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Permit Support Document • � . . TIGARD' City of Tigard December 3, 2013 Capitol Electric Company Inc. Attn: John McNeel 11401 NE Mars St. Portland, OR 97220 Re: Permit No. ELC2013 -00656 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 10220 SW Greenburg Rd. #535 Project Name: Robert Half TI Job No.: N/A Refund Method: ❑ Check # in the amount of $ . ® Credit card "return" receipt in the amount of $123.47. 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): Work completed and inspected under another permit (ELC2013- 00635). Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, 4/- i ' / / 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 pp ! 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 RequestforPermitAction 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: Capitol Electric Co. Inc. DATE: 12/3/2013 Attn: John McNeel 11401 NE Marx St REQUESTED BY: Dianna Howse Portland, OR 97220 TRANSACTION INFORMATION: Receipt #: 193765 - Case #: ELC2013 -00656 Date: 10/31/2013 . ' Address /Parcel: 10220 SW Greenburg Rd #535 Pay Method: CreditCard Project Name: Robert Half TI EXPLANATION: Work completed under ELC2013- 00635. 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 $110.24 12% State Surcharge 100 - 0000 -24001 13.23 • TOTAL REFUND: $123.47 APPROVALS: SIGNATURES /DATE: If under $5,000 Professional Staff If under $12,500 Division Manager OANJ If under $25,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: 1 Date: 1 /- 1 /,j //_3 1 By: 1 /P / - I: \ Building\ Refunds \RefundRequest.doc x 09/01/2010 10/31/2013 10:18 5032577121 CAPITOL ELECTRIC PAGE 01/04 City of f Tigard • COMMUNITY DEVELOPMENT DEPARTN V I' VS 4 iS q II Request Penn' ermit Action : �3 x-1 2;,\ R [1 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www. ig NOV 4 2013 TO: CITY OF TIGARD Building Division Services Supervisor CITY OF TI GARD 13125 5W Hall Blvd., Tigard, OR 97223 BUILDING DI Phone: 503.718.2430 Fax: 503.598 -1960 wwW rigard- or.gov FROM: ❑ Owner ❑ Applicant ig, Contractor. ❑ City Staff (check one) REFUND OR Name: INVOICE TO (Rus,ncss or Indiividua1) 111 1. L — .► C.,— Cso n.) (.___ Mailing Address: 1 Pk , f. A A &x Sl- City /State /Zip: pal(t._'S 1.Yt o 1e_ -Z Phone No.: 5 ZS 5 "1 ci 3 a' PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ❑ CANCEJ_. /VOID PERMIT APPLICATION. Egt REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). Nd ; ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ,' ` ', p 1 ❑ REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit). fPf'� (/ Permit #: G 2 - 'o 0 - - " , 5 - I r IC ago 5`1 roc Site Address or Parcel #: // 1e - CA OW 14 D Project Name: 0.s ia. S Tl Subdivision Name: Lot #: EXPLANATION: • ., ' 4 1 ti y - (NI OZ, itotit-C.:r ) S o a L8 oZ'Lo `:,..) 4 a I S_?)' � i c,J l i, i. sJr' -r it At (- P tT AP /e Date: a 3.I Signature: �.� o , - �- �-.�.. a..Q JA.c� / , 1.-4,-- 1.-4,-- Print. Name: iic f „ , ri- - (0357, cO A " (� `�(� £�.c ol013 - �c-� Refund Policy � i4_,Ap r a — . woos& 1. .11-1c Director or Ru,i(ing Official may s,urhorize the refund of a) any fur which was erroneously r aid or collected. 1 b) not more Ihnn RO% of the land use application fcc when an application is withdrawn or canceled before ony review effort has burn expended. c) not more than SO" /.. orncc land use .application fee for issued par n ut (1) not rnnrt. than RO% of the building plan review fcc when an application is canccicd before any plan review uffon has been cspendcd, c) not more Ihnn R0% , of the b.nldinq permit fcc For 3i tucd permits pnnr 1 u any inspection rcque•:t . 2, Refunds will Ix returned to the original Payer in the same method in which payment was received. Please allow 2 -1 weeks for processing mfundc. 1 [)R OFF 1 -? liSE ONLY Rte to S s Admin. Em©miocroml Rtc to B1d Adintn: Date ®XON 13 - 4- Refund Processed: Date / 3 / „ Invoice Processed: Date Pcnrut Canceled: Date 3 fjj Parccl Tat Added: Date Recei.t # Date Met lod Amount $ T.\ Rtuldi ng \ Forms \ItccPurm,inction.doc Rcv 115/2i/2012 /37. Jd /6 ,S �'WO , a Y f — /3 .a3 = 4? .5, V7 ,.-/__