Permit Support Document (56) May 2218,02:51 p Able Heating and Cooling 5036203980 p.1
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1 0 RECEIVED
City of Tigard • COMMUNITY DEVELOPMENT D .. A �RTh4ENT MAY 2 2 2018
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Request for Permit Action CITY OI{'TIGARD
1I G A RD 13125 SW Hall Blvd.•1� It' » T • 5'1 1 • C. ,_-jjfILDING DIVISION
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TO: CITY 0P Ttcium
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBui.ldingPerinits@tigard-or.gov
FROM: [] Owner ,..�/
Check(✓)one ❑ Applicant i,!/� C:onttactor.
❑ City Staff
REFUND OR Name:
INVOICE TO: (Be sin ss or Individual) L.
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Mailing Address: 1 f A II'R ,
City/State/Zip: •_ • Ag' • to
.911.911 • _1
Phone No.: ,�.` 4 , -_
PLEASE�� TAKE ACTION FOR THE ITEM(S)CHECKED(1):
t CANCEL/VOID PERMIT APPLICATION.
�� REFUND PERMIT FEES(attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEFS DUE(attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel perms).
Permit#: CAR n,l - M q 0
Site Address or Parcel# l'
: , , R
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Project Name: .]
Subdivision Name:
EXPLANATION: i tI --fj
Signature Date: —Q 1S
Print Name: \kiIll'
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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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 fec for issued permits prior to any inspection requests.
2.. All refands 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 equests.
1,e-z, --72 .-e t) .— ,''Ft t"-z7
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date / 9 f By
Refund Processed: Date !
��Z7�/!, By�1�/ Invoice Processed: Date B}.
Permit Canceled: Date /;, Zy By,W Parcel Tag Added: Date By
I:\1Bui:ding\Pones\RetpennitAcpon_nt 14.doc
11111
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TIGARD
City of Tigard
July 16, 2018
Able Heating&Cooling LLC
Attn: Kelly Wilhite
16285 SW 85th Ave, #105
Tigard, OR 97224
Re: Permit No. MEC2018-00370
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 11546 SW Lakeview Ter
Project Name: Jackson
Job No.:
Refund Method: ® Check#228901 in the amount of$80.64.
0 Credit card "return"receipt in the amount of$
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
0 Trust account"deposit"receipt in the amount of$
Comment(s): Per applicant's request as this was a duplicate permit (see MEC2018-
00321). Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
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
N
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: Able Heating&Cooling LLC DATE: 6/22/2018
16285 SW 85th Ave., #105
Tigard, OR 97224 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 417337 Case#: MEC2018-00370
Date: 5/18/2018 Address/Parcel: 11546 SW Lakeview Ter
Pay Method: CreditCard Project Name: Jackson
EXPLANATION: Per applicant's request as this was a duplicate permit(see MEC2018-00321). Refund
80% of permit fees.
Mechanical Permit Fee 230-0000-43102 $72.00
12%State Surcharge 100-0000-24001 8.64
TOTAL REFUND: $80.64
APPROVALS: SIGN S TU' S 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
Case Refund Processed: I Date: 6� �""
1:\Building\Refunds\RefundRequest.doc x 09/01/2010