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Permit Support Document (157) REGIF City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT AUG 3 N. Request for Permit Action 2016 q e� ° TIGARD 13125 S\V -Tall Blvd. •Tigard, Oregon 97223 • 503-718-2439 • www. 9 ° ;ARE) TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 /r ‘,./(0P,f Phone: 503-718-2439 Fax: 503-598-1960 'I'igardBuildingPermits a tigard-or.go FROM: [- Owner L Applicant E Contractor ❑ City Staff (;heck(✓)one REFUND OR Name: _ INVOICE TO: (I3usn,ess us individual) f—,) ,7 i is be /lct 1)1p r /(-1/2-76 Mailing Address: J/, e a �r' t t?aJ t,r. 0 City/State/Zip: _/� Phone No.: -G 9 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (V): CA NCH,/VOID PERMIT APPLICATION. -" RI:1 UN D PERMIT FEES (attach copy of original receipt and provide explanation below). INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Pen-tit#: E t C �tr? ---6Gt6.>5`/ Site Address or Parcel#: .`a 11/7.t'C 1%,eyc"' t4 Project Name: 4,ri,i644r / -eat,YJCC,2 Subdivision Name: Lot #: EXPLANATION: ( ,,f ret/1ze,.t" (10./ c: ./(Ce, Y'k Signature: e. - 7/4 a Date: Og'/ f/ , Print Name: , Yl� ' >Y f tELI') f Refund Policy 1. The city's(.kisnrnunity Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Ns.it more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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 US postal service. 3. Please allow 3-4 weeks for processing refund requests. FOR OFFICE USE ONLY Route to Sys Admin: Date !9i /G r' Route to Records: Date /Q 7//,E; By ::� Refund Processed: Date /'©/ //tg By1� nvoice Processed: Date / By Permit Canceled: Date f//�/ r„. B,/ Parcel Ta'Added: Date By I:\Building;\Forms\ReciPennitAction_) 231,.doe —_._. 711 ., i . . . TIGARD City of Tigard September 23,2016 Frahler Electric Company Attn: Sandy Harrison 11860 SW Greenburg Rd Tigard, OR 97223 Re: Permit No. ELC2016-00651 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 8965 SW Edgewood St Project Name: Arthur Job No.: N/A Refund Method: ® Check#222413 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 customer cancelled job. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, <09$14/#717- ___ 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: Frahler Electric Company DATE: 9/16/2016 Attn: Sandy Harrison 11860 SW Greenburg Rd REQUESTED BY: Dianna Howse Tigard, OR 97223 TRANSACTION INFORMATION: Receipt#: 405767 Case#: ELC2016-00651 Date: 8/23/2016 Address/Parcel: 8965 SW Edgewood St Pay Method: CreditCard Project Name: Arthur EXPLANATION: Per applicant's request as customer cancelled job. Refund 80%of permit fees. _# k,� r Po _ r ''`k` �,, }s{.,_ 4€ `a. '-iJA t^: �J� .+,� � ✓� &^" -t � � S�FS'��x� '?�� am"' r � '.3�'t �^ �t#^�y,� si_ 'i'� i 06415 U*R 8 18 �fiy i'dw' a3 C::'A ' ^iv' ll�i,.2� Electrical permit 220-0000-43103 $80.56, 12%State surcharge 100-0000-24001 9.66 TOTAL REFUND: $90.22 APPROVALS: SIGNATU: S/,11 ATE: If under$5,000 Professional Staff (# _ eir 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 ' OR in 5Y'SS,.TEiVI, 5' 1 �i.TIU ` 5 pm, , a Case Refund Processed: Date: 40/71/„ By: ,-zs = I:\Building\Refunds\RefundRequest.doc x 09/01/2010