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Permit Support Document RECEIVED AUG 06 2021 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT CITY OF TIGARD 4 Request for Permit Action BUILDING DIVISION T I A R I) 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 e' .7/3, 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) SYNCHRO SOLAR Mailing Address: 2870 NE HOGAN DRIVE STE E240 City/State/Zip: GRESHAM/OR/97030 Phone No.: 503-314-3455 PLEASE TAKE ACTION FOR THE ITEM(S) 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). Permit#: ELR2020-00017 Site Address or Parcel #: 11200 SW 83rd Avenue Tigard, OR 97223 Project Name: SAS Holdings Solar (Tigard) Subdivision Name: Steve & Hughie's Place Lot#: 32 EXPLANATION: This permit was a duplicate. This was for a solar installation. We pulled permit#: MST2020-00051 for this work. Which was a combo building and electrical permit. The MST2020-00051 Permit has already been inspected and finalized. Signature: B2 Date: 08/06/2021 Print Name: Zoe Bailey 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. p ty—d c) 7$r FOR OFFICE USE ONLY Route to Sys Admin: Date By Route to Records: Date T/y rV J Refund Processed: Date g/:Y 7/a-/ By ,e_.ldO Invoice Processed: Date By Permit Canceled: Date ,��>Af By Aa d Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_YN518.doc IIIq . TIGARD City of Tigard September 2,2021 Synchro Solar 2870 NE Hogan Dr, Suite E240 Gresham, OR 97030 Re: Permit No. ELR2020-00017 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 11200 SW 83`d Ave Project Name: SAS Holdings Solar Job No.: N/A Refund Method: ® Check#240448 in the amount of$84.00. ❑ Credit card"return"receipt in the amount of$ . 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 work was completed under master permit MST2020-00051. Refund 100% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, '. --9e56;e2 /A-----k41-- Dianna Ornelas Building Division Services Supervisor 1 Enc. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov . 1 ° City of Tigard I-,�A,�� 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: Synchro Solar DATE: 8/27/2021 2870 NE Hogan Drive, Ste E240 Gresham, OR 97030 REQUESTED BY: Dianna Ornelas TRANSACTION INFORMATION: Receipt#: 428055 Case#: ELR2020-00017 Date: 8/5/2021 Address/Parcel: 11200 SW 83rd Ave Pay Method: CreditCard Project Name: SAS Holdings Solar EXPLANATION: Per applicant's request as scope of work was completed under MST2020-00051. Refund 100%of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Permit Fee 220-0000-43103 $75.00 12%State Surcharge 100-0000-24001 9.00 TOTAL REFUND: $84.00 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager <2"?!�`t_ .J If under$25,000 Department Manager If under$100,000 City Manager If over$50,000 Local Contract Review Board FOR ACCELA SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: Vy/ By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010 I CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 T I GAR Project Name: SAS Holdings Solar(Tigard)Site Address: 11200 SW 83RD AVE l .✓� Receipt Number: 436287 - 09/04/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELR2020-00017 $-84.00 Total: $-84.00 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 240448 DHOWSE 09/04/2021 $-84.00 Payor: Synchro Solar Total Payments: $-84.00 Balance Due: $84.00 Page 1 of 1 CITY OF TIGARD RECEIPT i ' 13125 SW Hall Blvd.,Tigard OR 97223 III 503.639.4171 Tf[.A,P0; Project Name: SAS Holdings Solar(Tigard) Site Address: 11200 SW 83RD AVE Receipt Number: 428055 - 02/04/2020 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELR2020-00017 Restricted Energy Permit 220-0000-43103 $75.00 ELR2020-00017 12%State Surcharge-Electrical 100-0000-24001 $9.00 Total: $84.00 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 6014235 PUBLICUSER339 02/04/2020 $84.00 Payor: Total Payments: $84.00 Balance Due: $0.00 Page 1 of 1