Permit Support Document RECEIVED
FEB 4 2015
ROGERS ELECTRIC` CITY OFTIGARD
BUILDING DIVISION
February 2, 2015 V 0 1 0
�`'G/Lc � W
Community Development
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
To Whom It May Concern,
At this time, I would like to respectfully request the cancellation of permit number
ELC2014-00644. This permit was applied for in November for work that was to be
completed at the Toys R' Us located at 10065 SW Cascade Ave. The scope of work
was to "Install (1) quad receptacle recessed into the peg board at 3 inches above the
base deck. Using existing power." We have received notification from the customer
that we will not be performing the work applied for on this permit.
We would also like to request a refund of any permit fees that were paid, minus any
administrative fees. Please forward any refunds to my attention at the following
address:
Marja Burney, Project Assistant
Lin R. Rogers Electrical Contractors
2050 Marconi Drive,Suite 200
Alpharetta, GA 30005
If you need to contact me regarding this request, I can be reached using any of the
information below.
Sincerely,
Marja Burney, Project Assistant
ROGERS ELECTRIC
The power to get the job done.
2050 Marconi Drive, Suite 160
Alpharetta, GA. 30005
Direct 770.772.3464 /2-6�/A/
Fax 305.397.2655 __
mburney @lrogerselectric.com ' O ' 7� y�` 9y //,
6 , 7V - 5. 3 9 - � 3s
�d ..�.� is•--S"9
• q
TIGARD
City of Tigard
February 26, 2015
Lin R Rogers Electrical Contractors
Attn: Marja Burney
2050 Marconi Dr., Ste. 200
Alpharetta, GA 30005
Re: Permit No. ELC2014-00644
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 10065 SW Cascade Ave.
Project Name: Toys R Us
Job No.: N/A
Refund Method: ® Check#216578 in the amount of$50.33.
❑ Credit card"return" receipt in the amount of$
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 job was cancelled. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
4r/ i �9
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 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: Lin R Rogers Electrical Contractors DATE: 2/19/2015
Attn: Marja Burney
2050 Marconi Dr., Ste 200 REQUESTED BY: Dianna Howse
Alpharetta, GA 30005
TRANSACTION INFORMATION:
Receipt#: 198360 Case#: ELC2014-00644
Date: 11/11/2014 Address/Parcel: 10063 SW Cascade Ave
Pay Method: CreditCard Project Name: Toys R Us
EXPLANATION: Per applicant's request as job was cancelled. Refund 80% of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No Refund
'Example: Building Permit Fee Example: 2300000-43104 $Amount
:
Electric permit fee 220-0000-43103 $44.94
12%State surcharge 100-0000-24001 5.39
TOTAL REFUND: $30.33
APPROVALS: SIGN• DATE:
If under$5,000 Professional Staff r-W
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 ON/�Y -
Case Refund Processed: Date: _ ,2/.24/45' I By: I �YY
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
L