Correspondence r ; F n ky
City of Tigard, (•regon a 13125 SWjHall Blvd. o Tigard, OR 97223 1 1 1 0 4Ra a i c t l r r
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r fep r r ;
December 11, 2009
Northstar Electrical Contractors
19450 SW Cipole Rd., Ste 107
Tualatin, OR 97062
Re: Permit No. ELC2009 -00607
Dear Sir /Ms.:
The City of Tigard has processed a refund for fees on the above referenced permit(s) for the
following:
Site Address: 12770 SW Ash Ave.
Project Name: City of Tigard
Job No.:
Refund: ❑ Check # in the amount of $
Credit card "return" receipt in the amount of $112.78.
n Trust account "deposit" receipt in the amount of $
Notes: Scope of work changed from service to temporary service. Refund 100% of service
permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
_ -_-
Dianna Howse
Building Division Services Supervisor
Enc.
1: \ Building \Refunds \Administ ration \LtrRefund- RefundOnly.doc 01/16/07
Phone: 503.639.4171 o Fax: 503.684.7297 o www.tigard - or.gov o TTY Relay: 503.684.2772
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. . City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be
attached to this form. Refund requests are due to Accela System Administrator by Friday at
5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Northstar Electrical Contractors DATE: 12/11/09
19450 SW Cipole Rd., Ste 107
Tualatin, OR 97062 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt #: 175972 Case #: ELC2009 -00607
Date: 11/10/09 Address /Parcel: 12770 SW Ash Ave.
Pay Method: CreditCard Project Name: City of Tigard
EXPLANATION: Scope of work changed from service to temporary service. Refund 100% of service
fees.
REFUND INFORMATION: • '
Fee Description From Receipt Revenue Account No. • Refund
Example: [BUILD] Permit Fee Example: 245 - 0000 - 432000 $ Amount
Electrical Permit Fee 2200000 -43103 $100.70
12% State Surcharge 1003100 -24001 12.08
TOTAL REFUND: $112.78
APPROVALS:
If under $500: Professional Staff _ • ' kg Lk
If under $7,500 Division Manager
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR ACCELA SYSTEM ADMINISTRATION USE ONLY ,
Refund Request Reviewed: Date: " By: ` r
Case Refund Processed: Date: By: ,"
1: \ Building \ Refunds \RefundRequest.doc 04/13/09
%0V 1 8 - 2009 \NED 09:07 AM P. 001
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: v Community Development /4/V
Tn i % D Request for Permit Action
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TO: CITY OF TIGARD vED
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Buildin Division Services Coordinator
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13125 SW Hall Blvd., Tigard, OR 97223 N01 1 S 2009
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov
FROM: IN 0 G p �A .
❑ owner j�Applica El 111 City Sta1Y+
(check onc) BM-0
REFUND OR Name:
INVOICE TO: (Business or Individual) MA ( b,,, L ro
Mailing Address: /7 ‘16 - 0 $1.,) ceetme: R 0. 67 /0
City/State/Zip: 1i) 64roo 61R 9706X.
Phone No.: . 03 ..- fir} _d' C6c
PLEASE TAKE ACTION FOR THE ITEMS) CHECKED (V):
❑,--/ CANCEL PERMIT APPLICATION.
I v REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
n REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: 6LC..t9q d 6607
Site Address or Parcel #: /)..i7) 5' t) / T /o9f0 0r' 9 7 e k2 3
Project Name: ,/r` 0 r rhs c o - fl5 Im 6 .
Subdivision Name: Lot #:
EXPLANATION: Cllifiti6 E/ x! 6 f-, r& ✓a'r PaR aF+e ?' 57572t? 7e __, ,_
Rik ( F,< 4,c1 69nicTR Lc.crien) S "/i = e /149 Ledu(, JZ Pd /7,
Signature: ) Y 3� Date: ! l
Print Name:
petard Policy
I- The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 60 of the land use application fee when an application is withdrawn or canceled before any review effort has been expended,
c) not more than 60% of the land use application fee for issued permits.
d) not more than 60% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than SO% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method is. which payment wag received. Please allow 1-2 weeks for processing refunds.
msnmocetz-aue Amin
Itte to S s Admin: Date B r _ Rte to Bid: Ad. m i n . : Date /4- J B .
Refund Processed: Data B r -alb. Invoice Processed: Date B r
Permit Canceled: Date ''' B ` Parcel T • Added: Date B
Receipt # Date _ Method Amount $
L Building \ Forms \RegPermitAction.doc Rev 07/26/07
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