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Permit Jan. 19. 2015 8: 34AM No. 6657 P. 1 RECEIVED City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT JAN 2 0 2015 Request Permit Action CITY OF TIGARD q on BUILDING DIVISION 11 G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov • TO: CITY OF TIGARD VOID Building Division Services Supervisor f 13125 SW Hall Blvd.,Tigard,OR 97223 a/.2 /S���/A' Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov // FROM; ❑ Owner ® Applicant ❑ Contractor ❑ City Staff (check one) REFUND OR Name: EC Company INVOICE TO: (Business or Individual) Mailing Address: PO Box 10286 City/State/Zip: Portland, OR 97296-0286 Phone No.: 503-224-3511 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓); CANCEL/VOID PERMIT APPLICATION. ® REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE(attach case fee schedule and provide explanation below). El REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit). Permit#: ELC2015-00012 Site Address or Parcel#: 12000 SW 66th Ave Project Name: Landmark Ford Subdivision Name: West Portland Heights Lot#: 9 EXPLANATION: Electrician arrived on site and the work was for our Fire Alarm Division and EC would need a Fire Alarm Permit not an electrical circuit permit. Signature: _ .? ■ $ • Date: 1/19/15 Cindy Be( r 72iP""V Print Name: — y, g y _ //, �y Refund Policy . 7 y — 2 9 = 4 3_S" 1. The Community Development Director or Building Official may authorize the refund of ^--�— A _s-79 a) any fee which was erroneously paid or collected. �J • 33 b) nor more than 80•'o of the land use application fee when an application is withdrawn or canceled before any review effort has been expended. c) nor 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. e) nor more than 80%of the budding permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check. Please allow 3-4 weeks for processing refund requests. FOR OFFICE USE UNIX Rte to Sys Admin: Date B. Rte to ' Admin: Date .202M B Refund Processed: Date. .26® B (mi Invoice Processed: Date B. Permit Canceled: Date Ls® B• fsi r Parcel Ta• Added: Date By Receipt# Date Method Amount$ n/941.I a__ lig . I1 TIGARD City of Tigard February 26, 2015 E C Company Attn: Cindy BeGell PO Box 10286 Portland, OR 97296-0286 Re: Permit No. ELC2015-00012 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 12000 SW 66th Ave. Project Name: Landmark Ford Job No.: N/A Refund Method: ® Check #216563 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 fire alarm permit was required. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, igf ...... 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 ErCity 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 forPennitAction 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: EC Company DATE: 2/19/2015 Attn: Cindy BeGell PO Box 10286 REQUESTED BY: Dianna Howse Portland, OR 97296-0286 TRANSACTION INFORMATION: Receipt#: 198934 Case#: ELC2015-00012 Date: 1/7/2015 Address/Parcel: 12000 SW 66th Ave Pay Method: CreditCard Project Name: Landmark Ford EXPLANATION: Per applicant's request as fire alarm permit was required. Refund 801),O of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example:. Building Permit Fee Example: 2300000-43101 $Amount Electric permit fee 2 20-0000-43103 $44.94 12%o State surcharge 100-0000-24001 5.39 TOTAL REFUND: $50.33 APPROVALS: SIGNATIRE_S/DATE: If under$5,000 Professional Staff �i If under$12,500 Division Manager If under$23,500 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: Date: 02/2 6/5 By: ,L L\Building\Refunds\RefundRequext.doc x 09/01/2010