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Correspondence ti City of Tigard June 2, 2011 Johansen Electric Attn: Charlynn Leifsen 10948 SE Valley View Terr . Happy Valley, OR 97086 Re: Permit No. ELC2010 -00500 Dear Ms. Leifsen: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 15055 SW Sequoia Pkwy, #130 Project Name: PacStar Job No.: N/A Refund: n Check # in the amount of $ . ® Credit card "return" receipt in the amount of $379.90. n Trust account "deposit" receipt in the amount of $ . Notes: Per applicant's request as permit was not required. 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. 1:\Buddin Airlhiri q Taadcligv is ei P?n 97223 0 503.639.4171 TTY Relay: 503.684.2772 0 www.tigard- or.gov CC • III ■ Community D evelopment RECEIVED r i i Request for Permit Action MAY 2 5 2011 R. D CITY OF TIGARD TO: CITY OF TIGARD BUILDING DIVISION Building Division Services Supervisor 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: ❑ Owner ® Applicant ® Contractor ❑ City Staff (check onc) REFUND Ty T T TO: Name: Johansen Electric INVOICE O: (Business or Individual) Mailing Address: 10948 SE Valley View Terr City /State /Zip: Happy Valley, OR 97086 Phone No.: 503 -698 -3417 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): . • ❑ CANCEL PERMIT APPLICATION. VOID 0 REFUND PERMIT FEES (attach receipt, if available). INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PE1tMIT (do not cancel permit). 7 Permit #: ELC2010 -00500 Site Address or Parcel #: 15055 SW SEquoia Project Name: Subdivision Name: Lot #: EXPLANATION: Permit not needed Signature: Date: 5/25/2011 Charlynn Leifsen Print Name: Refund Policy 1. The Director or Building Official may authorize the refund of: a) any fee which was erroneously paid or collected. b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended. c) not more than 80/ of the land use application fee for issued permits. d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended. e) not more than 80% 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 in which payment was received Please allow 1 -2 weeks for processing refunds. TOR QI ICE USE ONLY Rte to S ' s Admin: Date B Rte to Bid • Admin: Date - © ISIMII B Refund Processed: Date . © B Invoice Processed: Date B Permit Canceled: Date ; a il Parcel Ta_ Added: Date B Receipt # Date Method _ Amount $ r: \Building \Forms \RegPermitAcrion.doc Rev 02/23/2011 T d XEEl3 13CH3Sd1 dH Wd2E:E T TOZ S2 ReW 3 C City of Tigard TiGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request. Refund requests are due to Accela System Administrator by Wednesday at 5:00 PM for processing by the following Wednesday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing. PAYABLE TO: Johansen Electric DATE: 6/2/2011 Attn: Charlynn Leifsen 10948 SE Valley View Ten REQUESTED BY: Dianna Howse Happy Valley, OR 97086 TRANSACTION INFORMATION: Receipt #: 179465 Case #: ELC2010 -00500 Date: 9/15/2010 Address /Parcel: 15055 SW Sequoia Pkwy #130 Pay Method: CreditCard Project Name: PacStar EXPLANATION: Per applicant's request as permit is not needed. Refund 80% of permit fees. -R. 'E' • N N ORM E U D - .escti t><on. >Ftom -Recei t' .^ :: Reve nue.Aecou0IVo-cA��::; - �rRefund= "=�� N�:Exa`m�'le`2300000�431�0 �Ain:o le; Butt - =P:errriif ee�' -`$ ..Exam • dm . .., . , ..... _ . . . . ........... ..... __ ,......r ..,.. , , .. _ , Electrical Permit 2200000 -43103 $339.20 12% State Surcharge 1003100 -24001 $40.70 TOTAL REFUND: $379.90 APPROVALS: If under $5,000 Professional Staff If under $12,500 Division Manager If under $25,500 Department Manager If under $50,000 City Manager if over $50,000 Local Contract Review Board .. FOR,TIDEMA1 °INISTRATION.USE.e Case Refund Processed: Date: f B : ,atp_ I:\ Budding \Refunds \Itcfundltcqucst doc x 09/01 /2010