Permit Support Document 11:
TIGARD
City of Tigard
August 9, 2019
Garner Electric Washington LLC
402 Valley Ave NW, Ste 106
Puyallup,WA 98371
Re: Permit No. ELC2019-00378
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 11109 SW Gabriel St
Project Name: Willow Brook,Lot 1
Job No.: N/A
Refund Method: ® Check#232917 in the amount of$90.22.
0 Credit card "return"receipt in the amount of$
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): Contractor purchased separate electrical permit for work that was
performed under master permit MST2019-00095. 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
IN
e II of Tigard
r i c n ii l� 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: 8/2/2019
402 Valley Ave NW, Ste 106
Puyallup,WA 98371 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 423879 Case#: ELC2019-00378
Date: 6/6/2019 Address/Parcel: 11109 SW Gabriel St
Pay Method: CreditCard Project Name: Willow Brook,Lot 1
EXPLANATION: Contractor purchased separate electrical permit for new SF however work and
inspections were performed under MST2019-00095. Refund 80%of permit fees.
REFUND INFORMATION: ' },
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-=13104 _ S Amount
Electrical Permit 220-0000-43103 $80.56
12%State Surcharge 100-0000-24001 9.66
TOTAL REFUND: $90.22
APPROVALS: SIGN URES DATE:
If under$5,000 Professional Staff
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: 471) / .t By: 4k'e
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
IN: li
a 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
T[G.ARD
Project Name: Willowbrook 1
Site Address: 11109 SW GABRIEL ST ,/r� Alb
Receipt Number: 436089 - 08/27/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2019-00378 $-90.22
Total: $-90.22
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 232917 DHOWSE 08/27/2021 $-90.22
Payor: Garner Electric Washington LLC
Total Payments: $-90.22
Balance Due: $90.22
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CITY OF TIGARD RECEIPT
i .-" 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
I IGAIZD
Project Name: Willowbrook 1
Site Address: 11109 SW GABRIEL ST Die-/‘ / c7 4
Receipt Number: 423879 - 06/06/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2019-00378 Services or Feeders-200 amps or less 220-0000-43103 $100.70
ELC2019-00378 12%State Surcharge-Electrical 100-0000-24001 $12.08
Total: $112.78
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 05859G PUBLICUSER134 06/06/2019 $112.78
Payor: Felicia Horan
Total Payments: $112.78
Balance Due: $0.00
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