Permit Support Document MRY-05-201a(MON) 10: 07 Bear Electric (FRX)5036781108 P. 001/002
.
RECEIVED
la
" Community Development MAY 5 2014
TI GARD Request for Per ar it Action CITY/OF FIGARU
BUILDINGII!.!JSifP
TO: CITY OF TIGARD
Building Division Services Supervisor
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM:
El Owner Applicant ❑ Contractor ❑ City ff 1 0
(check one) ///y/i v 49/194
REFL.7I•D OR Name: 'Bear
INVOICE TO: (Business or Individual) 1 l_e_ t no_ .
Mailing Address: 7D )G
City/State/Zip: b tD i/ aidJ r* DaC)
Phone No.: i J 9)-Low$•1
PLEASE TARE ACTION FOR THE ITEMS)CHECKED (1):
CANCEL PERMIT APPLICATION.
►.`!' REFUND PERMIT FEES (attach receipt,if available).
• INVOICE FOR FEES DUE (attach case fee schedule and explain below).
El REMOVE CONTRACTOR FROM PERMIT(do not cancel permit).
Permit#: jzl--'201 4/-0021 / pO
Site Address or Parcel#: 0a() r �4 uh T`garct
Project Name:
•
Subdivision Name: Lot#:
EXPLANATION: lW pul'd
Slgmlture: � Date: lc.?
Print Name: �s_ _� .�----
aY 9 is iri9. y9-Pcg.
Refwsl.PAlitx a7.9/ S, 9,P
1_ The Director or Building Official may authorize the refund oe
a) any fee which was erroneously paid or collected. p2 71,9 7 .9023, // �S�.d'L�
b) not more than B0%of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than so%of the land use application fee for issued permits.
d) not more than 80%of the building plan review fcc when an application is canceled before any plan review effort has been tecpended.
e) not more than 80%of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1-2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to S Admire: Date B Rte to BM_Admin: Date B ,-
Refund Processed: BEIPPAIMga B Invoice Processed: Date B,
EMEEMMURESWAMMI B. ,: Parcel Ta Added: Date B
Reed t# Date Method Amount$
I:\Build ng\Dorms\RegpeanitAction.doc Rev 02/23/2011
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TIGARD
City of Tigard
June 12, 2014
Bear Electric Inc
Attn: Vanessa
PO Box 389
Donald, OR 97020
Re: Permit No. ELC2014-00212
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 7090 SW Beveland Rd
Project Name: N/A
Job No.: N/A
Refund Method: ❑ Check# in the amount of$
® Credit card "return" receipt in the amount of$223.19.
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account"deposit" receipt in the amount of$
Comment(s): Per applicant's request as submitted as RES in error and resubmitted as
COM under ELC2014-00215. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
1 U�-
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
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 far 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: 6/12/2014
Attn: Vanessa
PO Box 389 REQUESTED BY: Dianna Howse
Donald, OR 97020
TRANSACTION INFORMATION:
Receipt#: 195855 Case#: ELC2014-00212
Date: 5/2/2014 Address/Parcel: 7090 SW Beveland Rd
Pay Method: CreditCard Project Name:
EXPLANATION: Per applicant's request as submitted as RES and resubmitted under ELC2014-00215 as
COM. 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 Fees 220-0000-43103 $199.28
12%State Surcharge 100-0000-24001 23.91
TOTAL REFUND: $223.19
APPROVALS: SIGNATURES/DATE:
If under$5,000 Professional Staff
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: Ce77/2//Cy I By: O(/
L\Building\Refunds\RefundRequest.doc x 09/01/2010