Permit Support Document Jun 241409:41a Oakley Electric 503-908-1729 p.1
IN City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 0 1 0
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Request Permit Action
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TIGARD 13125 S W Hall Blvd. •Tigard, Oregon 97223 • 503.7I 8.2439 • www.ti7• 1.t IV
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TO: CITY OF TIGARD JUN 2
Building Division Services Supervisor `,, z014
13125 SW Hall Blvd.,Tigard,OR 97223 T r O
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard or.go uiLfD EV ARj)
FROM: ID Owner ❑ Applicant ISJON
(check one) ® Contractor ❑ City Staff
REFUND OR Name: Oakley Electric&Plumbing
INVOICE TO: (Business or individual)
Mailing Address: 4120 SE International Way Suite A-102
City/State/Zip: Milwaukie,OR d.3 )aaa
Phone No.: 503-908-0514
PLEASE TAKE ACTION FOR THE ITEM(S)CHECKED (1):
❑ CANCEL/VOID PERMIT APPLICATION.
® REFUND PERbIIT FEES (attach copy of original receipt and provide explanation below).
El INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit).
Permit#: PLM2014-00203
Site Address or Parcel #: 13718 SW Tracy Place Tigard, OR 97223
Project Name: Collins
Subdivision Name: Hillshire Esates No.2 Lot#: 96
EXPLANATION: l i i-t� Qlvtiy�p'.- per,MS T
Sec- PLC /t/-0 i 33 j YP
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Signature: • ,P a e . Date: 06/24/14 A.
Print Name: Bella Schiopen 2�Cudc� EyiNea
72.CO — .5"�, p- y.S'0
Refund Pokey P.7o G ,y4, ,< I, 7 y'
I. The Director or Building Official may authoriue the refund o£ r�j
a) any fee which was erroneously paid or oolketed. 6 / • 96 6,.Z Y
b) not more than 80%of the land use application fee when an application is withdrawn or canceled before any review effort has been ex--pen
c) not more than 80%of the land use application fee:for issued permits.
d) not more than 80%0 of the building plan review fee when an application is canceled before any plan review effort has been expended
e; not more than 80"k of the building penult fee for issued permits prior to any inspection requests.
1 Refunds will be returned to the ongenal Pave.in the same method in which payment was rectived. Please allow 2-4 weeks for processing refun
FOR OFFICE USE ONLY
Rte to S•s Admire: Date t
•��-��' - Rte to Bldg Admin: Date 7 By i�!�!r
Refund Processed: Date 7,7 / : . A; P Invoice Processed: Date By
Permit Canceled: ' Date J ,Fit,/ By .%"r Parcel Tag Added: Date By
Receipt# , Date Method Amount$ 1
1:\Building\Form:\Rc4PennitAction.doc Rev 05/25/2012
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TIGARD
City of Tigard
July 31, 2014
Oakley Electric& Plumbing
4120 SE International Way
Suite A-102
Milwaukie, OR 97222
Re: Permit No. PLM2014-00203
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 13718 SW Tracy P1
Project Name: Collins
Job No.: N/A
Refund Method: ® Check#214518 in the amount of$64.96.
❑ Credit card"return" receipt in the amount of$ .
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 for the wrong type and was
resubmitted under ELC2014-00331. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
,---S-1. 46(.7-1---C--
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: Oakley Electric &Plumbing DATE: 7/24/2014
4120 SE International Way
Suite A-102 REQUESTED BY: Dianna Howse
Milwaukie, OR 97222
TRANSACTION INFORMATION:
Receipt#: 196512 Case #: PLM201-E-00203
Date: 6/17/2014 Address/Parcel: 13718 SW Tracy P1
Pay Method: CreditCard Project Name: Collins
EXPLANATION: Per applicant's request as permit was for wrong type;resubmitted under
ELC2014-00331. Refund 80°'o of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Plumbing Permit 230-0000-43101 $58.00
12% State Surcharge 100-0000-24001 6.96
TOTAL REFUND: $64.96
APPROVALS: SIGNAT EES/DATE:
If under$5,000 Professional Staff .�( ,i/e SC__ y /cj
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: 7�. / iy By:
I:\Building\Refunds\RefundRequest.doc x 09/01/2010