Permit Support Document (166) 02/14/2006 04:44 2532882156 GARNER ELECTRIC PAGE 01/04
RECEEIVED
City of Tigard • COMMUNITY DEVW...OPMENT DTP A RTMENT
JUN 23 2016
1411 g'' 7 Request for Permit Action CITY OF TIGARD
ITGARD 13125 SW Hall Blvd •'.rigarcl,Oregon 97223 6 503-718-2439 • ;Ii4 --.Nr: VISION
TO: CITY OF TIGARD V n 1 0
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223 7/.2/AQ 40144--
Phone: 503-718-2439 Fax: 503-598-1960 Tigardl3uildingPermits@tigard-or.gov
FROM: LI Owner 0 Applicant LA Contractor 0 City Staff
check(v')one
REFUND OR Name: Garner Electric Washington LLC
INVOICE TO: (13cEinesa or Individual) Felicia Horan
---
Mailing Address: 402 Valley Ave NW Suite 106
City/State/Zip: :Puyallup,WA 98371,
Phone No.: 253-872-6051 _
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (i):
kCANCEL/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).
Pt REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: ELC2016-00516 MST24)16 00054
Site Address or Parcel#: 13840 SW 175th.Ave
Tigard, OR 97224
Subdivision Name: River Terrace Lot 41: 98
EXPLANATION: Per email from Dianna.Howse Garner Electric is named the electrical
contractor for PEgon.Homes at West Rivet Terrace. These permits are to be refurided as they
were pulled by mistake. S-&- _ At-Cr,,/... ----0005V /=2,71-
Signature:
, ,, ., .
I ' P,1 i. 1111, eiltia3'
Date: 6/23/2016
Print Name: - .11.Alicia Gentcle
Z,cflancl Policy
1. the city's Cotnmunily Development Director,Building Official or City'Engineer may authorize the refund of
• Any fcc which wm;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• Not more than 80%of.the.application or plan review fee when an application is withdrawn or canceled before review effort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 13S postal service.
3. Please allow 3-4 weeks for processing refund requests. „/.0--bi , 7i1 - .5 , ... . 471-e#0'
- i.-A ...-
,
FOR OFFICE USE ONLY
.Routc to Sys Admin: Date . _A3 , .13 ODW, Route to Records: Date 7 ,,;. .,' 4.. By
Refund Processed: Date _ ' / , By .tiF;' - Invoice Processed: Date ),
---
Permit Canceled: Date 7 _JIM): By .1;07; steel Tag Added: Date 13y
TABuilding\Forms\ReciPermitAcion_•9231 Aloe
III
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. ELC2016-00516
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 13840 SW 175th Ave.
Project Name: Polygon at West River Terrace,Lot 98
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 MST2016-00054.
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
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: Garner 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#: 404653 Case#: ELC2016-00516
Date: 6/23/2016 Address/Parcel: 13840 SW 175th Ave
Pay Method: CreditCard Project Name: Polygon at West River Terrace,
Lot 98
EXPLANATION: Per applicant's request as electrical work is being completed under MST2016-00054.
Refund 80% of permit fees.
REFUND INFORMATION:.
Fee Description From Receipt Revenue Account No. Reflrcl
Example: Building Permit Fee Example. 2300000-43104 $Amq nt.,',
Electrical Permit Fee 220-0000-43103 $80.56
12%State Surcharge 100-0000-24001 9.66
TOTAL REFUND: $90.22
APPROVALS: - SIGNAT S/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: Date: 7/o2-9/46 By: L-
I:\Building\Refunds\RefundRequest.doc x 09/01/2010