HomeMy WebLinkAboutMEC2021-00769 : ? RECEIVED
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT MAR 1 4 2023
= Request for Permit Action BCITY OF UILDING DIVISION
1 I(;n R f) 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 ❑x Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) ' Jacobs Heating&Air Conditioning
Mailing Address: 4474 SE Milwaukee Ave
City/State/Zip: Portland, OR 97202
Phone No.: 503-234-7331 - EXT 270- Commercial Dept
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
❑ CANCEL/VOID PERMIT APPLICATION.
Q REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: MEC2021-00769
Site Address or Parcel#: 11544 SW Bull Mountain Road -2S110AC01400
Project Name: Array Apartments -Building D
Subdivision Name: Lot#:
EXPLANATION:
project has been canceled
Signature: ANDREA BOWLDS Date: 3/13/2023
Print Name: Andrea Bowlds
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
Route to Sys Admin: Date By Route to Records: Date By
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date'5,22k' ,Z By t,} Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_120518. oc
n
TIGARD
City of Tigard
3/22/2023
Jacobs Heating&Air Conditioning
4474 SE Milwaukie Ave
Portland, OR 97202
Re: Permit No.: MEC2021-00769
Site Address: 11544 SW Bull Mountain Rd
Project Name: Array Apartments -Building D
Dear Applicant:
The City of Tigard has received your request to cancel the above referenced permit. The
status of this permit indicates that plan review was already completed prior to the request to
cancel. In accordance with our policy,we are unable to grant a refund of your payment and
we will retain the fees paid to cover work already performed.
If you have any questions,please contact me at 503.718.2470.
Sincerely,
Holly Van De Wege
Program Development Specialist
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
CITY OF TIGARDIN FEE AND PAYMENT HISTORY r
■ ' ' 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171 W
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MEC2021-00769 - 11544 SW BULL MOUNTAIN RD, TIGARD, OR 97224
Array Apartments - Building D
Fee Description Revenue Fee Amount Invoiced Paid Date Paid Payment Receipt# Due
Account Number Method
12%State Surcharge-Mechanical 100-0000-24001 $62.76 $62.76 $0.00 $62.76
Info Process/Archiving-Lg$2.00(over 230-0000-43135 $12.00 $12.00 $0.00 $12.00
11x17)
Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $7.50 $7.50 $0.00 $7.50
11x17)
Permit Fee 230-0000-43102 $522.97 $522.97 $0.00 $522.97
Plan Review 230-0000-43111 $130.74 $130.74 $0.00 $130.74
Totals for Fees $735.97 $735.97 $0.00 $735.97
Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount
Total Payments:
Balance Due: $735.97