Permit Support Document (2) TIGARD
City of Tigard
April 3,2020
M&W Electric
29889 SW Hwy 34
Albany, OR 97321
Re: Permit No. ELC2019-00063
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 9860 SW Riverwood Ln
Project Name: Torrence Bath Remodel
Job No.: N/A
Refund Method: ® Check#235142 in the amount of$50.33.
❑ Credit card"return" receipt in the amount of$
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 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
UPI
. s
City of Tigard
l <<, D 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: M&W Electric DATE: 3/20/2020
29889 SW Hwy 34
Albany, OR 97321 REQUESTED BY: Dianna Ornelas
TRANSACTION INFORMATION:
Receipt#: 421394 Case#: ELC2019-00063
Date: 2/6/2020 Address/Parcel: 9860 SW Riverwood Ln
Pay Method: CreditCard Project Name: Torrence Bath Remodel
EXPLANATION: Per applicant's request as the 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 —
$44.94
12%State Surcharge 100-0000-24001 5.39
TOTAL REFUND: e-
APPROVALS: SIGNATURES/DATE: So 33
If under$5,000 Professional Staff ,A4T-Z7e .4---�
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 . i By:
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
api CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Bath Remodel at SFD
Site Address: 9860 SW RIVERWOOD LN
A/o
Receipt Number: 436226 - 09/03/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2019-00063 $-50.33
Total: $-50.33
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 235142 DHOWSE 09/03/2021 $-50.33
Payor: M &W Electric
Total Payments: $-50.33
Balance Due: $50.33
Page 1 of 1
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639,4171
TrC_ ,P
Project Name: Bath Remodel at SFD
Site Address: 9860 SW RIVERWOOD LN
Receipt Number: 421394 - 02/06/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2019-00063 Branch Circuits wo/Purchase Service or 220-0000-43103 $56.18
Feeder
ELC2019-00063 12%State Surcharge-Electrical 100-0000-24001 $6.74
Total: $62.92
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 060219E3E-F5B( PUBLICUSER268 02/06/2019 $62.92
Payor: MIKE WEAVER
Total Payments: $62.92
Balance Due: $0.00
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