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HomeMy WebLinkAboutApplication APPLICANT 1/16/2013 Gt,o-of-Springfield 0 SPRINGFIELD Development Services Depirtment 225 Fifth Street Springfield,,OR 97477 PERMIT REVIEW INTAKE FORM (City Staff completes form) V� *Ilk Dept of Motor Vehicles-New:1 El I Land Use Compatibility Statement: [I city: Nr Dept of Motor Vehicles-Renewal I Zoning Verification Letter: ❑ UGS: El ivi N, Applicant Name: Phone: Company: Cell: 0 Address: Prop rty Owner: P- Obte+ Phone: Company: lCell: Address:,� � .'q7 ASSESSOR'S MAP NO: ITAX LOT NO(S): 0 Property Address: I'Mol Main rtt+- (h /4 Oe­ q7cl-7-7 DescaRtion of Proposal: V V QrM - UneWd . - tiara at- in Mal(l-- 6W k Iva yeh (ut V AN likk T_­ A Record No. R-1 IV T D-1D1 Date Received: 20 Appl cation Fee: $ b Technical Fee: $ TOTAL FEES: 29S, ©Si Assigned Planner: Date Received'. JAN 16 2013 Original Submittal� Revised 11211 k] _ APPLICATIO OR �• .�. THREE YEAR VEHICLE DEALER CERTIFICATE ,=;^.�^� AS A DEALER OR REBUILDER OF VEHICLES CUSTOMER NUMBER EFFECTIVE DATE EXPIRATION DATE DEALER NUMBER ❑ ORIGINAL 9J I I RENEWAL If this is a renewal, do not complete the fee information. Use the attached > CERTIFICATE FEE billing list to calculate your fees. The billing list MUST be submitted with your renewal application. ) LATE FEE Original Certificate(Includes one plate)................................. $1,012.00 SUPPLEMENTALS Additional Locations 1 ) @x$230.00 ..................... $ 230.00 RENEWAL PLATES (Supplemental Application Form 735-372 required for each location) ADDITIONAL PLATES Additional plates 12"x 6"°1 or 7" x 4" @$54.00... $ 216.00 (Two sizes,standard and small,available) TOTAL $ TOTAL =$ 1,458.00 > TEMPORARY PLATES BUSINESS NAME AND ADDRESS Any alteration of Line 3voids location approval. LEGAL NAME OF APPLICANT(OWNER,PARTNERSHIP,LLC OR CORPORATION NAME) OREGON REGISTRY NUMBER(IF LLC OR CORPORATION) 1 HINES AUTOMOTIVE LLC 90644791 BUSINESS NAME(IF ASSUMED BUSINESS NAME,FILL IN REGISTRY NO.) OREGON REGISTRY NO. BUSINESS TELEPHONE 2 90644791 j 90644791 541 5542712 MAIN BUSINESS LOCATION(STREET AND NUMBER) CITY ZIP CODE COUNTY 3 1300 MAIN ST SPRINGFIELD 97477 . LANE MAILING ADDRESS CITY STATE ZIP CODE 4 1300 MAIN ST SPRINGFIELD OR 97477 PE OF OPERATION I It corporation,list the state under � which business is Incorporated: J CHECK ORGANIZATION TYPE: ❑Individual [:]Partnership 2LLC F]Corporation: 6 I/we primarily sell: ❑ New Vehicles Used Vehicles 7 1/we area franchise dealer: ❑ Yes ® No If"Yes," name the makes > 8 I/we sell NEW RECREATIONAL VEHICLES: [] Yes ® No IF-YES,-SERVICE FACILITY LOCATION (STREET AND NUMBER) CRY ZIP CODE i LOCATION APPROVAL (If renewal,required only if dealer is changing business location) Certification of Local Zoning and Business Regulatory Compliance. ORS 822.005 requires a vehicle dealer license, unless exempt under ORS 822.015,for any person who: (a) Buys, sells, brokers, trades or exchanges vehicles either outright or by means of any conditional sale, bailment, lease, Security interest,consignment or otherwise;OR (b) Displays a new or used vehicle,trailer,or semitrailer for sale;OR, (c) Acts as any type of agent for the owner of a vehicle to sell the vehicle or acts as any type of agent for a person interested in buying a vehicle to buy a vehicle. THE CERTIFICATION BELOW IS TO BE COMPLETED BY THE LOCAL ZONING OFFICIAL. Your approval below should be based upon whether the applicant can do ANY of the activities listed in (a)through (c) above under your ordinances, at the location of the business given on Line 3. Pursuant to ORS 822.025,applicant meets requirements below. As the zoning official for the locality in which'this business is located,I verify by my signature below that the location of this business as stated on this application, complies with any land use ordinances and business �regulatory ordinances of the city or county,as appropriate pursuant to ORS 822.025. S n n ) l ❑ TE PHONE NUMB R JO 9 CITY 1�O,�F:I / COUNTY OF: f � �" 1 U PRINT 1 Z I r r( l ( 1 TI �� fler 11 SV NATO E J a ) I DATE I I I A -�YYI/dJl I` 0 Mace stamp or seM here 0 Date Received: APPROVEDJAN 16 2013 CITY OF SPRINGFIELD Original Submittal ®" Page 1 ®-