Permit Support Document (54) 11111 M
TIGARD
September 21,2017 City of Tigard
Tyco Integrated Security
Attn: Tjy Helms
6305 SW Rosewood St
Lake Oswego, OR 97035
Re: Permit No. ELR2017-00179
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 7300 SW Hunziker Rd, #300
Project Name: Eagle Home Mortgage
Job No.: N/A
Refund Method: ® Check#226192 in the amount of$67.20.
0 Credit card "return"receipt in the amount of$
Note: Please allow 2-5 days for this refund transaction to be
0 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 a minor label.
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
ty
g
AccelaCiRefofundTi Reqanduest
TIGARD
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the RequestforPermit 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: Tyco Integrated Security DATE: 9/18/2017
Attn: Tjy Helms
6305 SW Rosewood St REQUESTED BY: Dianna Howse
Lake Oswego, OR 97035
TRANSACTION INFORMATION:
Receipt#: 412255 Case#: ELR2017-00179
Date: 8/9/2017 Address/Parcel: 7300 SW Hunziker Rd,#300
Pay Method: CreditCard Project Name: Eagle Home Mortgage
EXPLANATION: Work did not require a full permit;used a minor label. Refund 80%of permit fees.
• ,r-. .: � as a.. �'.t�sp a� "�g' ...s�°� ', S�` S(h d1 '� ..f'gsr .. �*��1" = °"`
+ iW 45OIS X46 tl P L 3." " ti - K f/ "S § ;:*if -'
wra �� `� ®._ ," a r` � -�,F� '�"��x ���"�� � �a ��0 e s a
gfr,�,F _ xn .a.$r� aaa " +�.�� .,r.��^; � `°ls - �°aq�`y� ? t��� '?"�� 3 �� Sgt �€ �165ea6ti
Restricted Enera Permit 220-0000-43103 $60.00
12%State Surchar.a 100-0000-24001 7.20
TOTAL REFUND: $67.20
APPROVALS: SIOI D TE:
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 Refundb jFOR TIDEM S STEM 4` p¢... S '. t t OSIRS0 ON =
Processed: Date: 3A5 /r I By: 4;► ;>
\Building\Refunds\RefundRequest.doc x 09/01/2010
114 _ la
11CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: EAGLE HOME MORTGAGE 108328637-03
Site Address: 7320 SW HUNZIKER RD 300 /��6ntiltb
IReceipt Number: 416296 - 03/23/2018
CASE NO. FEE DESCRIPTION
REVENUE ACCOUNT NUMBER PAID
ELR2017-00179
$-67.20
Total: $-67.20
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 226192 DHOWSE 03/23/2018
Payor: Tyco Integrated Security $-67.20
Total Payments: $-67.20
Balance Due: $67.20
•
Page 1 of 1
INCITY OF TIGARD RECEIPT
a 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: EAGLE HOME MORTGAGE 108328637-03
Site Address: 7320 SW HUNZIKER RD 300 0 i-/t,v4____
Receipt Number: 412255 - 08/09/2017
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELR2017-00179 Restricted Energy Permit 220-0000-43103 $75.00
ELR2017-00179 12%State Surcharge-Electrical 100-0000-24001 $9.00
Total: $84.00
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 099371 PUBLICUSER177 08/09/2017 $84.00
Payor: Jeffrey E. Fisher
Total Payments: $84.00
Balance Due: $0.00
Page 1 of 1