Permit Support Document (37) 1:/
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TO: CITY OF TIGARD
Building Division
13125 SW Hall BIvcL,Tigard,OR 97223
rhonc 503-718 2439 Fax: 503-598-1960 Tigardhuildiughertnits(pitigard-ocgov /_/Ze. /2
FROM: ❑ Owner Applicant ❑ Contractor ❑ Crty Staff
REFUND OR Nuuc
INVOICE TO: kt dtp.u�; C�► �� LLc_.
Mailing Address: IUDS <-N`rcity/shite:(zip. � hVl_2 OR .__93607
Phone No.: �"�1 1 `' . .71`7— /�._�t 0_..15
PLEASE TAKE ACTION FOR THE ITEM(S)CHECKED(1):(((
CANT, I11/\-'OIL)PERMIT APPLICATION.
RT:PCND PERMIT l'JSl3S(attach copy of original receipt:and provide explanation below).
INVOICE FOR FEES DLJL(attach case fee schedule and provide explanation below).
❑ RF:AIOV'Il,RFPI..ACID.CON FR ON i'LyR\4IT(do not cancel permit).
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TIGARD
City of Tigard
January 18, 2018
Sutherland Plumbing LLC
Attn: Courtney Wood
6765 SW 213th Ave.
Aloha, OR 97007
Re: Permit No. PLM2017-00505
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 9955 SW Kable St
Project Name: Carrigg
Job No.: N/A
Refund Method: ® Check#227207 in the amount of$64.96.
❑ Credit card "return"receipt in the amount of$
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 job was cancelled. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
,�0A i
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
ty of Tigard
I'IGARD V AccelaCiRefund 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: Sutherland Plumbing LLC
DATE: 12/28/2017
6765 SW 213th Ave.
Aloha, OR 97007 REQUESTED BY:
Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 414325
Date: 12/7/2017 Case#: PLM2017-00505
Pay Method: C2/d/2017d Address/Parcel: 9955 SW Kable St.
Project Name: Carrigg
EXPLANATION: Per applicant's request as job was cancelled. Refund 80%of permit fees.
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Plumbm. Permit ? a edea 8 s r y
12%State Surchar•e 230-0000-43101 $58.00
100-0000-24001 6.96
TOTAL REFUND: $64.96
APPROVALS: SIG ;TURES DATE:
If under$5,000 Professional Staff a /ri27
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
„. , 0. ITiIS �11, IngCase Refund Processed: Date:
B :
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
_ CITY OF TIGARD
g 13125 SW Hall Blvd.,Tigard OR 97223 RECEIPT
503.639.4171
TIC,t4il.
Project Name: Carrigg Water Service
Site Address: 9955 SW KABLE ST
l2AiliN
Receipt Number: 416598 - 04/06/2018
CASE NO. FEE DESCRIPTION
REVENUE ACCOUNT NUMBER PAID
PLM2017-00505
$-64.96
Total: $-64.96
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT Ip
Check CASHIER ID RECEIPT DATE RECEIPT AMT
227207
Payor: Sutherland Plumbing LLC DROWSE 04/06/2018 $-64.96
Total Payments: $-64.96
Balance Due: $64.96
Page 1 of 1
III
CITY OF TIGARD RECEIPT
, 1 s 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Carrigg Water Service
Site Address: 9955 SW KABLE ST
I Receipt Number: 414325
12/07/2017 I
CASE NO. FEE DESCRIPTION
REVENUE ACCOUNT NUMBER PAID
PLM2017-00505 Water Service
PLM2017-00505 12%State Surcharge-Plumbing 2 0-0000- 3 01 $62.54
100-0000-240
PLM2017-00505 Minimum Fee Adjustment-Plumbing01 $9 70
2330-0000--43143101 $9.96
Total: $81.20
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 05476J
Payor: Katrina Sutherland PUBLICUSER136 12/07/2017 $81.20
Total Payments: $81.20
Balance Due: $0.00
Page 1 of 1