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Permit Support Document RECEIVED City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT SEP 1 5 2021 111 ft Ct gTY OF T IGARD 2 Request for Permit Action BUILDING DIVISION T i t;A K I� 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-orov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard, OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner ❑X Applicant ❑ Contractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) EC Company Mailing Address: 2121 NW Thurman ST City/State/Zip: Portland, OR 97210 Phone No.: 503.278.6851 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): 0 •ID PERMIT APPLICATION. REFUND ' IT FEES (attach copy of original receipt and provide explanation below). •ICE FOR FEES DUE (attach case fee schedule and provide explanation below). Permit#: ELC2021-00517 Site Address or Parcel#: 13125 SW Hall Blvd Tigard, OR 97223 Project Name: City of Tigard, Police Bureau Generator Subdivision Name: Lot #: EXPLANATION: Accidentally marked needing 1 200A and 1 400A when I only needed the 400A. I caught it on the review screen, and went back to fix it, but it didnt seem to click, and I was charged'fo otf?,l would like to get a refund on the$100.70 200A. Signature: Date: 9.15.21 Print Name: Eli Smith 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. �/e,0 • 7 D /ere '7o P!2 0lo 7d1/f Swdcet p g (vn/ /L D , 7 a) Route to Sys Admin: Date B Route to Records: Date/ 2 3/2` By Refund Processed: Date 9/2 /zi $sI Invoice Processed: Date ,/ By Permit Canceled: Date A//,/I'- B}+ ' Parcel Tag Added: Date By 1:\Building\Forms\RegPermitAction_120518.doc f 7. by' i TIGARD City of Tigard October 3, 2021 EC Company 2121 NW Thurman St Portland, OR 97210 Re: Permit No. ELC2021-00517 Dear Applicant: The City of Tigard has processed a refund for fees on the above referenced permit(s) as follows: Site Address: 13125 SW Hall Blvd Project Name: City of Tigard-PD Job No.: N/A Refund: ® Check#;yowin the amount of$112.78. ❑ Credit card "return" receipt in the amount of$ 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$ Comments: Per applicant's request as they purchased the wrong electrical service online. Refund 100% of permit fees paid. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Omelas Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov i I ;i r IN . a ■ City of Tigard i liwk pi) Accela Refund Request i 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 Company DATE: September 20,2021 2121 NW Thurman St Portland,OR 97210 REQUESTED BY: Dianna Ornelas TRANSACTION INFORMATION: Receipt#: 436453 Case#: FT C2021-00517 Date: 9/15/2021 Address/Parcel: 13125 SW Hall Blvd Pay Method: CreditCard Project Name: City of Tigard-Police Dept. i EXPLANATION: Per applicant's request as they selected the wrong electrical service item online;refund 100%of permit fees paid. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Electrical Permit 220-0000-43103 $100.70 12%State Surcharge 100-0000-24001 12.08 TOTAL REFUND: $112.78 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager D. L. (9P'vi..eZct. 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: /Q/z l/z/ By: 1:\Building\Refunds\RefundRequest.doc x 09/01/2010 ili CITY OF TIGARD RECEIPT 1111 7 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 T I C A R.D Project Name: City of Tigard, Police Bureau Generator Site Address: 13125 SW HALL BLVD Receipt Number: 437134 - 10/23/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2021-00517 $-112.78 Total: $-112.78 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 240629 DHOWSE 10/23/2021 $-112.78 Payor: EC Company Total Payments: $-112.78 Balance Due: $112.78 Page 1 of 1 CITY OF TIGARD RECEIPT a ' 13125 SW Hall Blvd.,Tigard OR 97223 11 503.639.4171 TIGARD Project Name: City of Tigard, Police Bureau Generator Site Address: 13125 SW HALL BLVD 012/G LAJ,1_ Receipt Number: 436453 - 09/15/2021 O CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2021-00517 Services or Feeders-200 amps or less 220-0000-43103 $100.70 ELC2021-00517 Services or Feeders-201 to 400 amps 220-0000-43103 $133.56 ELC2021-00517 Branch Circuits w/Purchase Service or 220-0000-43103 $14.84 Feeder ELC2021-00517 12%State Surcharge-Electrical 100-0000-24001 $29.89 Total: $278.99 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 8275346 PUBLICUSER108 09/15/2021 $278.99 Payor: Total Payments: $278.99 Balance Due: $0.00 11 I Page 1 of 1 1 II CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: City of Tigard, Police Bureau Generator Site Address: 13125 SW HALL BLVD Receipt Number: 436453 - 09/15/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2021-00517 Services or Feeders-201 to 400 amps 220-0000-43103 $133.56 ELC2021-00517 12%State Surcharge-Electrical 100-0000-24001 $29.89 ELC2021-00517 Services or Feeders-200 amps or less 220-0000-43103 $100.70 ELC2021-00517 Branch Circuits w/Purchase Service or 220-0000-43103 $14.84 Feeder Total: $4 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 8275346 PUBLICUSER10895£09/15/2021 $278.99 Payor: eccompany Total Payments: $278.99 Balance Due: $0.00 Page 1 of 1