Permit Support Document (163) 02/14/2006 04:44 2532882156 GARNER ELECTRIC PAGE 02/04
RFGFIVED
City of Tigard • COMMUNITY DEVELOPMENT DEP .RTM.ENT
JUN 2 3 2016
' Request for Permit Action
CA-1Y OF TIGARD
T i GA RD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-71.8-2439 •
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TO: CITY OF TIGARD 0 1
Building Division
13125 SW Hal Blvd..,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigiudI3uildirigPertnits@tigard-or.gov
FROM: fl Owner Cl Applicant [ Contractor D City Staff
Cheek(✓)one
REFUND OR Name: Garner Electric Washington LLC
INVOICE TO: (Business or Tndividual) Felicia Horan.
Nailing Address: 402 Valley Ave NW Suite 106
City/State/Zip: Puyallup,WA 98371
Phone No.: 253-872-6051
A.PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
CANCEL/VOID PERMIT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
INVOICE FOR FEES DUE (attach case fee schedule a.11.d provide explanation below).
REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: ELC2016-00517 --fMT2O16 09955
Site Address or Parcel #: 13850 SW 175th Ave
Tigard, C;)R.97224
Subdivision Name: River Terrace Lot#: 99
EXPLANATION: Per email.from Dianna Howse Garner Electric is named th.e electrical
contractor for.Polygon Horneswat West River Terrace. These_permits arc to be refunded as they
were pulled.by ix>istalz .J S !`1S Tc � - C�l1OS5 / e4/2- 40e3/2-.- r
Signature: �4i„�/. _t� I Date: 6/23/2016
Print Name: Alicia Gentcle "
j, find Policy
1. The city's Community IDevelopment Director,Building Official or.City.Engineer may authorize the refund of:
• Any fcc which was erroneously paid or collected,
• Not more than 80%of the application or plan review fee when an appiical:i.on is withdrawn or canceled before review effort
has been expended.
• Not mote 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,
3. Fleece a.ilow 34 weeks for processing refund requests, /CV 7 ) — `s _ /V
// 76- 9O- ,2.. ,?g• -C
FOR.OFFICE USE ONLY
Route to Sys Adtnin:_ Date , ,3 j 13 1' Route to Records: Date -
7 %6 By w
Refund I?t:ocessecl: Date -I- .. Invoice Processed: Date
Permit Canceled: Date"/J B _ a..rce]Ta[,Added: Date By
T:\Building,\Yomms\Revennitneinn_ 9231,.duc:
III
. If
TIGARD
City of Tigard
July 29,2016
Garner Electric Washington LLC
Attn: Alician Gentele
402 Valle Ave NW, Suite 106
Puyallup,WA 98371
Re: Permit No. ELC2016-00517
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 13850 SW 175th Ave.
Project Name: Polygon at West River Terrace,Lot 99
Job No.: N/A
Refund Method: ® Check#221839 in the amount of$90.22.
❑ Credit card "return" receipt in the amount of$ .
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 under MST2016-00055.
Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
sg-- -0-je..--
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
: IIIICity 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: Gamer Electric Washington LLC DATE: 7/21/2016
Attn: Alicia Gentele
402 Valley Ave NW, Suite 106 REQUESTED BY: Dianna Howse
Puyallup,WA 98371
TRANSACTION INFORMATION:
Receipt#: 404654 Case#: ELC2016-00517
Date: 6/23/2016 Address/Parcel: 13850 SW 175th Ave
Pay Method: CreditCard Project Name: Polygon at West River Terrace,
Lot 99
EXPLANATION: Per applicant's request as electrical work is being completed under MST2016-00055.
Refund 80% of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No ` `Rem
Example: Building Permit Fee " Example: 2300000-43104 $Amount
Electrical Permit Fee 220-0000-43103 $80.56
12%State Surcharge 100-0000-24001 9.66
TOTAL REFUND: $90.22
APPROVALS: SIGN S D TE:
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: Date: „2c)//,�, By: e
I:\Building\Refunds\RefundRequest.doc x 09/01/2010