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Permit Support Document TIGARD City of Tigard December 26, 2013 Capitol Electric Attn: Johnathan McNeel 11401 NE Marx Portland, OR 97220 Re: Permit No. ELC2013 -00716 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 10300 SW Greenburg Rd., 410 Project Name: Buckendorf GP Receptacle Job No.: Refund Method: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $50.33. 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 a duplicate. 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 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: Capitol Electric DATE: 12/19/2013 Attn: Johnathan McNeel 11401 NE Marx REQUESTED BY: Dianna Howse Portland, OR 97220 TRANSACTION INFORMATION: Receipt #: 194169 Case #: ELC2013 -00716 Date: 12/04/2013 Address /Parcel: 10300 SW Greenburg Rd, 410 Pay Method: CreditCard Project Name: Buckendorf GP Receptacle EXPLANATION: Per applicant's request as job was cancelled. 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 $44.94 12% State Surcharge 100 - 0000 -24001 5.39 TOTAL REFUND: $50.33 APPROVALS: SIGNA S /DATE: If under $5,000 Professional Staff 07-C71 - 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 TIDEMARK SYSTEM AD INISTRATION USE 0 Y Case Refund Processed: Date: //02. 6 /3 B I: \ Building\ Refunds\ RefundRequest.dnc x 09/01/2010 12/04/2013 14:27 5032577121 CAPITOL ELECTRIC PAGE 01/02 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT RECEIVED 111 Request Permit Action DEC q 4 2013 11 ;_, r n 13125 SW Hall Blvd. • Tigard. Oregon 97223 • 503.718.2439 • www.tigard- or.aov . 1,1RD TO: CITY OF TIGARD BUILDING DIVISION Building Division Services Supervisor 13125 SW Hall Blvd., Tigard, OR 97223 V 0 Phone: 503.718.2430 Fax: 503398.1960 www.tigard- or.gov /o2 / fo /3 99/ FROM ❑ Owner ❑ Applicant ® Contractor ❑ City Staff (check onc) REFUND OR Name: Johnathan McNeel INVOICE TO: (Bua;ne:, or individual) Capitol Electric Mailing Address: 11401 NE Marx City /State /Zip: Portland OR 97220 Phone No.: 503 - 255 -9488 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ® CANCEL /VOID PERMIT APPLICATION. El REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit #: ELC2013 -00716 Site Address or Parcel #: 10300 SW Grecnburg Rd Project Name; Buckendorf GP Receptacle Subdivision Name: Lot #: EXPLANATION: Customer canceled work right after applying for the permit. Signature: Date: 12 -4-13 j n McNeel `/� Print Name: �! , /a yy , 9 f //r - Refund Policy 6 , 7 y .. s' 3 9 ,. 3S 1. The Director or Building Official may authorize the refund of: / Ja .`Q —2-2 /••2- , 5 y a) any fee which waF erroneously paid or collected, 402- b) not more than 80% of the land use application fcc when an application is withdrawn or canceled before any review effort has been expended. c) not more than 80% of the land uac application fee for issued permits. d) not more than till% of the building plan review fee when an application is canceled before any plan review effort has been expended. c) not more than 80% of the building permit fcc 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 recwvctl_ Plptce allow 2.4 wceka For processing refunds. FOR OFFICE USE ONLY Rtc to S s Admin: Date ,,, LIMMI %;;���, Bldg /._LWAgE iii 1 Rt to Bld Admire: Dare t• Refund Processed: Date ,LWALMEIMINA Invoice Processed: Date B Permit Canceled: Date /. /3 By • Parcel Tag Added: Date By Receipt # Date Method _ Amount $ I: \ Building \ Forms \RegPcrmitllction,doc Rev 05 /25/2012