Permit Support Document (30) 13605673320 Accurate Electric 08:46:30 a.m. 01-05-2019 1/1
RECEIVED
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT JAN 7 2099
Request for Permit Action GI F IGA
TI c A l',n 13125 SW Hall Blvd.•Tigard,Oregon 97223.503-718-2439•www,tigard-or hili DING DIVISION
TO: CITY OF TIGARD V 0 1
Building Division ./�j
13125 SW Hall Blvd.,Tigard,OR 97223 �/ / /
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPesmits@tigard-or.g6v
FROM: ❑ Owner ❑Q Applicant ErContractor 0 City Staff
Check(•r)one
REFUND OR Name:
INVOICE TO: (Business or Individual) Au ;C Vail i l Ai*
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Mailing Address: /*--Pt) {�0y ,'7/ K16;
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City/State/Zip: Van(Ui)ti r WA nto P1
Phone No.: ?10 D*5 to'7 ` 3c)
PLEASE TAKE ACTION FOR THE ITEM(S)CHECKED (1):
[3.--CANCEL/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).
Permit#: Y-007 g7
Site Address or Parcel#: t 3 ne- (fir f t ?GI.
Project Name: tiQ lnl -rift ivi tth 1k _ J
Subdivision Name: 1\30111- Lot#:jiDrl(
EXPLANATION: a1 L 'Gr✓ r+r °r t i `r✓ 1 a I
r" l,.)1,✓k G n C,j f iAAVVI .P r Pl i ci r aE r'G'"k ,-d.
Nd work IX140✓n^td .
Signature: l,(�{,.urtA�/ � � _ Date: if. 1
Print Name: ripe Q run?
Refund Policy
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 BO%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. s'
• 7, 6, - / S3
.5 r9. / r �
FOR OFFICE USE ONLY
Route to Sys Admin: Date / 7 1- By£ `. Route to Records: Date / 2 B
Refund Processed: Date /�f / q By / Invoice Processed: Date By
Permit Canceled: Date // � � B # , Parcel Tag Added: Date By
I:\Building\Porins\RegPem itAction_ 1 .doc
.
TIGARD
City of Tigard
January 24,2019
Accurate Electric Unlimited, Inc.
PO Box 871866
Vancouver,WA 98687
Re: Permit No. ELC2018-00737
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 9385 SW Greenburg Rd
Project Name: Les Schwab
Job No.: N/A
Refund Method: ® Check#231016 in the amount of$56.98.
❑ Credit card"return"receipt in the amount of$
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 job was cancelled. 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
IliCITY OF TIGARD RECEIPT
2 • 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TICAR
Project Name: New Tire Machines
Site Address: 9385 SW GREENBURG RD /,c ril A'Jj
Receipt Number: 421250 - 01/25/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2018-00737 $-56.98
Total: $-56.98
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 231016 DHOWSE 01/25/2019 $-56.98
Payor: Accurate Electric Unlimited, Inc.
Total Payments: $-56.98
Balance Due: $56.98
Page 1 of 1
CITY OF TIGARD RECEIPT
4 13125 SW Hall Blvd.,Tigard OR 97223
- 503.639.4171
Project Name: New Tire Machines
Site Address: 9385 SW GREENBURG RD
Receipt Number: 420307 - 11/09/2018
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2018-00737 Branch Circuits wo/Purchase Service or 220-0000-43103 $63.60
Feeder
ELC2018-00737 12% State Surcharge-Electrical 100-0000-24001 $7.63
Total: $71.23
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 044356 PUBLICUSER113 11/09/2018 $71.23
Payor: Breeanne Jordan
Total Payments: $71.23
Balance Due: $0.00
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