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Permit Support Document u1 I TIGARD City of Tigard June 24, 2019 Steele Electric 7741 SW Cirrus Dr Beaverton, OR 97008 Re: Permit No. ELC2019-00327 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 9370 SW Greenburg Rd, #413 Project Name: 190290 -Lara Cannon Job No.: N/A Refund Method: ® Check#232444 in the amount of$70.28. ❑ Credit card "return"receipt in the amount of$ 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 this was a duplicate permit (see ELC2019- 00251). 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 114 I City of Tigard T I G A u 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: Steele Electric DATE: 6/17/2019 7741 SW Cirrus Dr Beaverton, OR 97008 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 423518 Case#: ELC2019-00327 Date: 5/15/2019 Address/Parcel: 9370 SW Greenburg Rd,#413 Pay Method: CreditCard Project Name: 190290-Lara Cannon EXPLANATION: Per applicant's request as this is a duplicate permit(see FT C2019-00251). 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 $62.75 12%State Surchage 100-0000-24001 7.53 TOTAL REFUND: $70.28 APPROVALS: SIG S/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: _,,t i3`,;� I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD RECEIPT 1111 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: 190290 Site Address: 9370 SW GREENBURG RD 413 Receipt Number: 434446 - 05/21/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC201 9-00327 $ 70 28 Total: $-70.28 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 232444 DHOWSE 05/21/2021 $-70.28 Payor: Steele Electric Total Payments: $-70.28 Balance Due: $0.00 CITY OF TIGARD RECEIPT 11111 it • 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 If G.r1.R.D Project Name: 190290 Site Address: 9370 SW GREENBURG RD 413 Receipt Number: 423518 - 05/15/2019 I CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2019-00327 Branch Circuits w/Purchase Service or 220-0000-43103 $14.84 Feeder ELC2019-00327 Branch Circuits wo/Purchase Service or 220-0000-43103 $63.60 Feeder ELC2019-00327 12%State Surcharge-Electrical 100-0000-24001 $9.41 Total: $87.85 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 615122 PUBLICUSER109 05/15/2019 $87.85 Payor: Kandice Brown Total Payments: $87.85 Balance Due: $0.00 Page 1 of 1 CITY OF TIGARD RECEIPT II 2 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 T1CARD Project Name: 190290 Site Address: 9370 SW GREENBURG RD 413 Receipt Number: 423518 - 05/15/2019 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2019-00327 Branch Circuits w/Purchase Service or 220-0000-43103 $14.84 Feeder ELC2019-00327 Branch Circuits wo/Purchase Service or 220-0000-43103 $63.60 Feeder ELC2019-00327 12%State Surcharge-Electrical 100-0000-24001 $9.41 Total: $87.85 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 615122 PUBLICUSER109 05/15/2019 $87.85 Payor: Kandice Brown Total Payments: $87.85 Balance Due: $0.00 Page 1 of 1 1 ri \,/ fl /l-Thf RECEIVED City of Tigard • C.O,MMI'Nrry DEVEl.OPMME.NNT DEPARTMENT MAY 1 5 2019 Is ' Request for Permit Actionii CITY OF TIGARD iE 'TIGARD" 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tig,rd-t� i�s�ING DIVISION TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner ❑ Applicant RContractor E City Staff Check(✓)one REFUND OR Name: i N. INVOICE TO: (Business or Individual) ' �y r+�) }t ; L, t``�, "C ' Mailing Address: —7 1 ' \ 3\. C-A.' CC-' __-, CU City/State/Zip: q'')e.—<-7,A_ ).../...,...1' v-..., 1 Y"' '_}C. 6 Phone No.: fs) — 1 1 I PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): CANCEL/VOID PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). INVOICE FOR FEES DUE (attach case fee schedule anyd�provide explanation below). Site Address or Parcel #: ( '71)"1 0 �.`1G , r --z.,...Q Project.Name: + l Subdivision Name: Lot#: EXPLANATION: -___ - „),,c-- c ,('-.\Q.,„,,, IQ . c-;... c.---).-R , .. . ;lair • t $1 -cl..< \ 3 v / Signatuier.- oC..Q �-e� Date: ( 6( [ CI Print Name: 1� �� C� �� . . t�� t Refund Policy I. 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 Ice when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%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 3-4weeks for processing refund requests. /1 \...)�--D \ `„,. p,..„ ....„,.,_,,s2 FOR OFFICE USE ONLY Route to Sys Admin: Date By Route to Records: Date S L/y� ByOG Refund Processed: Datt4�7 / By ,S., Invoice Processed: Date By Permit Canceled: Date /V i9 By " Parcel Tag Added: Date By I:\Building\Farms\RegPermitAction_I-618. ve r, fu .2 .7 S / S, c„,- y. vi 7, 53 - /, pe r