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Permit Support Document City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT RECEIVED • Request for Permit Action MAR s 2020 1 CITY OF TIGARD .I..I t;,A It O 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-catitIC/ING DIVISION TO: CITY OF TIGARD VOID Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 3 7/� 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) G L E k art Mailing Address: p.0• bOy, 102So City/State/Zip: Pov-Hcod j 612 61-721t� Phone No.: 503"'2.2•-S"' cD1$7 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): 154 CANCFT /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#: EI.G2A?.�-Oo i 12- Site Address or Parcel #: 9000 S VA1 b u Irh iris 12 d t T�a trd �)2 Q72-23 • Project Name: T�! cl g r4- l J41Q?v1 my() schhol Subdivision Name: Lot#: EXPLANATION: PfJv 4- wits T ullet incorad Signature: ('i • Date: /I V/ f[-t1 W Print Name: net at I 1 Refund Policy I. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Nor more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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 — 9 t CI c li, 2-y ,, as /Z.s4 FOR OFFICE USE ONI.A Route to Sys Admin: Date By Route to Records: Date ?Ng./ By Refund Processed: Date By Invoice Processed: Date By Permit Canceled: Date 3 7/it) By .ice, arcel Tag Added: Date By l:\Building\Forams\RecPermitAction_I14051oc IN N . tl TIGARD City of Tigard April 3,2020 E C Company PO Box 10286 Portland, OR 97296 Re: Permit No. ELC2020-00112 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 9000 SW Durham Rd Project Name: Tigard High School Job No.: N/A Refund Method: ® Check#235113 in the amount of$50.33. ❑ Credit card"return"receipt in the amount of$ 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 permit was obtained for the wrong scope of work (see correct permit ELC2020-00115). 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 IIIII ill City 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: EC Electric DATE: 3/20/2020 PO Box 10286 Portland, OR 97296 REQUESTED BY: Dianna Ornelas TRANSACTION INFORMATION: Receipt#: 428341 Case#: ELC2020-00112 Date: 2/25/2020 Address/Parcel: 9000 SW Durham Rd Pay Method: CreditCard Project Name: Tigard High School EXPLANATION: Per applicant's request as they obtained permit for the wrong scope of work. 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 220-0000-43103 $44.94 12%State Surcharge 100-0000-24001 5.39 TOTAL REFUND: $50.34' 3 3 APPROVALS: SIG ATURES/DATE: If under$5,000 Professional Staff & .?-( 4-� 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 FOR ACCELA SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: f,X.3/7/ By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD RECEIPT IIi4 .. 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Tigard High School Theater Site Address: 9000 SW DURHAM RD /f_,7.2..tiv(_‘. Receipt Number: 436227 - 09/03/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2020-00112 $-50.33 Total: $-50.33 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 235113 DHOWSE 09/03/2021 $-50.33 Payor: EC Electric Total Payments: $-50.33 Balance Due: $50.33 Page 1 of 1 CITY OF TIGARD RECEIPT - 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 Tl „tIt1) Project Name: Tigard High School Theater Site Address: 9000 SW DURHAM RD a/4 i (ic71--(-g- Receipt Number: 428341 - 02/25/2020 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2020-00112 Branch Circuits wo/Purchase Service or 220-0000-43103 $56.18 Feeder ELC2020-00112 12%State Surcharge- Electrical 100-0000-24001 $6.74 Total: $62.92 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 6098620 PUBUCUSER10895IO2/25/2020 $62.92 Payor:eccompany Total Payments: $62.92 Balance Due: $0.00 Page 1 of 1