Permit Support Document (71) R.ECFrab
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Request for Permit Action M4Y 25 P117
"r' I(5 A,R1).. 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 •
TO: CITY OF TIGARD 1 ;' , ,
Ntii 0 I
Building Division
13125 SW Hall Blvd.,Tigard, OR 97223 .57 ` 7 ."Z‘",--
Phone:
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildirgperrnits(g Bard-orr- o
FR011'I: g
RO✓)one C Owner 11] Applicant Contractor [ CityStaff
REFUND OR Name:
INVOICE TO: (Business or Individual) Garner Eiectrlc WA LLC
Mailing Address: 402 Valley Ave NW Suite 106
City/State/Zip; Puyallup, WA 98371
Phone No.: 253-872.-6051
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
LI CANCEL/VOID PERMIT APPLICATION.
REFUNDPERMIT FEES (attach copy of original receipt and provide explanation below).
INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
LI REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit).
Permit#: ELC2017-00380
Site Address ox Parcel#: 15150 SW Missouri PL
Project Name:
Subdivision Name: River Terrace Lot#: 77
EXPLANATION: Permit was pulled by mistake. We will be using minor labels for this job.
` t •-
Signature: 4 ' .+ .i ;I A'V, Date:
Print Name: /25 17
Alicia Gentele -
fund no.�
1. The city's Community Development Director,Building Oficial or City Engineer may authorize the refund of
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdraws or canceled before review effort
has been expended.
• Not more than 80%of the application or 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 via US postal service.
3. PIease allow 3-4 weeks for processing refund requests.
.5C, ,/f — 4/r` i`/ -- //1(74,–ti:
/, SSV/
'l . ?el' — S`, 3 9? — /i
-?'?-- Sit , 33 / -52
FOR OFFICI USE ONLY
Route to Sys Admin: Date B, Route to Records: Date - ... «"`'—
_Refund Ptocessed: .S B�.�r InvoiceI/
Date
�� processed: Date lgy
Permit Canceled: Date f 13`isize Parcel Ta:Added: Date B
I:\Building\Forms\RegPermitAcdor i9231'.doc
. V
1111111 .
TIGARD
City of Tigard
June 1, 2017
Garner Electric Washington LLC
Attn: Alicia Gentele
402 Valley Ave NW,Suite 106
Puyallup,WA 98371
Re: Permit No. ELC2017-00380
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 15150 SW Missouri PI
Project Name: River Terrace Northwest,Lot 77
Job No.: N/A
Refund Method: ® Check#224850 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 a minor lable was used. 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
IIIn
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: Garner Electric Washington LLC DATE: 5/26/2017
Attn: Alicia Gentele
402 Valley Ave NW, Suite 106 REQUESTED BY: Dianna Howse
Puyallup,WA 98371
TRANSACTION INFORMATION:
Receipt#: 410833 Case#: ELC2017-00380
Date: 5/25/2017 Address/Parcel: 15150 SW Missouri P1
Pay Method: CreditCard Project Name: River Terrace Northwest,Lot
77
EXPLANATION: Per applicant's request as they will use a minor label. Refund 80%of permit fees.
i.,Q _ i, wC ,t:s Ea ''.,i`;`s% ' _.. ;4 #Tjc ° : WW' "�a '' 7€„ ", ,v . y^- #:- a a s,
' k ."-
,�`.7' 's'$ r s'. -4'4'244,L:::-TV!.'!
#gd es7 v e' �xc-. ,, ..? fin€ 3 a r `` ^+ Y
1 a 't :. " _E,4 —�..tia 4ld b.,;;;,""'E�ty 32LI lj'il: , e wi+ s
Electrical Permit "�� ,`� � - � t_� _.._.
220-0000-43103 $44.94
12% State Surchar.a 100-0000-24001
5.39
TOTAL REFUND: $50.33
APPROVALS: SIGNA ES/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
„4,1<,1k1 .....4i4.n a��.�. tF .' t, ,TM ,S .fi R ,: ,�'4 A `�T �'!��; '�'*'r�% "'p3"ta..ya fi
Case Refund Processed: Date: I 3/L AF B : `�
I y ����
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: River Terrace 77
Site Address: 15150 SW MISSOURI PL ^/?!_)
Receipt Number: 415895 - 03/02/2018
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2017-00380 $-50.33
Total: $-50.33
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 224850 DHOWSE 03/02/2018 $-50.33
Payor: Garner Electric Washington LLC
Total Payments: $-50.33
Balance Due: $50.33
Page 1 of 1
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 410833 - 05/25/2017
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2017-00380 Branch Circuits wo/Purchase Service or 220-0000-43103 $56.18
Feeder
ELC2017-00380 12%State Surcharge-Electrical 100-0000-24001 $6.74
Total: $62.92
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 07790G PUBLICUSER134 05/25/2017 $62.92
Payor: Felicia Horan
Total Payments: $62.92
Balance Due: $0.00
Page 1 of 1