Permit Support Document 114 11
TIGARD
City of Tigard
February 6, 2014
Capitol Data &Comunications
Attn: Terry Brasch II
11401 NE Marx
Portland, OR 97220
Re: Permit No. ELR2014-00003
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 9585 SW Washington Square Rd.
Project Name: Washington Square - Unwired
Job No.: N/A
Refund Method: ❑ Check# in the amount of$ .
® Credit card"return"receipt in the amount of$67.20.
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account"deposit" receipt in the amount of$ .
Comment(s): Per applicant's request as customer cancelled job. Refund 80% of permit
fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
/ 1 -411 .,•
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 Data&Communications DATE: 1/30/2014
Attn: Terry Brasch II •
11401 NE Marx REQUESTED BY: Dianna HowsAPI
•
Portland, OR 97220
TRANSACTION INFORMATION:
Receipt#: 191'115 Case#: ELR2014-00003
Date: 1/3/2014 Address/Parcel: 9585 SW Washington Sq Rd.
Pay Method: CreditCard Project Name: Washington Square-Unwired
EXPLANATION: Per applicant's request as customer cancelled job. Refund 80%.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Electrical Permit 220-0000-43103 $60.00
12%State Surcharge 100-0000-24001 7.20
TOTAL REFUND: $67.20
APPROVALS: SIGNAT ES DATE:
If under$5,000 Professional Staff %,J� Y' -- ,Ll1-C.--
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 ADMINISTRATION USE ONLY
/�
Case Refund Processed: Date: I ,9yOr y By: I ...1
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
01/13/2014 14:28 5032551966 CAPITOL ELECTRIC PAGE 01 '✓
City of Tigard • COMMUNITY DEVELOPMENT DEPARTME> ECEIVED
Permit on
�.
Re uest Pit Acti JANY32014
T i C A I:l) 13125 SW.Hall Blvd. • Tigard, Oregon 97223 • 503.7I8.2439 •w v gard-or.gov
TO: CITY OF TIGARD BUILDING DIVi ION
Building Division Services Supervisor
13125 SW Hall Blvd.,Tigard,OR 97223 I D
Phone: 503-718.2430 Fax: 503398.1960 www.tigard-or.gov
0//r 419?6/
FROM: ❑ Owner ❑ Applicant ® Contractor ❑ City Staff
(check talc)
REFUND OR Name: Capitol Data&Communications
INVOICE TO: (Business or Individual)
Mailing Address: 11401 NE Marx
City/State/Zip: Portland,Ot. 97220
Phone No.: 503.255.9488
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
❑ CANCEL/VOID PERMIT APPLICATION.
® 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#: ELR2014-00003
Site Address or Parcel #: 9585 sw Washington Square Drive #CC13
Ptoject Name: Unwired CC
Subdivision Name: Washington Square Estates Lot#: S
EXPLANATION: The mans ement decided not use Comcast cable
Signature: Date: 1/13/14
Ferry Brasch II
Print Name:
Rdiuidjukx :jib
1. 'l'he Director or Building Official may authorize the refund of.
FAXED
a) any fcc which was erroneously paid or collected.
b) not more than 80"/n of the land urc application fcc when an application is withdrawn or canceled before any review effort has bet„ezpcnded.
c) not more than 30''/o of the land use application fcc for issued permins.
d) not more than Rfr/n of the building plan review fee when an applieantm is canceled before any plan review effort has been exprnde .
c) nnc mum than SO%of the builelingpermit fcc for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the lame method in which payment was received Pisan allow 2-4 weeks for processing refunds.
FOR 0.1-iFICE USE ONLY
Rtc to S•s Adrnin: Datc AM= . _ Rte to B1d• /1.dmin: Date 9 AwQ1' B_4✓ii
Refund Ptoccssed: EmErwrA B 19.4 Invoice Processed: Date B.
Pertnit Canceled: DateN / B / •• Parcel Tag Added: Date B
Receipt# Date Method Amount$
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