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Permit Support Document M. il B TIGAR© City of Tigard December 31, 2015 Capitol Electric Co., Inc. Attn: Hillary Porter 11401 NE Marx St Portland, OR 97220 Re: Permit No. ELC2014-00702 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 10200 SW Greenburg Rd., 110 Project Name: Fidelity National Title Outlet Job No.: N/A Refund Method: ® Check#215965 in the amount of$56.98. ❑ Credit card "return" receipt in the amount of$ . 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 work was completed by someone else. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, Ze:-.--- ,e../ ..-€._— 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 Co., Inc. DATE: 12/18/2014 Attn: Hillary Porter 11401 NE Marx St REQUESTED BY: Dianna Howse Portland, OR 97220 TRANSACTION INFORMATION: Receipt#: 198675 Case#: ELC2014--00702 Date: 12/08/2014 Address/Parcel: 10200 SW Greenburg Rd, 110 Pay Method: CreditCard Project Name: Fidelity National Title Outlet EXPLANATION: Per applicant's request as work was completed by someone else. 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 Fee 220-0000-43103 $50.88 12% State Surcharge 100-0000-24001 6.10 TOTAL REFUND: $56.98 APPROVALS: SIGNQ.TPURES/DATE: If under$5,000 Professional Staff - s � 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: I Date: 4.2/3'/Y By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010 12/16/2014 17:20 5032551966 CAPITOL ELECTRIC PAGE 01 • MMUNITY DEVELOPMENT DEPARTMENT / City of Tigard • ca SEC' 1 Iii, so , . . Request Permit Action . /rp,-16 2014 r lc.;A R.f7 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503.718.2439 • w, 11, v TO: CITY OF TIGARD Building Division Services Supervisor volD 13125 SW Hall Blvd.,Tigard,OR 9'7223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov 42/3/// FROM: n Owner ❑ Applicant ® Contractor. ❑ City Staff (check one) REFUND OR Name: Capitol Electric Co-, Inc. INVOICE TO: (Business<,r Individual) Mailing Address: 11401 NE Marx St City=/State/Zip: Portland, OR 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). 0 INVOICE FOR FP.ES DUE (attach case fee schedule and provide explanation below). [] RPMOVE/REPLACP CONTRACTOR ON PERMIT (do not cancel permit). Permit#: ELC2014-00702 Site Address or Parcel#: 10200 SW Gr-eenburg Rd / STE /10 Ptoject Name: Fidelity National Title Outlet Subdivision Name: Lot#: EXPLANATION: Need to cancel permit and get a refund for permit fees. Work had already been completed when we arrived to do job. *Receipt for permit attached. Page 2 Signature: Date: 12/16/14 Hillary Porter F-r-4"/n '2v7 n/ Print Name: fob•C/O — 56 r 1—(P" = /o? • 2.2._�. 7. (o2' - G. /O /. 53 Refund Policy: '-'7 ..A .:2----s" 1. The Community Development Director or Ruib ling Official may authorize the refund of _� 'q f a) any fee which was erroneously paid or collected. 13) not more than SO%of the land use application fee when an application it withdrawn or canceled before any review effort has been expended. c) not more then FiO%of the land use application fee for i;:.ued 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. c) not more than 80%of the building permit fce for issued permits prior to any inspection ralucr+ts. 2. AU refunds will be returned to the original layer in the Form of a check. Please allow 3-4 weeks for processing refund rev .ucsay. FOR OFFICE USE ()NIA" Rte to Sys Admin: Date _Qwfair3awyz Rte to Bld_Adztnn: DFtte f.24glrZAIEraVAIIIII Refund Processed: Date /// By NPir invoice Processed: Date By Permit Canceled: Date , i 33 ,4%� a arcel Ta:Added: Date B Receipt# Date Method Amount$ I:\Building\forms\RtyPer ,itAction_O62614,doc