Permit • '!
TI GARD
City of Tigard
August 6, 2015
Squires Electric Inc.
Attn: Andres Cohen
657 SE Yamhill St.
Portland, OR 97214
Re: Permit No. ELC2015-00453
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 10130 SW Nimbus, D6
Project Name: Nimbus Business Park D6
Job No.: N/A
Refund Method: ® Check#218221 in the amount of$103.52.
❑ Credit card "return" receipt in the amount of$
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.
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
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: Squires Electric Inc. DATE: 8/3/2015
Attn: Andres Cohen
657 SE Yamhill St. REQUESTED BY: Dianna Howse
Portland, OR 97214
TRANSACTION INFORMATION:
Receipt#: 201215 Case#: ELC2015-00453
Date: 6/11/2015 Address/Parcel: 10130 SW Nimbus,D6
Pay Method: CreditCard Project Name: Nimbus Business Park D6
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 $92.43
12%State Surcharge 100-0000-24001 11.09
TOTAL REFUND: $103.52
APPROVALS: SIGNATURES/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$50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE 015r$NIi
Case Refund Processed: I Date: �' /!/s � By: . Y
I:\Building\Refunds\RefundRe.uest.doc x 09/01/2010
, .
•; VOID
City of Tigard • COMMUNITY DEVELOPMENT DEPART/0E11; �/�°�S 'Q/'
Ilti- ,--
Re ue s t for Permit CEl V
q t Action 1 J ; ED•
T 1 I,;\it p 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 •ww ,tigar $v?
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TO: CITY OF TIGARD i D!/ � Dili jQN
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223 i
Phone; 503-718-2439 Fax 503598-196t) d$uildingNrrnits @tigard-or.gov
FROM: ❑ Owner ❑ Applicant Contractor j❑ City Staff;
Check(1)one
REFUND OR Name:
INVOICE TO: (Business or Individual) 1
Mailing Address: S k, ' '� �,i
City/State/Zip: p . ,n 1 t av, di cta_4______
Phone No.: — i
i
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED 6(): {
❑ CANCEL/VOID PERMIT APPLICATION. I j
1 REFUND PERMIT FEES (attach copy of.original receipt and provide exlanatio>,i below).
• INVOICE FOR FEES DUE (attach case fee schedule and provide explan4tiion below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel pe. mit). j
Permit#: VA 1 n 0;r14 3
i
Site Address or Parcel#: ` 0, ' J� N `ma c 1
Project Name: i k► ,., 0 uC ,a- • i. *L; IL* ,
Subdivision Name:
Lot#:
•
•
EXPLANATION:
Signature: / Date: '7 l i 3/1cc
Print Name: ► /g,
Refund_P_olicy ad
1. The city's Community Development Director,Budding 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 i5 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 req{�ests. A-6-P41
Ni
2. All refunds will be returned to the original payer in the form of a check via US postal service. //
3. Please allow 3-4 weeks for processing refund requests. i //5' V-- 9a y3 er23.//
1 /3. G- 7i. c' -.2 Z 7 7
', /a9 ye /03,Sa O5 ill
FOR OFFICF. USE ONLY
Route to 5 s Admin: Date Aguigermagly Route to Records: i Date ,-AKOZAIIMAr4111
Refund Processed: Date ''LYME B ,, nvoice Processed: Date MM.
Permit Canceled: Dare QNI l�� Parcel T.:Added: Date
I:\Building\Forma\RegPermitAction_ 231,.doc
I
■
CITY OF TIGARD (LO� ELECTRICAL PERMIT
Permit lf: ELC2015-00453
1111I COMMUNITY DEVELOPMENT
Date Issued: 06/11/2015
TtGAkRI) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S134AA01800
Jurisdiction: Tigard:
Site address: 10130 SW NIMBUS AVE D6
Project: Nimbus Business Park unit 06 Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot; 2
Project Description: Unit D6,Service and 2 circuits
Contractor: SQUIR S ELECTRIC Owner: HANSON, RONALD D
100 1 D 01'10N 'EE -1 ROBINSON, C(7NSTANCE A
PO"T 'ID, • ! 20 ROBINSON, CHESTER TRUST ET AL
�l 203604 EAST FINLEY RD
t2 7 T 6\V4‘1'1 ( KENNEWiCK,WA 99331
PHONE: 503-252-1509 ( (j')" C(112—'1 PHONE.
FAX: 503-253-5831
FEES
Quantity Description Data Amount
1 ea Services or Feeders-200 06/11/2015 $100.70
Specifics: amps or less
2 crt Branch Circuits w/Purchase ; 05/11/2015 $14.84
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 1 06/11/2015 $13.86
Electrical
Type of Const:
•
Occupancy Grp:
Total $129,40
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes an l all other, applicable law, All work will
be done in accordance with approved plans. This perrnit will expire if work is riot started within 180 days of issuance. or; if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center,! Those I rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 Or I.800.332F2344.
Issued By: Nominee Signature:
OWNER INSTALLATION ONLY
The Installation is being made on property I own which Is not Intended for sale,lease or rent_
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SI"''fTURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 603.639.4176 by 7:00 a,m,for the next available inspection date.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the Job site at the time of each inspection. •