HomeMy WebLinkAboutApplication APPLICANT 6/26/2013 City of Springfield SPRINGFIELD
Development Services Department
225 Fifth Street
Springfield, OR 97477
PERMIT REVIEW INTAKE FORM (City Staff completes form)
P ;, � > z . n ' s � � � s .
o- >
Permit Type < " < - ' `•, ■
Dept of Motor Vehicles-New: ❑ Land Use Compatibility Statement: ❑ City: El
Dept of Motor Vehicles-Renewal: Zoning Verification Letter: ❑ UGB: ❑
Projeet;Information 11 3r
A• • licantName: !A b U T t - Phone:
Colman : Cell:
Address: 31.L. tsn Vt. per( 914
Pro•e Owner: w Phone:
Corn •an : Cell:
Address:
ASSESSOR'S MAP NO: I - 61-1 - TAX LOT NO S : 9707-D
Pro•e Address: -2D3 7 D kN.
Description of Proposal: C . ' - . Ar 0 ,;
Jib Record Information
r
Record No: � r �1 CDCDEXD 1 Date Received: C9 2. 4
A. •lication Fee: $ 2 U j Technical Fee: •/ 1 GS
TOTAL FEES: $ 2 . v�/ Assi • ned Planner: Li
Date Received:
JUN 262013
Original Submittal
Revised 11.2.11 kl
( + APPLICATIt FOR
D1VIV= THREE YEAR VEHICLE DEALER CERTIFICATE
Of,.OFa aAT
,��:.":°v,O/oAEau.,s, AS A DEALER OR REBUILDER OF VEHICLES
CUSTOMER NUMBER EFFECTIVE DATE ' EXPIRATION DATE DEALER NUMBER. ❑ ORIGINAL
. ❑ 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 0 LATE FEE
renewal application. F
Original Certificate (Includes one plate) $ 1,012.00 I SUPPLEMENTALS
Additional Locations @$230.00 $ E RENEWAL PLATES
(Supplemental Application Form 735-372 required for each location) t7 ADDITIONAL PLATES
Additional plates 12"x 6" 2 or 7" x 4" @$54.00... $ (08•00 • u
(Two sizes,standard and small,available) s TOTAL $E
TOTAL = $ 1 110.00 > TEMPORARY PLATES
BUSINESS NAME AND ADDRESS Any alteration of Line 3 voids location approval.
LEGAL ME OF APPLICANT(OWNER,PARTNERSHIP,LLC OR CORPORATION NAME) -OREGON REGISTRY NUMBER(IF LLC OR CORPORATION)
1 fe6 W. I?u"("z( E2
BUSINESS NAME(IF ASSUMED BUSINESS NAME,FILL IN REGISTRY NO.) OREGON REGISTRY NO. BUSINESS TELEPHONE
2
MAIN BUSINESS LOCATION(STREET AND NUMBER) CITY ZIP CODE COUNTY
3 90500 PAciPIc i-l'v\IY w, EUGENE, 97402 LANE
4
MAILING ADORESS ,/� GSPR�IJLFIELD
-STATE ZIP 971171
3382. FIaI.GoN OWE-
TYPE OF OPERATION If corporation,list the state under
which business is incorporated:
5 CHECK ORGANIZATION TYPE: I I Individual Partnership ❑LLC ❑Corporation:
6 I/we primarily sell: New Vehicles X Used Vehicles
7 I/we are a franchise dealer: ❑ Yes N No If"Yes," name the makes >
8 I/we sell NEW RECREATIONAL VEHICLES: ❑ Yes ® No
IF"YES,"SERVICE FACILITY LOCATION (STREET AND NUMBER) CITY ZIP CODE
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.
TELEPHONE NUMBER
9 X CITY OF: 'SPP-lt'Jt FIELD I J COUNTY OF: ( 541 ) 7210 -3753
PRINT NAME TITLE
10 Ahits9 Lim/e iv_S ' JtcR .P..Ar11,)t
SIGNATURE • DATE
11 X A- /' . I et,'abl4;03
V Pkcce stamp or ssai Mrs V
Date Received:
APPROVED JUN 2 6 2013
CITY OF SPRINGFIELD
t (( ( C mat Submittal
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Pe e 1 ✓ Y-iYNn - 5TK n 300171
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PRINCIPAL'S DEALEEISTORY •
Information on the principals of this business is requested under Oregon Revised Statutes (ORS) 822.035 and Oregon
Administrative Rule (OAR) 735-150-0024.
OAR 735-150-0010(26)defines the principal of a dealership as"an owner, partner, corporate officer or other person
who controls or manages the business organization or the employees or agents of the business organization."
Please provide the following information about all owners listed on this application and other principal(s)of
the business:
12 Has any principal of this dealership been financially or operationally involved in any jurisdiction, including Oregon,
with a vehicle dealership whose license or right to apply for a license was revoked or is currently suspended?
NO n YES, revoked currently suspended. If"YES," complete Section 13.
13 NAME OF DEALERSHIP PRINCIPAL'S NAME
DEALER LICENSE NUMBER STATE WHERE SUSPENDED/REVOKED DATE OF SUSPENSION/REVOCATION EXPIRATION OF SUSPENSION
14 Have you ever been an owner or principal on a vehicle dealer license in Oregon (excluding current application)?
r�M NO n YES: If"YES," complete Section 15.
NAME OF DEALERSHIP PRINCIPAL'S NAME
15
DEALER LICENSE NUMBER
OWNER INFORMATION AND CERTIFICATION
False certification is a Class B misdemeanor under ORS 162.085 and is punishable by six months in jail, a fine of up to
$1,000 or both. In addition, civil penalties and DMV sanctions against you or your dealer certificate may be imposed.
With this in mind . . ..
I CERTIFY . . .
• I am the owner, a partner, limited liability company member or corporate officer of this dealership and my name is
listed on this application.
• ALL information on this application is accurate and complete.
• I deal in vehicles and conduct business at the location given on Line 3 of this application.
• The dealership will comply with all applicable laws and administrative rules.
• I/we hereby certify that the persons named in this application are not acting as the alter ego, in the place of, or on
behalf of, any other person or persons in seeking this license.
BUSINESS LOCATION INFORMATION:
Property is (check one): OWNED n LEASED/RENTED: LEASE OR RENTAL PERIOD:
If property is "Leased/Rented"complete the following:
PROPERTY OWNER'S FULL NAME TELEPHONE NUMBER
PROPERTY OWNER'S ADDRESS CITY STATE ZIP CODE
DMV AGENT AGREEMENT
The dealer is granted the following options as a DMV agent and must comply with all applicable laws and administrative
rules. The dealer is not obligated to perform any of these options except as required by law. * Snowmobile dealers
must act as DMV agents for Oregon residents.
• * Accept applications and fees for titles and registrations of vehicles they sell, and only charge fee amounts set by
Oregon Revised Statutes and Oregon Administrative Rules.
• Perform vehicle identification number inspections on vehicles they sell, except a dealer rOarkej Reiwed:
inspection under those situations described in OAR 735-22-007(5)(a-q).
• Issue temporary registration permits for unregistered vehicles they sell. tfStt a �a
• Agent status can be placed on probation, suspension or revoked as allowed in Oregon Adm'
735-150-0120 for non-compliance of any Oregon Revised Statute of the Oregon Vehicle Code.
• By signing this application on Page 3, the dealer becomes an agent of DMV and agi3JJglfBbStithlyniiif1s11 '
administrative rules and all dealer related statutes in the Oregon Vehicle Code.
Jun..24. 2013 1 : 08PM •DMV • No. 4957 P. 2
1DNI 1 REQUEST FOR LOCATION
t4?anar OF REQUIREMENT EXEMPTION
twin,aSolT11 ,
DEALER OERr1FICATE It EXVIRATION DATE
_, . INSTRUCTIONS'==(t)EALER PLEASE READY
Complete (please pant or type) and submit to DMV Business Regulation, 1905 Lana.Ave NE, Salem
OR 97314.
A DMV Investigator will review your request, If approved, a signed copy of the request will be
returned to you. You must keep the signed copy on hand at your business location. Failure to do so
may subject you to a civil penalty or administrative sanction.
This exemption is valid only for the dealer certificate number and location listed. A new exemption
must be applied for if there is a change in name, address or dealer certificate number.
SECTION 1 ' NAME AND LOCATION OF DEALER BUSINESS
NAME OF DEALERSHIP
1:4)131-4) � c\C) \ ?tt.TZI�IZ
STREET ADDRESS(BUSINESS LOCATION)
C STATE ZIP CODE COUNTY
Who is business conducted with:
ORetail customers; list locations: .
❑ Other dealers; name examples:
❑ Auto Auctions; name auctions:
SECTION 2.-:EXEMP.TION
This dealer business location is unable to comply with the requirement(s) marked below.
(Please mark each box that applies to you.):
'O,A
,rR 735-150-0030(1)(a) Has sufficient space to display one or more vehicles.
L Display or storage of motor vehicles not allowed by city/county. (Explain in Section 3)
❑ Other (Explain on back)
OAR 735-150-0030(1)(b) Provides a means of public contact. (Explain in SactIon
Late 'Received:
[ OAR 735-150-0030(1)(c) There is an exterior sign affixed to the land or building.which
identifies the business and is clearly visible from the road. (Explain in Section. N 2 6 2013
755-XRBHUe9).
Original Submittal
Jun..24. 2013 1 : 09PM •DMV • No. 4957 P. 3
SECTION:3 -APPLICANT EXPLANATION"OF,;;EX MPTION REQUEST
Applicant explanation of exemption request per OAR 735-150-0030 (2) (a), a dealer shall submit a
written request for the exemption(s) to PMV documenting the reason(s) for the exemptions(s) being
sought.
Lo`n� aoQSv-\ )
•
•
•
•
I SIGNATURE "
certify that I am the owner, a partner, a member of LLC or a corporate officer of this dealership. I
understand that Oregon Administrative Rules require a dealer business location to comply with each
of the three conditions listed above. However, the business location of this dealership, as shown in
Section 1, is unable to meet the requirements. An explanation of why an exemption is necessary is
given in Section 3. Based on this explanation, I hereby request the exemptions masked in Section 2.
Note;
This exert ption does not constitute a variance on state, county or city land-use restrictions-or laws.
Violation of zoning laws/restrictions could result in cancellation of your dealer's license.
PRINTEO NAME OF PERSON SIGNI TNIS FORM TITLE
`J-U%\\
SIGNATURE OATS
X a (ex- 1"1 \
APPROVAL(This section will be completed by a OWN Investigator);
An exemption is granted for the items marked by the dealer in Section 2, as there appears to be no
reasonable alternatives availabfe for compliance with ttA a ovppqq.Administr tive Rule(s).
PRI •-•NAME OF INVESTIGATOR C Ileceivet TTLE
• 0 L as: clalTPWSRASSCAL29
INVEST1GAT - SIGNATURE JUN 2 6 2013 °A'�
x $ \ A__._--
Original Submittal
•
Jun. 24. 2013 1 : 08PM DMV No 4957 P. 1
• •
* ',ONO/G FACSIMILE ev%
OREGON DMV COVER SHEET OREGON DMV
Qt'SGONp
Qp,��` ON
DEALER INVESTIGATIONS
To: Liz
Company: City of Springfield
Fax: (541) 726-3689
From: Ron Kramer/Business Regulation
Phone: (503) 945-5496
Fax: (503) 945-5289
Date: June 24, 2013
# of pages following the cover sheet: 2
RE: Putzier Dealer license location exemption
(mailing original)
Date Received:
JUN 2 6 2013
Original Submittal