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Permit 702783 RECEIVED City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT ■ •• Request for Permit Action APR 2 3 2015 1 1,,A R i) 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 • www.t 'IT QF 't(;ARD . DIVISION TO: CITY OF TIGARD Building Division VOID 13125 SW Hall Blvd.,Tigard,OR 97223 S77/4 f APV Phone: 503-718-2439 Fax: 503-598-1960 T igardBuildingPermits @tigard-or.gov FROM: ❑ Owner ❑ Applicant © Contractor ❑ City Staff Check V)one REFUND OR Name: INVOICE TO: (BusvxssorIndividual) Oregon Electric Construction, Inc Mailing Address: 1709 SE 3rd Ave City/State/Zip: Portland. OR 97214 Phone No.: 503-234-9900 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#: ELC2015-00220 Site Address or Parcel#: 16530 SW Greenland Dr. Tigard Project Name: Kim Lindman Residence Subdivision Name: Lot#: EXPLANATION: This job was cancelled Signature: 0,1e, I_ t " t//.j 411A Date: 4/23/15 Print Name: (1 A Vl eNmpvjt VU Refund Policy 1 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service p 3. Please allow 3-4 weeks for processing refund requests. -5-6 , AP- 'r . /9 - //, .2y C,7y- y= /. 3S 9.57)• 33 42 . s9 FOR OFFICE USE ONLY Route to S s Admin: Date B Route to Records: Date -40,® B '/W' Refund Processed: Date 6 7 S By d%' Invoice Processed: Date By Permit Canceled: Date . /7 By4^ Parcel Tag Added: Date By 1:\Suit ding\Forms\RegPermitrlction_o'f23t .doc . 1 a TIGARD City of Tigard May 7, 2015 Oregon Electric Construction Inc. Attn: Laurel Semprivivo 1709 SE 3rd Ave. Portland, OR 97214 Re: Permit No. ELC2015-00220 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 16530 SW Greenland Dr. Project Name: Lindman Job No.: N/A Refund Method: ® Check#217317 in the amount of$50.33. ❑ Credit card"return" receipt in the amount of$ 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 job was cancelled. 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 'FIGARD 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: Oregon Electric Construction Inc. DATE: 4/30/2015 Attn: Laurel Semprivivo 1709 SE 3`i Ave. REQUESTED BY: Dianna Howse Portland, OR 97214 TRANSACTION INFORMATION: Receipt#: 200196 Case#: ELC2015-00220 Date: 4/07/2015 Address/Parcel: 16530 SW Greenland Dr Pay Method: CreditCard Project Name: Lindman 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: SIGNATURES/DATE: If under$5,000 Professional Staff i G"7(1---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: _ -5-/�/Lc By: 44 L:\Building\Refunds\RefundRequest.doc z 09/01/2010