Permit Support Document p
•IN
TIGARD
City of Tigard
January 28, 2020
Five Star Electric
756 SW Bailey Dr
Hillsboro, OR 97123
Re: Permit No. ELC2019-00841
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 16060 SW 85th Ave
Project Name: CWS - Durham Digester
Job No.: N/A
Refund Method: ® Check#234461 in the amount of$130.84.
❑ Credit card "return" receipt in the amount of$
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 scope of work required plan review and was
submitted under new permit ELC2019-00887. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
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
TIGARD 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: Five Star Electric DATE: 1/17/2020
756 SW Bailey Dr
Hillsboro, OR 97123 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 427226 Case#: ELC2019-00841
Date: 12/4/2019 Address/Parcel: 16060 SW 85th Ave
Pay Method: CreditCard Project Name: CWS -Durham Digester
EXPLANATION: Per applicant's request as scope of work required plan review(resubmitted under
ELC2019-00887). 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 $116.82
12%State Surcharge 100-0000-24001 14.02
TOTAL REFUND: $130.8/
APPROVALS: SIGNA TE:
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
FOR ACCELA SYSTEM ADMINISTRATION USE ONLY,
Case Refund Processed: Date: 9/3/y� By: =�#t—( —
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
44
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Durham Digester Gas Mods ?�—
Site Address: 16060 SW 85TH AVE c'�/mac
Receipt Number: 436201 - 09/03/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2019-00841 $-130.84
Total: $-130.84
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 234461 DHOWSE 09/03/2021 $-130.84
Payor: Five Star Electric
Total Payments: $-130.84
Balance Due: $130.84
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CITY OF TIGARD RECEIPT
ligI 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TI GAP,O',
Project Name: Durham Digester Gas Mods
Site Address: 16060 SW 85TH AVE /'/ C/A74C--
Receipt Number: 427226 - 12/04/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2019-00841 Branch Circuits wo/Purchase Service or 220-0000-43103 c-t7 90 $71.02 f'
Feeder
ELC2019-00841 Signal circuit or Limited Energy Panel 220-0000-43103 ,C--0 Cld $75.00 &
ELC2019-00841 12% State Surcharge- Electrical 100-0000-24001 to fig $17.52 <-
Total: $163.54
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 5820902 PUBLICUSER109 12/04/2019 $163.54
Payor:
Total Payments: $163.54
Balance Due: $0.00
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