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Permit Support Document (2) City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT to Request for Permit Action i ,:. ,,„,, 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 • ,..W W_u;.,q_dw_0 r .i% TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fair 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner ❑ Applicant ® Contractor ❑ City Staff check of)one REFUND OR Name: INVOICE TO: (Butioesror'ndivid"a9 Nice Electric Co Mailing Address: PO Box 636 City/State/Zip: McMinnville OR 97128-0636 Phone No.: 503.434.5802 h aJ ,i i' .e.. CC wt. PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED(/): CANCEL/VOID PERMIT APPLICATION. 41/2 REFUND"PERMIT FEES(attach copy of original receipt and provide explanation below). • 'y4 • II ••ICE FOR FEES DUE(attach case fee schedule and provide explanation below). Permit#: ELC2021-00191 Site Address or Parcel#: 11230 SW Buffalo Pl Project Name: Pure Environmental Subdivision Name: Dakota Meadows Lot#: 8 EXPLANATION: _ This is a burn job. However,I did not -know that the first floor was not damaged,so the service was not affected. Pleas DELETE the Service,but add FOUR(4)more Circuits for the upstairs remodel.T t i es us a total of FOURTEEN 04)Circuits&No Service. Signature: Date: 5/3/2021 Print Name: Jennifer J Sio ks,Office Manager Ref ndPolicy 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 • Not more than 80%of the application or plan review fee when en application is withdrawn or canceled before review effort has been expended • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2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. t 9 C. 1 /5.2.& — /70 ,90 y l'3 gym- ,.= . .vim Route to ays.Adman: Dare By Route to Records: Date 9 N ' 1 B. Refund Processed: Date V,-/ By'I� Invoice Processed: Date / " _k Permit Canceled: DateB ) , Parcel Tag Added: Date By''\lltn3digg\Fcam3\Regt'emrtAction IIIa TIGARD City of Tigard September 2, 2021 Nice Electric Co. PO Box 636 McMinnville, OR 97128-0636 Re:Permit No. ELC2021-00191 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: 11230 SW Buffalo P1 Project Name: Pure Environmental Job No.: Refund: ® Check#240428 in the amount of$24.93. ❑ Credit card"return"receipt in the amount of$ . ❑ Trust account"deposit"receipt in the amount of$ . Notes: Per applicant's request as a change in scope of work resulted in overpayment of permit fees and refund of the difference. If you have any questions please contact me at 503.718.2430. Sincerely, e<a,5 :(a,/,,,..__e_/‹...4___./ Dianna Ornelas Building Division Services Coordinator Enc. I:\Boilding\Refunds,i iiia Aiiiikiiidzdvela a iWregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov 1Cit111 y of Tigard T I G A R D 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: Nice Electric Co DATE: 8/27/2021 PO Box 636 McMinnville, OR 97128-0636 REQUESTED BY: Dianna Ornelas TRANSACTION INFORMATION: Receipt#: 433808 Case#: ELC2021-00191 Date: 4/13/2021 Address/Parcel: 11230 SW Buffalo P1 Pay Method: CreditCard Project Name: Pure Environmental EXPLANATION: Per applicant's request as change in scope of work resulted in an overpayment of permit fees;refund 100%of difference. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee,_..r.e Exmple: 2300000-43104 $Amount Cash Over 100-0000-48001 $24.93 TOTAL REFUND: $24.93 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager ,��►i1___/ 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: � '�� `' i•-• By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010 U CITY OF TIGARD RECEIPT g 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Pure Environmental-11230 Buffalo Site Address: 11230 SW BUFFALO PL AC A// Receipt Number: 436285 - 09/04/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2021-00191 $-24.93 Total: $-24.93 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 240428 DHOWSE 09/04/2021 $-24.93 Payor: Nice Electric Co. Total Payments: $-24.93 Balance Due: $24.93 Page 1 of 1 1111 CITY OF TIGARD RECEIPT 2 . 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Pure Environmental-11230 Buffalo Site Address: 11230 SW BUFFALO PL Receipt Number: 433808 - 04/13/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2021-00191 Branch Circuits wo/Purchase Service or 220-0000-43103 $152.64 Feeder ELC2021-00191 12% State Surcharge-Electrical 100-0000-24001 $18.32 ELC2021-00191 Cash Over 100-0000-48001 $24.93 Total: $195.89 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 7609311 PUBLICUSER126 04/13/2021 $195.89 Payor: Total Payments: $195.89 Balance Due: $0.00 Page 1 of 1