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Permit ' Feb,missys-- 18. 2015*s10:48AN se_:..:. -...,, _„.,.,�a: .- __. ,.....aw_ ._—_—No. l/ AVg Il , . i City. of Tigard •!.cOMMUNITY DEVELOPMENT DEPARTMENT FEB . S ' zi .` ' • Request Permit Action iltN uv ' t;,�K� 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503.718.2439 • www-ti a 6DjvISjnr r . ii TO: CITY OF TIGARD J E Building Division Services Supervisor J 13125 SW Hall Blvd.,Tigard,OR 97223 c9/2CQ/.c e Phone 503.718.2430 Fax: 503.598.1960 www.pgard-or.govc FROM: ❑ Owner ❑ Applicant ® Contractor ❑ City Staff (check one) • REFUND OR Name: • ADT LLC • INVOICE TO: • (Business or tndividual) Y • Mailing Address: 7989.SW Cirrus Dr City/State/Zip: Beaverton,OR 97008 . Phone No.: 503-469-7241 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 #: ELR2014-00243 • Site Address or Parcel #: 10999 SW Sage Ter Project Name: Karen Brauser . Subdivision Name: Village at Summer Creek Lot#: 29 EXPLANATION: Full permit not needed ' wignaturt: ) `ti 1..�'4 a_ - Date: 2/18/2015 19 �✓� Lori McMurphy \ 0. / oveN Print Name:. 75 o ) - &0• 15. c.--0 Refund_Pniicy T 49 r ''” 7 0.10 r 0450 I. The Director or Building 01560,1 may authorize the retina at ` a 1 a) any fee which was erroneously paid or collected. p V /4,h- b) nor more than 8u%of the land usc application fee when an application is withdrawn or canceled before any review effort has been expended c) not more than 80%of the land usc application fee For issued permits. o) not more than WA of the.building plan review fee when an application is canceled before any.plan review effort has been expended. e) not more than 80%of the building permit fee for issued permits prior to any inspection requests. 2. Refunds will be returned to the original Payar in the same method in which payment was received Please allow 2-4 weeks for processing refunds. FOR ovHcT; 1-SE ONL.V �©terria Rte to Bld• Adrnin: Date ��r� Rcc to S s Admire. Date T' - . ���'��•'� Refund Processed: Dat ` By •Zi Invoice Processed: Dace Permit Canceled:: Date,t.2L/t, By vIn i Pnrce:'la:Added: Date Receipt# Date Method _ _amount ii I:\Building\Forms\RegPermitAcrion.doc Rev 05/25/2012 TIGARD City of Tigard February 26, 2015 ADT LLC Attn: Lori McMurphy 7989 SW Cirrus Dr. Beaverton, OR 97008 Re: Permit No. ELR2014-00243 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 10999 SW Sage Terr Project Name: Brauser Job No.: N/A Refund Method: ® Check#216538 in the amount of$67.20. ❑ Credit card "return" receipt in the amount of$ 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 not required. 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 TIG.ARD 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 fir Perm'tAction 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: ADT LLC DATE: 2/19/2015 Attn: Lori McMurphy 7989 SW Cirrus Dr REQUESTED BY: Dianna Howse Beaverton, OR 97008 TRANSACTION INFORMATION: Receipt#: 198160 Case#: ELR20i00243 Date: 10/24/2015 Address/Parcel: 10999 SW Sage Terr Pay Method: CreditCard Project Name: Brauser EXPLANATION: Per applicant's request as permit was not required. Refund 80%o of permit fees. REFUND INFORMATION:: Fee Description From Receipt Revenue Account No Refund F. i*nple: Building Permit Fee Example: 2300000-43104 $Amount Restricted energy permit fee 220-0000-43103 $60.00 12% State surcharge 100-0000-24001 7.20 TOTAL REFUND: $67.20 APPROVALS: SIGNA URES DATE: If under$5,000 Professional Staff 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: By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010