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Permit Eihr TIGARD City of Tigard February 6,2014 Bear Electric, Inc. Attn: Vanessa PO Box 389 Donald, OR 97020 Re: Permit No. ELC2014-00011 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 15840 SW Greens Way Project Name: Gianelli Job No.: N/A Refund Method: ❑ Check# in the amount of$ ® Credit card"return" receipt in the amount of$56.98. Note: Please allow 2-5 days for this refund transaction to be credited to your account by the company that issued your card. ❑ Trust account"deposit" receipt in the amount of$ Comment(s): Per applicant's request as they requested permit for wrong address. 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 II M 71 i City of Tigard TIGARD 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: Bear Electric, Inc DATE: 1/30/2014 Attn: Vanessa Diosdado PO Box 389 REQUESTED BY: Dianna Howse Donald, OR 97020 ,� mod' TRANSACTION INFORMATION: LL • Receipt#: 194504 Case#: F �014-00011 Date: 1/10/2014 Address/Parcel: 15840 SW Greens Way Pay Method: CreditCard Project Name: Gianelli EXPLANATION: Per applicant's request as they requested permit at the wrong address. Refund 80%. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Electrical Permit 220-0000-43103 $50.88 12%State Surcharge 100-0000-24001 6.10 TOTAL REFUND: $56.98 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff 4,r7/7/„.,-J.e..._ If under$12,500 Division Manager If under$25,500 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: a`6,//y 1 By: I ,t() I:\Buil ding\Refunds\RefundRequest.doc x 09/01/2010 FEB-03-2014(MON) 08: 01 Bear Electric (FRX)5036781108 P. 001/002 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMEN'� I D : ' Request Permit Action \{'/-2 ,y T1 C A R.D 13125 SW Hall Blvd. •Tigard, Oregon 97223 -503.718.2439-vw►'w.tigard-or.av TO: CITY OF TIGARD Building Division Services Supervisor 13125 S\V Nall Blvd.,Tigard,OR 97223 • Phone: 503.718.2430 Fax: 503598.1960 www.tigard-or.gov FROM: ❑ Owner Applicant ❑ Contractor ❑ City Staff (check one) REFUND OR Name: INVOICE TO: (Business or lndinidusl) l�G c ) t 1� Mailing Address: ?(� :ci • City/State/Zip: )Drat CL J of- 91 Phone No.: f2 &Q ' 1L • PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ANC CANCEL./VOID PERMIT APPLICATION. REFUND PERMIT FF.P.S (attach copy of original receipt and provide explanation below). ❑ 1NVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). 0 REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: o IL.t — tC) I 1 , �� Site Address or Parcel #: ` 540 5\N Eix n5 u.y� . 1 Ica(& - Project Name: _ V Subdivision Name: ( C � . it#: EXPLANATION: ,)ViD CQl~nCe.k4i• Signature: � ..Mas i Dater /J4 Print Name: V � l2rfimd Pricy 1. The Director or Budding Official may authofrte the refund of. a) any fee which was erroneously paid i or collected b) not mote than 80%of the land use application fee when an ah pheatiom is withdrawn or canceled before any review effort Nis been expended. e) nut more than 1,40%of the land use application fee fur issued permit?, r nut*noire than a l%of the building plan review fee when an appliciniun is canceled before any plan review effort has been expended- e) not morn Own FM%ill-the building permit fee for issued permits prior to any irrcpectioon requests. 2. Refunds will be retttrnal to the original Payer in the same method in which payment was reecived. Please allow 2-4 weeks for processing refunds. FOR OFFICE USE ONLY Rte ao Sts Admin: Date By Rte to Bldg Admin: Date 2%. //t, By t '� Refund Processed: Date 6Z/(v/'r/ By Invoice Processed: Date / By Permit Canceled: Date., / B .tI 544- Parcel Ta-Added: Date B Receipt# Date Method Amount$ t:\liotilding\Forms\RegPemnt ction.doc Rev 05/25/2012 JAN-10-2014(FRI) 10: 52 Bear Electric (FRX)5036781108 P. 001/0022 C/ 1 ■ 11: 2 Community Development RECEIVED TI GAIZD Request for Permit Action JAN 1 3 2014 TO: CITY OF TIGARD CITY OF rIGARD BUILDING DIVISION Building Division Services Supervisor 13125 SW Mall Blvd.,Tigard,OR. 97223 Phone: 503.718.2430 Faac: 503.598.1960 wswv.tigard-or.gov FROM: ❑ Owner COApplicant El Contractor ❑ City Staff (check one) REFUND OR Name: r- } (� INVOICE TO: (Business or Individual) .— 1.�,a,I' `-c . Mailing Address: .--PnaTX1 City/State/Zip: fak C j Q it )(Phone No.: ) LO-1 (J• I ' PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ciffe 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#: EL.000 1Z-( -0001 I Site Addxcss or Parcel#: 15 NO S\N arttnn W at? i-S I I I CC-1 uo co • Project Name: G 11- E l-l- Subdivision Name: Lot#: EXPLANATION: DAL_Q i erfr L . -enir' (A) address • t __ C rl _ Signature: Date: )//0/I(71. Print Name: YO.CLQ S J 1 Q 3dQ O ttrFjind Policy 1. The Director or Building Official may authorise the refund of a) any fee which was erroneously paid or collected. b) not more than 80"!s of the land use application Fee when an application is withdrawn or canceled before any review effort has been expended. c) not mote 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 expendtd e) not more than 80%of the building permit fee for issued permit prior to any inspection requests. 1 Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1-2 weeks for proceeting refunds. ),;r._.1 ,_)-... 11FICE USE ONLY Rte to Sys Admits: Date / /3 / Rte to Bldg Admin: Date By Refund Processed: Date By Invoice Processed Date By Permit Canceled: Date By Parcel Tag Added: Date By Receipt# Date Method Amount$ ,,mss j:\Building\Form\RcgPcanitAction,doc Rev 02/23/2011 44:,.,,03 O X r dio T SQ •�6 �'2.7..Z ,N✓ x. 63 � -dv = G , /o x, 53 seAr•c�..,/b. /2c77Aveb FEB-03-2014(MON) 08: 01 Bear Electric (FRX)5036781108 P. 002/002 nn uuuc/ . .wc ILY VJ e . uv� 02/42/2014 28:24 5835981968 CITY OF TIGARD PAGE 91/01 CITY OF TIGARD _ ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Pormlt e: ELC 011 Oat&laswa 01110/2014 T f(•th.FJ) 13125 SW Hull Btv ..TIgaftl OR 97223 503.719.2433 Remo!: 25111 CC10600 Juriedlctlon: Tigard Sato addrtrss: 15840 SW GREENS WAY Project 0 Subttivlelon: SUMMERFIELD NO.2 Lot: 133 Project Ooccrfpijon; New an and bath circuit Contractor. BEAR ELECTRIC Ownor GIANELLI,PEGGY FRANCES REVOCALE PO BOX 389 LIVING TRUST DONALD,OR 97020 15840 SW GREENS WAY TIGARD,OR 97224 PHONE: PHONE: 503•B78-1355 FAX: 503-878-1108 -- FEES QubnUty Description Oats Amount 2 Cr1 Branch Clrwults wofPurcharc 01I1012014 343.00 SQaeiTirs; Service or Feeder 1 ea 12%State Sur:narpe- 01/10/2014 $7,83 Type or Uco: SF Eloctrlcal Class of Work: ADD Type of Gant: Occupancy Grp: Total 57123 Required Rama and Report:(Conditions) This bornll i9 .eeued :ubJCC1 to the reculet■0ly contained In the Tigard Municipal Coda, State 01 OR Soedatty Code. and all other Op011Ootoko law. A11 wOtk will co dorm in accardan:a wish opproved pinnn. This permit w01 supra if work is net slened 4 hin 180 days of iaao0nne. Or if wOfk IS eusbendeC for trlo'e time 180 days. ATTENTION Oregon low re1uiroa you l0 relaw the rvlee adopted by !No Oro90n Utility Not1110ellOn contar ThOSB rules vre set lortn In OAR 952.001.09101hrou9'+CAA 952-001-00W YOU may oetain a copy 0!MO fule7 Or Greet 3d ti011S 10 OUNC t!y osli rag 801.232 1987 of 1.800.332.23 laced Sy: Permit-tea Signature: OWNER INSTALLATION ONLY Tao it 31:311On s berg made on property I tarn wrath.3 1101 imendad for 3010,lease or lent OWNER'S SIGNATURk Dato: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' tiara UCENSE N0. _ Call$03.09.417S by 7:00 a.m.for the newt available InepaCilon este. Thie portnit curd oh111 co We In•eoneplauoua place on Mu job alto YRtll complatlon of the protect. Approved plena ere required on the lob site wt the Ilene of each Impaction.