Permit Support Document (162) 02/14/2006 04:44 2532882156 GARNER ELECTRIC PAGE 03/04
RECEIVED
City of Tigard, * COMMUNITY DEVELOPMENT DEPARTMENT JUN 2 3
2016
0- Request for Permit Action CITY OTIGARD
TIGARD 1.31.25 SW hall.Blvd. • Tigard,i.gard, Oregon 97223 • 503-718-2439 •www tl' E i V€S Cs N
TO: CITY OF TIGARD
Building Division
1.3125 SW Hall Blvd.,Tigard,OR 97223 7/2/7j6,
Phone: 503-718-2439 Far: 503-598-1960TigardliuildingPerinits@tigard-or.gov
FROM: ❑ Owner E Applicant X Contractor ❑ City Staff �7Y
Check(V)one
REFUND OR Name: Gamer Electric Washington LLC
INVOICE TO: (;''''nes:;or individ'Al) Felicia,Horan
Mailing Address: 402 Valley Ave NW Suite 106
City/Sta.te/Zip: Puyallup,WA 98371
Phone No.: 253-.872-6051
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (i):
CANCEL/VOID PERMIT APPLICATION.
§1.)
REFUND PERMIT FEES (attach copy of originsal receipt and provide explanation below).
INVOICE FOR.FEES DUE (attach case fee schedule and provide explanation below).
0 REMOVE/R.EPLA..CE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: ELC201G-00515 -
Site Address or. Parcel#: 13853 SW 174'1',Ave
Tigard, OR 97224
..
Subdivision Name: River Terrace Lot#: 1,1.2
EXPLANATION: Per email,from Dianna Howse Garner Electric is named the electrical
-contractot:forPo.lygon.Homes at West River Terrace. These permits are to be refunded.as`they
,
were pulled by mistake. �6 Y�-S. Tom,►/� - OO/6 0 ,/ ,'Z, C-tJd2/e. . 'C --
Signature: ./ / i i 1 0 A
�.r. 1 . . w% - Date: 6/23/2016
Print Name: Alicia. Gentele
Refund 1!Jie,V,
1. The city's Community Development Director,Builrluig Official or City 1;ngi.neer ma.y 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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 forth of a check via US postal service.
3. Please allow 3-4 weekH for pmccsaing refund requests. foO. 74) ..2e), //
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�
FOR OFFICE USE ONLY
Route to Sys Admin: Date -„SI , MOM Route to Records: 13 l._
Refi n.d Processed.: Date / B .: T--�• .i.�s
....�..... � . ^,,, f 7-Invoice.Processed: Date. '8y
Permit Canceled: DateX4arcs/Tag Added; Date By
Y
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IN . 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. ELC2016-00515
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 13853 SW 175th Ave.
Project Name: Polygon at West River Terrace,Lot 112
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 MST2016-00160.
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
IR 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#: 404652 Case#: ELC2016-00515
Date: 6/23/2016 Address/Parcel: 13853 SW 174th Ave
Pay Method: CreditCard Project Name: Polygon at West River Terrace,
Lot 112
EXPLANATION: Per applicant's request as electrical work is being completed under MST2016-00160.
Refund 80%of permit fees.
REFUND,INFORMATION:`
Fee
Description From Receipt Revenue Account No- R rtct
Eicample: Building Permit Fee Example: 2300000-43104 . .. Am4uut
Electrical Permit Fee 220-0000-43103 $80.56
12%State Surcharge 100-0000-24001 9.66
TOTAL REFUND: $90.22
APPROVALS: SIGNnAT ES/DATE:
If under$5,000 Professional Staff �,/
If under$12,500 Division Manager ��--CC
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/o2-9s/ j By: „(05,1----
I:\Building\Refunds\RefundRequest.doc x 09/01/2010