Inspections s
624b b
City of Tigard
October 8, 2015
ADT LLC
Attn: Lori McMurphy
7989 SW Cirrus Dr
Beaverton, OR 97008
Re: Permit No. ELR2015-00175
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 11564 SW Pacific Hwy
Project Name: Sharper Edge
Job No.: N/A
Refund Method: ® Check#218836 in the amount of$67.20.
Ti Credit card"return" receipt in the amount of$
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$
Comrnent(s): Per applicant's request as this was a duplicate permit (see ELR2015-
00173). 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
pri
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 fir Permit Actran 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: _\DT LLC DATE: 10/1/2015
Attn: Lori McMtuphv
7989 SW Cirrus Dr REQUESTED BY: Dianna Howse
Beaverton, OR 97008
TRANSACTION INFORMATION:
Receipt#-. 201819 Case ;;=: ELR2015-00175
Date. 7/27/2015 Address/Parcel: 11564 SW Pacific Hwy
Pay Method: CreditCard Project Name: Sharper Edge
EXPLANATION: Per applicant's request as this was a duplicate permit (see ELR2013-00173) 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 $60 00
12% State Surcharge 100-0000- >2e/OC/ 7.20
TOTAL REFUND: $67.20
APPROVALS: SIGNATURES/DATE:
If under$5,000 Professional Staff ,l '
If under$12,500 Division Manager
If under$25,500 Department Manager
If under$50,000 City Manager
If over$50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed. Date: /e/f-As- By:
I\Building\Refunds\RefundRequestdoe .09/1)1/21110
Sep. 15. 2015 10:01AM No. 2572 P. 1
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT .
Request Permit Action
1 1,;,,Iti l) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.god ./ rep
oCP
TO: CITY OF TIGARD Obi 15 2015
Building Division Services Supervisor U (#14,,
13125 SW Hall Blvd.,Tigard,OR 97223. • 8 jLDar�jgkb,
• Phone; 503.718.2430 Fax; 503.598.1960 www.tigard-or,gov 4 vj$j0
FROM: ❑ Owner ❑ Applicant [ J Contractor ❑ City Staff 7
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) A \ ) 1 Li_ Cl
Mailing Address: ✓�'C j�,,j ,(c ��
City/State/Zip: 22‘JC1..LQ r ire — CO., 97 6 O
`n
Phone No.: _� � �� i-2,(-4 (
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
. ❑ CANCEL/VOID PERMIT APPLICATION.
MrREFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
INTVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: (g r3-- oo l
Site Address or Parcel#: I `5 la`-( 5j Pcx•t 4t C '\Lk) /
Project Name: J
Subdivision Name: Lot#:
EXPLANATION: 0 1 4Qcr '4- :_.R.2 O UO f
— i
Signature: • \ Date: k l�.
•Print Name: l Cr t MC-M ��.
Rcfim i policy J 7 - /. 1v
1. The Director or Building Official may authorize the refund of
I •v�
a) any fee which was erroneously paid or collected. ry re 6 ., X2.0 /a. •�C)
b) not more char 80��of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) nor more than 80%of the land uac application fee for issued permit,
d) not more than 80%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 ins pcetion requests.
2. Refunds will be resumed to the original Payer in the same method in which payment was received. Please allow 2-4 weeks ftir proct:iiing refunds.
FOR OFFICE USE ONLY
Rte ro Sys Admin: Date 1111/1011 IMP Rte to Bld_Admit►: Dare ; ,-,, ,M B _ i/w
Refund Processed: Dare d/71311E %!/11 Invoice Processed: Date B' -
Permit Canceled: Dare /p e is By .°�rd. Parcel Tag Added: Date 1 By
Receipt# Date Method Amount$
I:\Building\Forms\RegPemvtAcriondoc Rev 05/25/2012