Permit Support Document (2) p
TIGARD
City of Tigard
October 11, 2019
E C Company
PO Box 10286
Portland, OR 97296
Re: Permit No. ELC2019-00610
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 13335 SW Hall Blvd
Project Name: City of Tigard
Job No.: N/A
Refund Method: ® Check#233552 in the amount of$209.90.
❑ Credit card"return" receipt in the amount of$
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 to void permit as it was a duplicate permit.
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: E C Company DATE: 10/4/2019
PO Box 10286
Portland, OR 97296 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 425848 Case #: ELC2019-00610
Date: 9/17/2019 Address/Parcel: 13335 SW Hall Blvd
Pay Method: CreditCard Project Name: City of Tigard
EXPLANATION: Per applicant's request as they obtained duplicate permits for same 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 Fee 220-0000-43103 $187.41
12%State Surcharge 100-0000-24001 22.49
TOTAL REFUND: $209.90
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
FOR ACCELA SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: ,?/J a ,'.7. f By: 4 J
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
IIIII CITY OF TIGARD RECEIPT
■ 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
_t.[G A Tx.0
Project Name: City of Tigard 77350-12
Site Address: 13335 SW HALL BLVD
Receipt Number: 436097 - 08/27/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2019-00610 $-209.90
Total: $-209.90
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 233552 DHOWSE 08/27/2021 $-209.90
Payor: EC Company
Total Payments: $-209.90
Balance Due: $209.90
_
CITY OF TIGARD RECEIPT
1111 g 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: City of Tigard 77350-12
Site Address: 13335 SW HALL BLVD ti4 4 6/ t1--
Receipt Number: 425848 - 09/17/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2019-00610 Services or Feeders-200 amps or less 220-0000-43103 $100.70
ELC2019-00610 Services or Feeders-201 to 400 amps 220-0000-43103 $133.56
ELC2019-00610 12%State Surcharge-Electrical 100-0000-24001 $28.11
Total: $262.37
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 5568044 PUBLICUSER10895109/17/2019 $262.37
Payor: eccompany
t Total Payments: $262.37
Balance Due: $0.00
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