Permit City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
I N
T I GARD
July 2, 2008
Signaling System Solutions, Inc.
6816 NE Hwy 90
Vancouver, WA 98665
Attn: Paul Siefer
Re: Permit No. BUP2008 -00005
Dear Mr. Siefer:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 11462 SW Pacific Hwy
Project Name: America's Tire Company
Job No.: N/A
Refund: ® Check #58053 in the amount of $62.41.
❑ Credit card "return" receipt in the amount of $ .
❑ Trust account "deposit" receipt in the amount of $ .
Notes: Per applicant's request as job was done by another contractor. Refund 80% of
permit fees only as plan review was completed.
If you have any questions please contact me at 503.718.2430.
Sincerely,
dX 21 /4-(<__,
Dianna Howse
Building Division Services Coordinator
Enc. •
1: \ Building \ Refunds \ Administration \LtrRefund- CancelPermitdoc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
City of Tigard
TIGARD Tidemark 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 Tidemark System Administrator by Friday
at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Signaling System Solutions, Inc. DATE: 6/25/08
6816 NE Hwy 90
Vancouver, WA 98665 REQUESTED BY: Dianna Howse
Attn: Paul Siefer
TRANSACTION INFORMATION:
Receipt #: 2008 -62 Case #: BUP2008 -00005
Date: 1/8/08 Address /Parcel: 11462 SW Pacific Hwy
Pay Method: Check Project Name: America's Tire Company
EXPLANATION: Per applicant's request as job was done by another contractor. Refund 80% of permit
fees only as plan review was done.
REFUND INFORMATION :' ' :: •
`Fee Description From Receipt .Revenue Account No Refund
Example: [BUILD] Permit Fee • Example:- 245 - 0000-432000::.. $ Amount
[BUILD] Permit Fee 245- 0000 - 432000 $55.72
[TAX] 12% State Surcharge 100 - 0000 - 207020 6.69
TOTAL REFUND: $62.41
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager G7 . 0 U
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
: , FOR. TIDEMARK SYSTEM ADMINISTRATION USE ONLY
. Case Refund Processed: I Date: I 0`T S/O, By: 1,054—
'
I:\ Building \Refunds \RefundRequestdoc 05/23/07
pr CITY OF TIGARD 6/25/2008
13125 SW Hall Blvd. 1:46:21 PM
Tigard, OR 97223 503.639.4171
TIGARD
Receipt #: 27200800000000000062
Date: 01/08/2008
Line Items:
Case No Trail Code Description Revenue Account No Amount Paid
BUP2008 -00005 [BUILD] Permit Fee 245 - 0000 - 432000 69.65
BUP2008 -00005 [TAX] I2% State Surcharge 100- 0000 - 207020 8.36
BUP2008 -00005 [FLS] FLS Pln Rv 245- 0000 - 433020 27.86
Line Item Total: $105.87
Payments:
Method Payer User ID Acct. /Check No. Approval No. 1 - low Received Amount Paid
Check SGNALING SYSTEMS BB 1034 In Person 105.87
Payment Total: $105.87
elteeeipt.rpt Page 1 01' I
f
RECEIVED
ga
Community Development JUN 2 5 2008
TIGARD Request for Permit Action3 e YOF i 3GAR7
PLARd MfFN4;lrlF RING
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)
REFUND OR Name: Signaling System Solutions, Inc.
INVOICE TO: (Business or Individual)
Mailing Address: 6816 NE Hwy 99
V 0 1 City /State /Zip: Vancouver
gig/ Phone No.: 360.694.9199
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 #: BUP2008 -00005 / ELR2008 -00008
Site Address or Parcel #: 11462 SW PACIFIC HWY Tigard, OR
•
Project Name: America's Tire Company
Subdivision Name: N/A Lot #: N/A
EXPLANATION: Owner hired another F/A company prior to job start
Oner hired SSS CORP. to design and install, then hired a national company at the same time.
Ade .
Signature: l ''(! Date: 6/19/08
aul E. Sie ; r
Print Name:
•
RefundRefund Polic
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected. ' '." ' ' ' " ' ' " " ' ' ' " ' ' "'
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is.canceled before any plan review effort has been expended.
• c) not more than 80% of the building permit fee for issued permits prior to any inspection requests. •
2. Refunds will be returned to the original Payer in'the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Sys Adrnin: Date By Rte to Bldg Admin: Date 7 pr--' By r4P 5 7
Refund Processed: Date /2sc f- By404e Invoice Processed: Date By
Permit Canceled: Date B LS o6 By Parcel Tag Added: Date By
Receipt #114' /, A_ Date I/k /c - Method ( .4 Amount $
I:\ Building \Forms \RegPermitAction. oc ev 07 /26/07
.SS. 7a t 4 6 ;-7 - y/