Permit Support Document IIa
TIGARD
City of Tigard
June 24, 2019
Stoner Electric Inc.
1904 SE Ochoco St
Milwaukie, OR 97222
Re: Permit No. ELC2019-00269
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#232445 in the amount of$67.20.
❑ Credit card "return"receipt in the amount of$
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 taken out for the wrong address.
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
1114
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: Stoner Electric Inc. DATE: 6/17/2019
1904 SE Ochoco St
Milwaukie, OR 97222 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 423022 Case#: ELC2019-00269
Date: 4/24/2019 Address/Parcel: 9000 SW Durham Rd
Pay Method: CreditCard Project Name: Tigard High School
EXPLANATION: Per applicant's request as address was incorrect. 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 $60.00
12°A)State Surcharge 100-0000-24001 7.20
TOTAL REFUND: $67.20
APPROVALS: SIGNA RES/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: ..s/-;,',./ ./ By: .% '
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
IN it 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: TIGARD HIGH SCHOOL
Site Address: 9000 SW DURHAM RD
Receipt Number: 434450 - 05/21/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2019-00269 $-67.20
Total: $-67.20
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 232445 DHOWSE 05/21/2021 $-67.20
Payor: Stoner Electric Inc.
Total Payments: $-67.20
Balance Due: $0.00
Page 1 of 1
CITY OF TIGARD RECEIPT
NI . , 13125 SW Hall Blvd.,Tigard OR 97223
- 503.639.4171
TIGA_RD
Project Name: TIGARD HIGH SCHOOL
Site Address: 9000 SW DURHAM RD
Receipt Number: 423022 - 04/24/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2019-00269 Signal circuit or Limited Energy Panel 220-0000-43103 $75.00
ELC2019-00269 12%State Surcharge-Electrical 100-0000-24001 $9.00
Total: $84.00
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 011255 PUBLICUSER108 04/24/2019 $84.00
Payor: STONER ELECTRIC, INC.
Total Payments: $84.00
Balance Due: $0.00
it
Page 1 of 1
04/30/2019 15:38 (FAX) P.001/002
RECEIVED
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT APR 3 0 2019
-
Request for Permit q Action C,I rY OF r IUARD
1•i( .'\p.w> 13125 SW Hall Blvd. •Tigard,Oregon 97223 . 503-718-2439 •may_waigarkailiDING DIVISION
TO: CITY OF TIGARD
Building Division v D
I
13125 SW Hall Blvd.,Tigard,OR 97223 /- I Iq Q --•
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPctmits(a tigard-or. v /
FROM: ❑ Owncr ❑ Applicant ❑✓ Contractor ❑ City Staff
Check(V)one
REFUND OR Name:
INVOICE TO: (Business ot Individual) STONER ELECTRIC, INC
Mailing Address: 1904 SE OCHOCO
City/State/Zip: MILWAUKIE, OREGON 97222
Phone No.: 503-462-6500
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (/):
CANCEL/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#: ELC2019-00269
Site Address or Parcel#: 9000 SW DURHAM ROAD
Project Name: TIGARD HIGH SCHOOL
Subdivision Name: Lot#:
T
EXPLANATION; INCORRECT ADDRESS ON PERMIT- NEW ADDRESS WILL BE
IN A DIFFERENT JURISDICTION
Signature: -
S Date: 04/30/2019
Print Name: SARABETH DODD
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 800/o 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. -7 5"r _ 4; C, r . C*6
9'e '� - F- /4-0
�Na-J �,�.o �O
Route to S s Admin: Date B Route to Records: Date. / B
Refund Processed: Date fr, /21/e�j B Invoice Processed: Date By
Permit Canceled: Date 6 ,7// B Parcel Tag Added: Date By
I:\Building\Forma\RegPermirActiorc si 8.6oc