Loading...
Permit Support Document (49) City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Request for Permit Action `> _5 ?Pi T1 Li A R.D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • , , _. .t . it ` rd . ,-4 ,,,,,, •. 114111 ,.`, . TO: CITY OF TIGARD Building DiUvision 13125 SW Hall Blvd.,Tigard,OR 97223 -.5.' 2-0 7 Phone; 503-718-2439 Fax: 503-598-1960TigardBztildingPemmIs@tigard-ox.gov FROM: ❑ Owner check(v)one ❑ Applicant X Contractor ElCity Staff REFUND OR Name: INVOICE TO: (Business or individual) Garner Electric WA LLC Mailing Address: 402 Valley Ave NW Suite 106 City/State/Zip: Pu allup, WA 98371 Phone No.: 253.872..6051 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): n CANCEL/VOID PERMIT APPLICATIION. REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). Li INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: LC2017-00379 Site Address or Parcel#: 13429 SW Pum kin Valle Terrace Project Name: Subdivision Name: River Terrace _ Lot#: 71 — EXPLANATION: Permit was pulled by mistake. We will be usin minor labels for this-ob. Signature: . [ '57Da Print Name: _ Date: 5/25/2017 Alicia Gentele efu 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was erroneously paid or collected- • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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 more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. Alt 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_ . 7V-- S. 39 — t 33 I~OR OFFICE USE ONLY Route to S rs Admin; Date 13 Refund Processed: S�� 13 Route to Records: Date © B Date a� Invoice Processed: Date Permit Canceled: Date , ' B PV3uiiding\Fomis\R,PennitA.caon`0+231 .doe ✓�� Parcel Ta:Added: Date B III m TIGARD June 1,2017 City of Tigard Gamer Electric Washington LLC Attn: Alicia Gentele 402 Valley Ave NW, Suite 106 Puyallup,WA 98371 Re: Permit No. ELC2017-00379 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 13429 SW Pumpkin Valley Ter Project Name: River Terrace Northwest,Lot 71 Job No.: N/A Refund Method: ® Check#224850 in the amount of$50.33. 0 Credit card "return"receipt in the amount of$ Note: Please allow 2-5 days for this refund transaction to be credited to your account by the company that issued your card. 0 Trust account"deposit"receipt in the amount of$ . Comment(s): Per applicant's request as a minor lable was used. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, 4 ,..------•I%l Dianna Howse Building Division Services Supervisor Enc. i 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov 11 I ® 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: 5/26/2017 Attn: Alicia Gentele 402 Valley Ave NW, Suite 106 REQUESTED BY: Dianna Howse Puyallup,WA 98371 TRANSACTION INFORMATION: Receipt#: 410831 Case#: ELC2017-00379 Date: 5/25/2017 Address/Parcel: 13429 SW Pumpkin Valley Ter Pay Method: CreditCard Project Name: River Terrace Northwest,Lot 71 EXPLANATION: Per applicant's request as they will use a minor label. Refund 80%of permit fees. Ste , asp S[ � _+n '� •3 ra< ``s. g �' � �' '�'t r s t ` Electrical Permit 220-0000-43103 $44.94 12%State Surchar.a 100-0000-24001 5.39 TOTAL REFUND: $50.33 APPROVALS: SIG TS/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 Case Refund Processed: Date: .3 B : --gra I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD RECEIPT fill‘ it 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: River Terrace 57 Site Address: 13429 SW PUMPKIN VALLEY TER Receipt Number: 415896 - 03/02/2018 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2017-00379 $-50.33 Total: $-50.33 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 224850 DHOWSE 03/02/2018 $-50.33 Payor: Garner Electric Washington LLC Total Payments: $-50.33 Balance Due: $50.33 Page 1 of 1 CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD l7/2-/ 4/(97-- Receipt /F!'LReceipt Number: 410831 - 05/25/2017 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2017-00379 Branch Circuits wo/Purchase Service or 220-0000-43103 $56.18 Feeder ELC2017-00379 12%State Surcharge-Electrical 100-0000-24001 $6.74 Total: $62.92 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 01947G PUBLICUSER134 05/25/2017 $62.92 Payor: Felicia Horan Total Payments: $62.92 Balance Due: $0.00 Page 1 of 1