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Permit City of Tigard, Oregon 0 13125 SW IIall Blvd. o Tigard, OR 97223 FITAVANZTF1X1 ,,, 3 v k r tf } � Xy r � t �� � (. e �iR a. r q;qi EMS trOtagt December 11 2009 Rosendin Electric, Inc. 2925 NW Aloclek Dr., Ste 170 Hillsboro, OR 97124 Atten: Desta Whitten Re: Permit No. ELC2009 -00526 Dear Ms. Whitten: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 10940 SW Meadowbrook Dr. 31 Project Name: Salzer Job No.: N/A Refund: ❑ Check # in the amount of $ ® Credit card ` receipt in the amount of $90.22. n 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, / L Dianna Howse Building Division Services Supervisor Enc. I: \Building \Refunds \Administ ra tion \LtrRefund- CancelPermit.doc 01/16/07 Phone: 503.639.4171 0 Fax: 503.684.7297 o www.tigard - or.gov o TTY Relay: 503.684.2772 , C Ic S -603 - 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 or Refund 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: Rosendin Electric, Inc. DATE: 12/10/09 2925 NW Aloclek Dr., Ste 170 Hillsboro, OR 97124 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt #: 175526 Case #: ELC2009 -00526 Date: 10/07/09 Address /Parcel: 10940 S\V Meadowbrook Dr 31 Pay Method: CreditCard Project Name: Salzer 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 Electrical Permit Fee 2200000 -43103 $80.56 12% State Surcharge 1003100 -24001 9.66 TOTAL REFUND: $90.22 APPROVALS: If under $500,',` Professional Staff ' at9.__A✓t/L.__A-.�- 9 If under $7,500 Division Manager If under $22,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board • FORACCELA SYSTEM ADMINISTRATION USE ONLY Refund Request Reviewed: Date: By: - "' Case Refund Processed: Date: By: I: \Building \Refunds \RefundRequest.doc 04/13/09 i, ,, •I I /F ..-11,.. ei6 zi:_ei_fit, (i)sz 6 pi .:: „ MN I t community Development DEC ®8 2009 Request for Permit Action � 1 CITY OF TIGARD BUILDING DIVISION TO: CITY OF TIGARD Building Division Services Coordinator 13125 SW Hall Blvd,, 'f'igard, OR 97223 Phone: 503.718.2430 fax: 503.598.1960 www.tigard- or.gov FROM: ❑ Owner El Applicant ❑ Contractor ❑ City Staff (0,c k. OnC) REFUND OR Name: Rosendin Electric, Inc. INVOICE TO: (BusirLess or Individual) — _ Mailing Address: 2925 NW Aloclek Drive, Suite 170 City /State /Zip: Hillsboro /OR/97124 Phone No.: 503- 615 -8'189 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ❑ CANCEL PERMIT APPLICATION. El 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 #: ELC2009 -00526 Site Address or Parcel #: 10940 SW Meadowbrook Dr 31 Project Name: Replace Panel Subdivision Name; N/A Lot #: 0 • EXPLANATION: The customer, Ramona G, Salzcr, has cancelled this job, . ' .f bate: ��TO�v Signature: _i`— . &a,. r : Print Name: . • 'C iLL:lild P(ilic I. The Director or Building, Officia) may authortie the refund of; a) any fee which w; $ erroneously paid or collected. b) nut more than sO'/ of the Auld use application fee when cm applicuuon is withdrawn or collected bcl'are any review effort has been expended. c) not more shun bt)''' of the l use tip cation fev Pot is: :ued permits d) nOL more than tiiU" /o of the building plan review fcc when an application is cuneelcd b.•forc any plan review effort hay been expended c) nut more than yUW,4 of the building permit fee for issued permits prior to any inspection requests. 2. gerund:; will bt' returned to the original Payer in the ,ume method in which payment was received, rIcase allow 1 -2 weeks for proses; :ing refunds. rtR` ' irigPg,bl ! tCL, HISL C) hTLl ,1 . Rte to S s r e d Date B Dale al 13' ;sue Refund Processed: Date twin B,zy _� Invoice Processed; Permit' Canceled: Date r Parcel 'fa; Added: Date IMIIIMI Recci•t Date Method Amount r 1: Roil ding; \Pori: itccihererLAction.doc Ruv07 /26 /07 TO /TO 30dd DIa10313 NIQN3S0d 6890STHOS 9Z :ZT 600Z/80/ZT ti . City of Tigard, Oregon a 13125 SW Hall Blvd.. 6 Tigard, OR 97223 5 ;L 4 ts.' �•; ' -n2 ® .� December 11, 2009 Rosendin Electric, Inc. 2925 NW Aloclek Dr., Ste 170 Hillsboro, OR 97124 Atten: Desta Whitten Re: Permit No. ELC2009 -00526 Dear Ms. Whitten: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 10940 SW Meadowbrook Dr., 31 Project Name: Salzer Job No.: N/A Refund: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $90.22. ❑ 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, • L Dianna Howse Building Division Services Supervisor Enc. • I: \Building\ Refunds \Administration \LtrRefund - CancelPermit.doc 01/16/07 • Phone: 503.639.4171 0 • Fax: 503.684.7297 o www.tigard - or.gov A TTY Relay: 503.684.2772 mi City of Tigard T l G A R D 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 or Refund 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: Rosendin Electric, Inc. DATE: 12/10/09 2925 NW Aloclek Dr., Ste 170 Hillsboro, OR 97124 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt #: 175526 Case #: ELC2009 -00526 Date: 10/07/09 Address /Parcel: 10940 SW Meadowbrook Dr 31 Pay Method: CreditCard Project Name: Salzer EXPLANATION: Per applicant's request as customer cancelled job. Refund 80% of permit fees. REFUND INFORMATION: _ Fee Description Froin Receipt . . Revenue Account No . Refund •Example `, [BUILID] Permit Fee - Example:' 245- 0000 - 432000. '$ Amount Electrical Permit Fee 2200000 -43103 $80.56 12% State Surcharge 1003100 -24001 9.66 TOTAL REFUND: $90.22 APPROVALS: If under $5000 Professional Staff 6- �✓✓� -� If under $7,500 Division Manager 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: I / '; By: , Case Refund Processed: Date: I By: :c . I: \Building \ Refunds \RefundRequest.doc 04/13/09 CITY OF TIGARD RECEIPT a 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 176272 - 12/11/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2009 - 00526 $ - 90.22 Total: $ -90.22 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 062334 DHOWSE 12/11/2009 $-90.22 Payor: Daryl Hamaker, Rosendin Electric, Inc. Total Payments: $ - 90.22 Balance Due: $90.22 Page 1 of 1 • CITY OF TIGARD RECEIPT n II 0 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD ( it it":: ft. -/ - Receipt Number: 175526 - 10/07/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2009 -00526 Services or Feeders - 200 amps or less 2200000 -43103 $100.70 ELC2009 -00526 12% State Surcharge - Electrical 1003100 -24001 $12.08 Total: • $112.78 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 062334 DADAMSKI 10/07/2009 $112.78 Payor: Daryl Hamaker - Rosendin Electric Inc Total Payments: $112.78 Balance Due: $0.00 • • Page 1 of 1 ■ b..., i. :_Fj llr of _ f. '" Community Development Y DEC 0 8 2.009 R equest for Permit Action 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 E Applicant ❑ Contractor ❑ City Staff (check one) REFUND OR Name: Rosendin Electric, Inc, INVOICE TO: (Business or Individual) Mailing Address: 2925 NW Aloclek Drive, Suite 170 City /State /;Gip: Hillsboro /OR /9 7124 Phone No.: 503 - 615 -8189 PLEASE TAICE ACTION FOR THE ITEM(S) CHECKED (✓): • CANCEL PERMIT APPLICA'T'ION. E 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 #: ELC2009 -00526 Site Address or Parcel #: 10940 SW Meadowbrook Dr 31 Project Name: Replace Panel Subdivision Name: N/A • Lot #: 0 EXPLANATION: The customer, Ramona G. Salzer, has cancelled this job. Signature: • ∎ ■ _/, / .4r.,. - )1_ _ Date: 1cq /q Print Name: b rt:Z . \ob.3't fl t it d Praicy 1. The Director or Building Official may authorise the refund of: a) any fee which was erroneously paid or collected. b) nut more than BU!n of the Lind use application Fee when tin application is withdrawn or canceled before any review effort had been expended. c) not more than BO of the land use application fee for issued permits. d) not more than Bit% of the building plum review fee when an application is canceled before any plan review effort has been expended, e) nor more than BO% of the building permit fee for issued permits prior to any inspection requests. 2. Refund:: will be returned to the original Payer in the same method in which payment wit received. Please allow 1.2 weeks for processing refunds. . ' F•OR OF1'10E USE, ONO"' - Rte to S s Admin: Date B Rte to 131d Admia Dace L BB Refund Processed: Date :' 9 : B !,I Invoice Processed: Dace ' Permit Canceled: EMI t f ' , Parcel Ta; Added: Date Recci • t• #f Method Amount $ I: Ruilding \Forms \ItegPernutActiomdoc Rev 07/26/07 TO/TO 39Vd 0Ia10313 NIQN3SOb 6890919E0S 9Z:ZZ 600Z/80/Zt