Loading...
Permit Support Document IIII q 0 EN TIGARD City of Tigard April 3, 2020 ADT LLC 7989 SW Cirrus Dr Beaverton, OR 97008 Re: Permit No. ELR2019-00193 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 12700 SW Hall Blvd, G Project Name: Transparent Distributing LLC Job No.: N/A Refund Method: ® Check#235088 in the amount of$134.40. ❑ Credit card "return"receipt in the amount of$ . 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, ,e) �, ) Dianna Ornelas 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 I !GAR 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: ADT LLC DATE: 3/20/2020 7989 SW Cirrus Dr Beaverton, OR 97008 REQUESTED BY: Dianna Ornelas TRANSACTION INFORMATION: Receipt#: 426303 Case#: FT R2019-00193 Date: 10/8/2019 Address/Parcel: 12700 SW Hall Blvd,G Pay Method: CreditCard Project Name: Transparent Distributing LLC EXPLANATION: Per applicant's request as job was cancelled;refund 80%of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Electrical Permit 220-0000-43103 $120.00 12%State Surcharge 100-0000-24001 14.40 TOTAL REFUND: $134.40 APPROVALS: SIGNA/ S� e- Ifunder$5,000 Professional Staff �//v l�/� l/ If under$12,500 Division Manager If under$25,000 Department Manager If under$100,000 City Manager If over$50,000 Local Contract Review Board FOR ACCELA SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: 9/3/ By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD1N RECEIPT a 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Transparent Distributing LLC Site Address: 12700 SW HALL BLVD G .— L Receipt Number: 436222 - 09/03/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELR2019-00193 $-134.40 Total: $-134.40 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 235088 DHOWSE 09/03/2021 $-134.40 Payor: ADT LLC Total Payments: $-134.40 Balance Due: $134.40 Page 1 of 1 CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 if(. \rD Project Name: Transparent Distributing LLC Site Address: 12700 SW HALL BLVD G G rz-(6. Receipt Number: 426303 - 10/08/2019 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELR2019-00193 Restricted Energy Permit 220-0000-43103 $150.00 ELR2019-00193 12%State Surcharge-Electrical 100-0000-24001 $18.00 Total: $168.00 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 5637796 PUBLICUSER107 10/08/2019 $168.00 Payor: Total Payments: $168.00 Balance Due: $0.00 Page 1 of 1