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Permit Support Document V 0 I ,a,.9 7,4 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMEN T w =1 Request for Permit Actionpp TIGARD' 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 •www.tigard-"i ovR 1021 city OF TIGARD TO: CITY OF TIGARD BUILDING DIVISION Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 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) Meyer Sign Co of Oregon Mailing Address: 15205 SW 74th Ave City/State/Zip: Tigard, OR 97224 Phone No.: 503-620-8200 GJ'?/ _ o 3.. - 5 0/,6 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): CANCEL/VOID PERMIT APPLICATION. [J 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#: ELC2020-00495 Site Address or Parcel #: 7805 SW Dartmouth St Project Name: Autozone Tigard Subdivision Name: Lot#: EXPLANATION: We are no longer doing the work. Another sign company is applying for these permits and will be in contact. Signature: Russel Mason, -°°" '" Date: 3/5/2021 Print Name: Russel Mason 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. aD.3. 4,•2 7B .291- yam- 227. ! lv y. _ 'F FOR OFFICE USE ONLY Route to Sys Admin: Date 3 By 4z-- Route to Records: Date 9 6t /2.1 By . ' / Refund Processed: Date rf, By� Invoice Processed: Date By Permit Canceled: Date J /'f iyir By 4?j Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_1 0518. oc III II TIGARD City of Tigard September 2, 2021 Meyer Sign Co of Oregon 15205 SW 74'Ave Tigard, OR 97224 Re: Permit No. ELC2020-00495 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 7805 SW Dartmouth St Project Name: Auto Zone Job No.: N/A Refund Method: ® Check#240427 in the amount of$182.36. ❑ Credit card "return"receipt in the amount of$ 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, Dianna Ornelas Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov City of Tigard TtcnRD 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: Meyer Sign Co of Oregon DATE: 8/27/2021 15205 SW 74th Ave Tigard, OR 97224 REQUESTED BY: Dianna Ornelas TRANSACTION INFORMATION: Receipt#: 431307 Case#: ELC2020-00495 Date: 10/7/2020 Address/Parcel: 7805 SW Dartmouth St Pay Method: CreditCard Project Name: Auto Zone EXPLANATION: Per applicant's reuqest as job was cancelled. Refund 80% of permit fees. REFUND INFORMATIONS ^� Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount nu Pert Fee 220-0000-43I03 $162.82 12%State Surchage 100-0000-24001 19.54 TOTAL REFUND: $182.36 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager If under$25,000 Department Manager If under$100,000 City Manager If over$50,000 Local Contract Review Board s w B o?atxr d ECm i V NS t sy k k68 .r.:' d F 2T � Case Refund Processed: Date: q By: 40 I:\Building\Refunds\RefundRequest.doc x 09/01/2010 ill CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 �^ 503.639.4171 TIGARD Project Name: Auto Zone Site Address: 7805 SW DARTMOUTH ST Receipt Number: 436280 - 09/04/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2020-00495 $-182.36 Total: $-182.36 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 240427 DHOWSE 09/04/2021 $-182.36 Payor: Meyer Sign Co. of Oregon Total Payments: $-182.36 Balance Due: $182.36 Page 1 of 1 CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TEL;A.PU Project Name: Auto Zone Site Address: 7805 SW DARTMOUTH ST Receipt Number: 431307 - 10/07/2020 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2020-00495 Sign or Outline Lighting 220-0000-43103 $203.52 ELC2020-00495 12% State Surcharge-Electrical 100-0000-24001 $24.42 Total: $227.94 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 6888217 PUBLICUSER106 10/07/2020 $227.94 Payor: Total Payments: $227.94 Balance Due: $0.00 Page 1 of 1