Correspondence City of Tigard, Oregon o 13125 SW Hall Blvd. o Tigard, OR 97223
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August 27, 2009
Squires Electric
P.O. Box 16851
Portland, OR 97292
Attn: Donna Toothman
Re: Permit No. ELC2008 -00509
Dear Ms. Toothman:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 16800 SW 72' Ave.
Project Name: Bed, Bath & Beyond
Job No.:
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $71.77.
❑ Trust account "deposit" receipt in the amount of $
Notes: 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 Howse
Building Division Services Supervisor
Enc.
1: \ Building \ Refunds \ Administration \LtrRefund- CancelPermit.doc 01/16/07
Phone: 503.639.4171 o Fax: 503.684.7297 . o www.tigard-or.gov o TTY Relay: 503.684.2772
City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for Permit Action orRefund form (if applicable) must be
attached to this form. Refund requests are due to Accela System Administrator by Friday at
5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Squires Electric DATE: 8/20/09
P.O. Box 16851
Portland, OR 97292 REQUESTED BY: Dianna Howse
Attn: Donna Toothman
TRANSACTION INFORMATION:
Receipt #: 2008 -3112 Case #: ELC2008 -00509
Date: 9/4/08 Address /Parcel: 16800 SW 72 ^d Ave.
Pay Method: CreditCard Project Name: Bed, Bath & Beyond
EXPLANATION: Per applicant's request as customer cancelled job. Refund 80% of permit fees.
REFUND INFORMATION: •
Fee Description From Receipt Revenue Account No. Refund .
Example: • [BUILD] Permit Fee . Example: 245 - 0000 - 432000 $ Amount
[ELPRMT] ELC Permit 220 - 0000 - 431510 $64.08
(TAX] 12% State Surcharge 100 - 0000 - 207020 7.69
TOTAL REFUND: $71.77
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager Ji,4 " Oc"„,4-4.
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR ACCELA SYSTEM ADMINISTRATION USE ONLY
Refund Request Reviewed: Date: By:
Case Refund Processed: Date: '
By: . -• 'j:
s
I: \Building \Refunds \RefundRequest.doc 04 /13/09
•
RECEIVED
el
Community Development DEC 3 0 2008
TIGARD Request for Permit Action CITY OF TIGARD
BUILDING DIVISION
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard or.gov
FROM: ❑ Owner . ❑ Applicant Contractor ❑ City Staff
(check one) / 1
REFUND OR Name: 4-16,7y) )
INVOICE TO: (Hucinus or Individual) 9j r ,4 c. {
Mailing Address: t ,/ ) CX 1 w5 i
City /State /Zip: F 4 1 CIALCe I D le. 9 7 i- 9 . 1
Phone No.: 5e•3 - I (,
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES (attach receipt, if available).
INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: 4e-da___- _d50q
Site Address or Parcel #: 1 teFOlO ka.,6 U) rie,ax
Project Name: Ott- T .‘,4
.r
Subdivision PC%-1..CtaccC t Ct A6A'C
Lot #: D2b
EXPLANATION: 400 C •
I •
•
Signature: Date: l- ` J
Print Name: A hv\c t G 4--CVn ma rk ,
Refund ro1;Fv
1. The Director or Building Official may authorize: the refund ot:
a) any fcc which was ern neoualy paid or collected.
b) not more than W) /u of the land use application fee when an application is withdrawn or cant:a:led before any review effort has been expended.
c) not more Man RO% of thc land use applicsuinn fcc for issued permits.
not moot: than 80% of thc building plan review fee when an application i+ canceled before any plan review effort has been erpc ndcd.
e) not more than 80% of thc building permil fee for ia. ucd permit: Prior to any inspection requests.
2. Refunds will be retuned to the organ] Payer in the sarne enamel in which payer -nt wa.. recczvcd. Please allow 1 -2 weeks for proce :Adng refunds.
FOR OFFICE..USE ONLY . •
Rte to Sys Admin: Date WISYNNEKTIIII Rte to Bl. _ Admire: Datc 2117AIZI i s =
Refund Processed: Date , AgrafilariAr= nvoice Processed: Date B
Permit Canceled Date , o't7 0," By l i %t, ParcelTakAdded: Date By
Rec.- •t # Date Ivlcthod Amount $
l:\ Building \Forms \Re eermitAction.doc Rev 07/26/07
Z00/1.00 'd OLLO# 0I813313 s]aIflhs LC89E9ZEO9 n:01. 8002 /OEM