PFI2014-00014 IMF
City of Tigard
April 2,2015
Four D Construction Company
12600 SW 72"d Ave., #200
Tigard, OR 97223
Re: Permit No. PFI2014-00014
Dear Applicant:
The City of Tigard has processed a refund for overpayment of permit fees on the above
referenced permit for the following:
Site Address: 11760 SW Gaarde St.
Project Name: Medallion Meadows
Job No.:
Refund: ® Check#216935 in the amount of$3,975.00.
❑ Credit card "return"receipt in the amount of$
❑ Trust account"deposit" receipt in the amount of$
Notes: Refund amount paid for city installed signs and contractor installed the signs.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
Enc.
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TTY Relay: 503.684.2772 0 www.tigard-or.gov
'� City of Tigard
Accela Refund Request
-PM
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request far Pemid 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 Plat. 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: Four D Construction Company DATE: March 1 3,, 2015
12600 SW 72nd Ave. # 200
Tigard, Oregon 97223 REQUESTED BY: Alfred Dickman
Senior Engineering
Technician
TRANSACTION INFORMATION:
Receipt#: 179562 Invoice# Case#: PFI2014-00014
Date: 08//121/2014 Address/Parcel: 11760 SW*Gaarde St.
Pay Method: 41'G C4� Project Name: Medallion Meadows
EXPLANATION: Contractor installed signs not city.
REFUND INFORNLATION:
Fee Description From Receipt Revenue Account No. Refund
E-xample: Building Permit Fee Example- 2300000-43104
$Amount.
Misc Fee (city installed street signs) 3,973.00
TOTAL REFUND: $3,975.00
APPROVALS: SIGNATURES/DATE:
If under$5,000 Professional Staff fS 3 ,
If under$12,500 Division Nianager
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: Date: `/ 2 /S B�
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