY Relay: 503.684.2772 0 www.tigard-or.gov City of 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: Parsons Excavating Inc. DATE: 7/22/2016 Attn: Greg Parsons PO Box 3607 REQUESTED BY: Dianna Howse Tualatin, OR 97062 AK TRANSACTION INFORMATION: Receipt#: 404305 Case#: PFI2016-00117 Date: 6/6/2016 Address/Parcel: 15315 SW Bull Mountain Rd Pay Method: Check Project Name: Parsons Partition EXPLANATION: Refund overage amount paid by customer. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 230000043104 $Amount Cash Over 100-0000-48001 $100.00 TOTAL REFUND: $100.00 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 OANLY Case Refund Processed: Date: 7 oZ9 /6B I:\Building\Refunds\RefundRequest.doc a 09/01/2010 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Request for Permit Action 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 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner Applicant © Contractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) ��lrS� S 7&�,CIA-VcA,}1` o'cJ �' �/,�� mr�&,,-s Mailing Address: 122U �LO O� City/State/Zip: Oy- CI-1 Ll(0 2 Phone No.: Gjl��j. (��11 ,O1 (�Q PLEASE TAKE ACTION FOR THE ITEMS) CHECKED (✓): ❑ CANCEL/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 CONTRACTOR ON PERMIT (do not cancel permit). Permit#: per`tuku- Oto t n Site Address or Parcel #: `s -3I 5 SV.I (I f ckC nM(r? P-d. Subdivision Name: Pav- cru VAY-h(n-, Lot#: 2 EXPLANATION: CAr?p h rG r d �N rbf& tel'z r rA wi L), ,r\-f- G kt. LO�4 tIw Signature: Date: ce J Print Name: e-0 Vv 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 ITSE • Route to Sys Admin: Date ByRoute to Records: Date?�9' i� B Refund Processed: Date I& By voice Processed: Date By Permit Canceled: Date i(/ Byarcel Tag Added: Date B 1:ABuilding\Forme\RcgPermit;lction_I 92314.doc