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Correspondence wpm kii , A ; —. .. - :$0 114 ap City of Tigard October 20, 2011 Bear Electric PO Box 389 Donald, OR 97020 Re: Permit No. ELC2011 -00362 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 11131 SW Greenburg Rd. Project Name: Jump Sky High Job No.: N/A Refund Method: n Check # in the amount of $ . ® Credit card "return" receipt in the amount of $63.64. 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 as customer canceled job; 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 \Building \Refunds1[34456rsy14�ntif G,capa;ard 97223 ® 503.639.4171 TTY Relay: 503.684.2772 e www.tigard - or.gov . r 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 fir 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: Bear Electric DATE: 10/20/2011 PO Box 389 Donald, OR 97020 REQUESTED BY: Dianna Howse Applicant TRANSACTION INFORMATION: Receipt #: 183079 Case #: ELC2011 -00362 Date: 6/29 /2011 Address /Parcel: 11131 SW Greenburg Rd. Pay Method: Cred.itCard Project Name Jump Sky High EXPLANATION: Per applicant as customer canceled job. Refund 80% of permit fees. s� �y , . � "�-, _q �� °- _• °• •��. � � . ,_ - `'�- ,'s -r�' ;?�"_".�v��»`� `�"i: ° 5 ,�,t';� �:i'i?�, �fi . 'd; §• . - �.� ¢;�— c �.'�a� - >"is?, ��e�� M k��' ukK } - - tg.,PX JND IN°FQRMA.T�ION - , „'' ,,- ,-, , `, � , ." r"+ d Es +.,e mk^� "'�:� � €'imb..e... � ��s °�: t "-''" p y*^.e �.u.c fart �� ��s..,.fL'��:.e"e4N`:r. :.�.. - :.�..��`.�¢.= „ >#�--�€?'s'.'. -. �'�= � '-.��"+..�:�.', � tis., �F��:' ��#,.,':: e6��u` .�+ai'+:.�''a���.es'7?sh� s;:".' �a,2�•� °° �+ �:. �: �t; �. ��, �.`; �: s. � y��' S, �;"”- � .z°a�x °.;�- i :.;�;a y ti +�;�„� i tix, ,,,� s r � e esOT ionlF Receipt ; s r f= ; Reven e A' No =Refund ' �,�,r'r?„`�a ��g. ;%.�`�`� :� � �.t. ,i ° -, <.. *�' '�wa��, � =�a, - �°�, "� . xn ^ '�; , ° ,. , 2� s E i3: �gPe tl ,,y�° gat t ..g.. Fee`��� ,.�u;F,�.��� s .. ,.� xample:��G2 =3000�00�4�31 � `�K,"� Electrical Permit Fee 220- 0000 -43103 $56.82 12% State Surcharge 100 -0000 -24001 6.82 TOTAL REFUND: $63.64 APPROVALS: If under $5,000 Professional Staff If under $12,500 Division Manager A If under $25,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board `axis:,`;, '.. 3p 0.r,- �.��',.t. - -. -� `v: " - ° � <-�;' - - - - �. � - - <�.an.�. _,:; ��� °� $. SI'ST�EM -�°A_ rD1VIII�T`I- STRAT�IONtTS ^E�' IVLI'��- -x �,,: �,: ,, � ¥ ,�i„ ° °fit r� �`t4�� zr�. - -, - � _ ..F_ ,.. �.... s ... O � �S,�e�,.� Case Refund Processed: Date: I /O/2/,. B I \ Buildin \Refunds \RcfundRc doc s 09/01/2010 RUG- 16- 2011(TUE) 09:06 Bear Electric (FRX)5036781108 11t F.4,OI /002 L. ii Yf i'+`J fill C f9 jJ AUG 4 2011 Community Development C1T `c F ���, C Request for Permit Action D1 , r �G L ?� ' , c j TIGARD i Vi .' TO: CITY OF TIGARD 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 121 Applicant 12 Contractor ❑ City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) it 17m Mailing Address: City /State /Zip: C �c\ I C` _ q io r Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED ( CANCEL PERMIT APPLICATION. V 0 REFUN N'I FE (a r if avait�ble). INV OICE FOR PE1 TEES T DUE (attach cas fee schedule and explain below). / p / / ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: \ S \2. Site Address of Parcel #: L^ r� Project Name: Subdivision Name: Lot #: EXPLANATION: oC o ∎e . u, \ , r Signature: j />r ► ) Date: — \ Le 11 Print Name: 1 � 64 • - 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 die land use application fee when an application is withdrawn or canceled before any review eff.rt hAS been expended. e) not more than 80% of the land use application fee f 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. FOR OFFICE USE ONLY ro to S s Admin: Date p y B M. RIe to Bid: Aclmin: Date /, © M B t41,,� Refund- Processed: Date , Z, B ,kra Invoice Processed: Date B Permit Canceled: Date (• fN B ' arcel Ta: Added: Date B Receipt ## Date Method Amount $ T:\ Building \Forms \RegPenniulerion.doc Rev 02/23/2011