Permit Support Document (36) 707085
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT " .Typp
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Ns Request for Permit Action MAR 2 3 2016
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TO: CITY OF TIGARD V0I
Building Division , ,
13125 SW Hall Blvd.,Tigard,OR 97223 1/4 Of A L--
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner X❑ Applicant ❑ Contractor ❑ City Staff
Check(1)one
REFUND OR Name:
INVOICE TO: (Business or Individual) On Electric Group, Inc.
Mailing Address: 1709 SE 3rd Ave
City/State/Zip: Portland, OR 97214
Phone No.: 503-234-9900
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
X❑ CANCEL/VOID PERMIT APPLICATION.
X❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
0 INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: ELC2018-00196
Site Address or Parcel#: 10220 SW Greenburg Rd / ..rit- So f
Project Name: Lincoln Center 2 5th Floor Lobby TI
Subdivision Name: Lot#:
EXPLANATION: We were told to proceed, then found out the job has been
awarded to a different electrical contractor.
Signature: `- 'IG SSnIJIV/VD Date: (13/23/18
Print Name: Laurel Semprevivo
Refund Policy
1. The city's Community Development Director,Building Official 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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 octal service.
3. Please allow 3-4 weeks for processing refund requests. .5-6,/, .— z 7 0/• o2,Y
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Route to Sys Admin: Date By Route to Records: Date 2/jz//7 By
Refund Processed: Date ' ,f4- Invoice Processed: Date / By
Permit Canceled: Date By arcel Tag Added: Date By
I:\Building\Forms\RegPemutAction_0 23 4.doc
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TIGARD
City of Tigard
April 18,2018
On Electric Group, Inc.
1709 SE 3rd Ave.
Portland, OR 97214
Re: Permit No. ELC2018-00196
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 10220 SW Greenburg Rd, Ste 501
Project Name: Lincoln Center 2 - 5th floor lobby
Job No.: N/A
Refund Method: ® Check#228209 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.
0 Trust account"deposit"receipt in the amount of$
Comment(s): Per applicant's request as job was awarded to another contractor. Refund
80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
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Dianna Howse
Building Division Services Supervisor
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13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov