Permit Support Document n
TIGARD
City of Tigard
August 9, 2019
Garner Electric Washington LLC
402 Valley Ave NW, Ste 106
Puyallup, WA 98371
Re: Permit No. ELC2019-00311
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 11330 SW Gabriel St
Project Name: Willow Brook,Lot 2
Job No.: N/A
Refund Method: ® Check#232917 in the amount of$90.22.
❑ Credit card "return" receipt in the amount of$
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): Contractor purchased separate electrical permit for work that was
performed under master permit MST2019-00056. 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
City of Tigard
r►c n R a 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#: 423404 Case#: ELC2019-00311
Date: 5/9/2019 Address/Parcel: 11330 SW Gabriel St
Pay Method: CreditCard Project Name: Willow Brook,Lot 2
EXPLANATION: Contractor purchased separate electrical permit for new SF however work and
inspections were performed under MST2019-00056. Refund 80%of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No, l Refund
_Example: Building Permit Fee Example,x t i000 431t4 $Amount_
Electrical Permit 220-0000-43103 $80.56
12%State Surcharge 100-0000-24001 9.66
TOTAL REFUND: $90.22
APPROVALS: SIGNATURES/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
Case Refund Processed: Date: )-7/a-/ 1 By: ,
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
2 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Willowbrook 2
Site Address: 11330 SW GABRIEL ST
Receipt Number: 436090 - 08/27/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2019-00311 $-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
13125 SW Hail Blvd.,Tigard OR 97223
- 503.639.4171
7 tG,ARL3
Project Name: Willowbrook 2
Site Address: 11330 SW GABRIEL ST 2/6- I ic./q—(>
Receipt Number: 423404 - 05/09/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2019-00311 Services or Feeders-200 amps or less 220-0000-43103 $100.70
ELC2019-00311 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 08593G PUBLICUSER134 05/09/2019 $112.78
Payor: Felicia Horan
Total Payments: $112.78
Balance Due: $0.00
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