Permit Support Document (164) 02/14/2006 04:44 2532882156 GARNER ELECTRIC PAGE 04/04
RECEIVED
City of Tigard • COMMUNITY DEVE.LOPME.NT DEPARTMENT JUN 2 3 2.016
*.' `w
Request for Permit Action ct-ry OF T 9
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T't G A 1-t 1'3 13125 SW Hall Blvd, • Tigard, Oregon 97223 • 503-71.8-2439 • wvvr i PrP ;0;'3S,1°N
TO: CITY OF TIGARD
Building Division. VO D
I
13125 SW Hall Blvd.,Tigard,OR 97223 /�//�
Phone: 503-718-2439 Fax: 503-598-11960 TigardBui.IdingPermi.ts��tigard-or.gov 052:14
FROM: El Owner Q Applicant �C Contractor El City Staff
Check.(✓)one
REFUND OR Name: Garner Electric Washington LLC
INVOICE TO: p3L,.i of rndicndual) E'cli.ci.a.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 (1):
C.A.NCEL/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).
Itl�1VIC)VL/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: ELC2016-00518 — MST.Qi-C 00161
Site Address or Parcel ft: 13837 SW 17411'Ave
Tigard, OR 97224
Subdivision Name: River Terrace Lot#: 113
EXPLANATION: Per, email from.Dianna Howse Gaa7y.er. Electric is named the electrical
contractor for Polygon.Homes at West River Terrace. These permits_ate,to be refunded.as the y
were pulled by mistake. 2.p/fo--00/6/ Ar-or_
Sit�natnuc: 4 I 1 ��� IAS
.11111.a.–. J. t 1 Date: 6/23/2016
Print Name: Alicia Gentele
RcrallattZgliq.
1. The city's Community Development Director,Building 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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 he returned to the original payer in the form of a check via US postal service,
3, please allow 3-4 week.:for processing refund requests- 10c 90 — � , _ v2.c, i
42.0 -- tel. tv = 2. '/.2.
7f 9 v , .2.22 .,S76
roR OFFICE USE ONLY
Route to Sys Admin: -Date all HAMA B� Route to Records: Date By
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date`/v?///(v Iiy �f�— Parcel Tag Added: Date By
(:\.Building\Forms\ReciPe:m,it:Action 923:4.doc
44
.
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. ELC2016-00518
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 13837 SW 174th Ave
Project Name: Polygon at West River Terrace,Lot 113
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 MST2016-00161.
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
44
City of Tigard
TIGARD Accela Refund Request
Ci
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#: 404655 Case#: ELC2016-00518
Date: 6/23/2016 Address/Parcel: 13837 SW 174th Ave.
Pay Method: CreditCard Project Name: Polygon at West River Terrace,
Lot 113
EXPLANATION: Per applicant's request as electrical work is being completed under MST2016-00161.
Refund 80%of permit fees.
REFUND INFORMATION:.
Fee Description From Receipt _ Revenue Account No:. Iefit
Example: Building Permit Fee Example: ;2300600-43104 : $Abuut
Electrical Permit Fee 220-0000-43103 $80.56
12%State Surcharge 100-0000-24001 9.66
TOTAL REFUND: $90.22
APPROVALS: SIG► 'E /DATE:
If under$5,000 Professional Staff40.
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°MAL_
Case Refund Processed: Date: `77 //,6j By: ^�
I:\Building\Refunds\RefundRequest.doc x 09/01/2010