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TIGARD
City of Tigard
December 22, 2020
Empowered Electrical LLC
39422 S Cooper Rd
Molalla, OR 97038
Re: Permit No. ELC2020-00173
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 7115 SW Spruce St
Project Name: Jered Coates
Job No.: N/A
Refund Method: ® Check#237549 in the amount of$70.28.
❑ Credit card"return"receipt in the amount of$
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
n Trust account"deposit"receipt in the amount of$
Comment(s): Per applicant's request as they obtained a residential permit in error and
replaced with commercial permit ELC2020-00262. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
<N4/
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
1114
City of Tigard
T A 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 Empowered Electrical LLC DATE: 12/9/2020
TO:
39422 S Cooper Rd
Molalla, OR 97038 REQUESTED BY: Dianna Ornelas
TRANSACTION INFORMATION:
Receipt#: 428843 Case#: ELC2020-00173
Date: 03/26/2020 Address/Parcel: 7115 SW Spruce St
Pay Method: CreditCard Project Name: Jered Coates
EXPLANATION: Per applicant's request as they obtained a residential permit in error, see ELC2020-
00262. Refund 80%of permit fees.
REFUND INFORMATION;
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Electrical Permit Fee 220-0000-43103 $62. 5
12%State Surcharge 100-0000-24001 7.53
TOTAL REFUND: $70.28
APPROVALS: SIGNATURES/DATE:
If under$5,000 Professional Staff
If under$12,500 Division Manager D. L. Ornelais
If under$25,000 Department Manager
If under$100,000 City Manager
If over$50,000 Local Contract Review Board T�syi
Case Refund Processed: Date: 1 e / v/ :) By: .J 0
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
41
a 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Jered Coates
Site Address: 7115 SW SPRUCE ST
Receipt Number: 435828 - 08/13/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2020-00173 $-70.28
Total: $-70.28
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 237549 DHOWSE 08/13/2021 $-70.28
Payor: Empowered Electrical LLC
Total Payments: $-70.28
Balance Due: $70.28
Page 1 of 1
LI
CITY OF TIGARD RECEIPT
i
fl 13125 SW Hall Blvd.,Tigard OR 972213
503.639.4171
TiGARD
Project Name: Jered Coates
Site Address: 7115 SW SPRUCE ST 6)4-/67A4L-/
Receipt Number: 428843 - 03/26/2020
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2020-00173 Branch Circuits wo/Purchase Service or 220-0000-43103 $78.44
Feeder
ELC2020-00173 12% State Surcharge-Electrical 100-0000-24001 $9.41
Total: $87.85
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 6218161 PUBLICUSER348 03/26/2020 $87.85
Payor:
Total Payments: $87.85
Balance Due: $0.00
Page 1 of 1
Dianna Ornelas
From: Brian Ferlan <empoweredelectricllc@gmail.com>
Sent: Tuesday, June 16, 2020 5:11 PM
To: #Building Permit Technicians
Subject: Empowered Electric Refund
Attachments: ELC2020-00173.jpg; Receipt.jpg
Caution!This message was sent from outside your organization.
Attached is the Request for Permit Action for residential permit ELC2020-00173 and receipt of payment. A
residential permit was pulled instead of a commercial permit. We corrected it by purchasing a commercial permit in its
place.
Please let me know if you need more information.
Thank you,
Brian Ferlan
Empowered Electric Company, LLC
(503) 535-9290
1