HomeMy WebLinkAboutApplication APPLICANT 10/9/2013 City of Springfield • • SPRINGFIELD
Development Services Department
225 Fifth Street
Springfield, OR 97477
REVIEW INTAKE FORM (City Staff completes form)
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PermitType "
Dept of Motor Vehicles-New: ❑ Land Use Compatibility Statement: ❑ City: ❑
Dept of Motor Vehicles-Renewal: X Zoning Verification Letter: ❑ UGB: X
Project Information'.; �.
A. • licant Name: Freewa E Auto Inc Phone: 541-600-3000
Com •an : Cell:
Address: 4055 Franklin Blvd, Eugene OR 97403
Pro•ert Owner: Dor-Mar Glenwood LLC Phone:
Com •an : Cell:
Address: 2020 NE 160th Avenue, Vancouver, WA 98684
ASSESSOR'S MAP NO: 17033443 TAX LOT NO S : 9300
Pro•ert Address: 4055 Franklin Blvd, Eugene, OR 97403
Description of Proposal: DMV Renewal in the Urban Growth Boundary. Existing car lot
Change to dealer on site.
Record I_nformat�on
Record No: rIL-►I `1. ( --60010 Date Received: 10 q I
A• 'libation Fee: $ 340 Technical Fee: $ 17
TOTAL FEES: $357 Assi• ned Planner: L. Miller
Date Received:
OCT -9 2013
Original Submittal
Revised 11 2.11 kl
i • APPLICATIc FOR
=DMV= THREE YEAR VEHICLE DEALER CERTIFICATE
DEpARTMEPIT orTRANSPORTATION
TORVEHICLE, SEn,,,,, AS A DEALER OR REBUILDER OF VEHICLES
DRIVER AND 79051.APth AYE NE,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
renewal application. LATE FEE
Original Certificate (Includes one plate) $ 1,012.00 SUPPLEMENTALS
Additional Locations @$230.00 $ 0.00 -RENEWAL PLATES
(Supplemental Application Form 735-372 required for each location). ADDITIONAL PLATES
Additional plates 12"x 6" 4 or 7"x 4" @$54.00 $ 216.00
(Two sizes,standard and small,available) TOTAL $
TOTAL =$ 1,228.00 1 TEMPORARY PLATES
•
BUSINESS NAME AND ADDRESS Any alteration of Line 3 voids location approval.
LEGAL NAME OF APPLICANT(OWNER,PARTNERSHIP,LLC OR CORPORATION NAME) OREGON REGISTRY NUMBER(IF LLC OR CORPORATION)
1 Freeway E Auto, Inc 94791697
BUSINESS NAME(IF ASSUMED BUSINESS NAME,FILL IN REGISTRY NO.) OREGON REGISTRY NO. BUSINESS TELEPHONE
2 Freeway E Auto, Inc (541)600-3000
MAIN BUSINESS LOCATION(STREET AND NUMBER) CITY ZIP CODE COUNTY
3 4055 Franklin Blvd Eugene 97403 Lane
MAILING ADDRESS CITY STATE ZIP CODE
•
4 4055 Franklin Blvd Eugene Oregon 97403
TYPE OF OPERATION It corporation,list the state under
which business is incorporated:
5 CHECK ORGANIZATION TYPE:I I Individual n Partnership LLC 1 1/I Corporation:Oregon
6 I/we primarily sell: n New Vehicles VI Used Vehicles
7 I/we are a franchise dealer: I I Yes Iv l No If"Yes," name the makes
8 I/we sell NEW RECREATIONAL VEHICLES: Yes n 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.
n TELEPHONE NUMBER
9 g CITY OF:SOn(��/I{ C f(( COUNTY OF: �'J+-{t ) / 2-0 22o
' PRINT NAME rr U U • TITLE
10 1-A 14' iuV • Ito Imint%
SIGNATUR 1 In DATE
11 X 1kV to 13
V place stamp or seal here V
Date Received:
APPROVED
CRY OF SPRINGREID OCT -9 2013
Original Submittal
1®' Page 1 • Ui
• • •
PRINCIPAL'S DEALER HISTORY
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 YES, revoked currently suspended. If"YES," complete Section 13.
13 NAME OF DEALERSHIP PRINCIPAL'S NAME
DEALER LICENSE NUMBER STATE WHERE SUSPENDED I 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)?
✓� NO 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 71 LEASED/RENTED: LEASE OR RENTAL PERIOD: 3 years
If property is"Leased/Rented"complete the following:
PROPERTY OWNER'S FULL NAME TELEPHONE NUMBER
Norman L. Frank& Martha J. Frank, Dormar-Glenwood, Inc. (541 )521-0507
PROPERTY OWNER'S ADDRESS CITY STATE ZIP CODE
2511 Lily Avenue Eugene Oregon 97408
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 may not perform an
inspection under those situations described in OAR 735-22-007(5)(a-q).
• Issue temporary registration permits for unregistered vehicles they sell.
• Agent status can be placed on probation, suspension or revoked as allowed in OregonQate
Real
med:
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 agrees tcOfi ply tins
administrative rules and all dealer related statutes in the Oregon Vehicle Code.
Page 2 Original Submittal
• • •
Complete the section(s) below and sign.
•
(Be sure to attach a separate sheet to show additional owners.)
• List the primary owner, partners, LLC members or corporate officers below.
• If a member of a limited liability company (LLC) is a corporation, the president must provide information below.
• If a partner of a partnership is a corporation, the president must provide information below.
• By signing below, I/we certify that the answers provided on Page 2 are true and accurate information.
• If corporation or LLC,the Oregon registered agent name and addresses required below.
OREGON REGISTERED AGENT NAME TELEPHONE NUMBER
16 Benjamin Wang (541 )484-1811
OREGON REGISTERED AGENT MAILING ADDRESS CITY STATE ZIP CODE
17 P.O. Box 50925 Eugene OR 97405
OREGON REGISTERED AGENT STREET ADDRESS CITY STATE ZIP CODE
18 1672 Willamette Street Eugene OR 97401
OWNERSHIP INFORMATION •
PRINT NAME OF OWNER,PARTNER,LLC MEMBER OR CORPORATE OFFICER TITLE RESIDENCE TELEPHONE NUMBER
• 19 Haibin Gao President (626 )800-7777
DATE OF BIRTH DRIVER LICENSE NUMBER STATE OF ISSUANCE
20 09/12/1985 4130265 Oregon
RESIDENCE ADDRESS CITY STATE ZIP CODE
21 1150 Darlene Lane. Apt. 108 Eugene OR 97401
MAILING ADDRESS(IF DIFFERENT) CITY STATE ZIP CODE
22 4055 Franklin Blvd Eugene OR 97403
CERTIFYING SIGNATURE OF OWNER SHOWN ON LINE 19 ABOVE DATE
23 X
PRINT NAME OF OWNER,PARTNER,LLC MEMBER OR CORPORATE OFFICER TITLE RESIDENCE TELEPHONE NUMBER
24 Xue Liang Secretary/Treasury (775 )800-7777
DATE OF BIRTH DRIVER LICENSE NUMBER STATE OF ISSUANCE
25 08/03/1987 4252606 Oregon
RESIDENCE ADDRESS CITY STATE ZIP CODE
26 1150 Darlene Lane, Apt. 108 Eugene OR 97401
MAILING ADDRESS(IF DIFFERENT) CITY STATE ZIP CODE
27 4055 Franklin Blvd Eugene OR 97403
CERTIFYING SIGNATURE OF OWNER SHOWN ON LINE 24 ABOVE DATE
28 X
PRINT NAME OF OWNER,PARTNER,LLC MEMBER OR CORPORATE OFFICER TITLE RESIDENCE TELEPHONE NUMBER
29 -• ( )
DATE OF BIRTH DRIVER LICENSE NUMBER STATE OF ISSUANCE
30
RESIDENCE ADDRESS _ CITY STATE ZIP CODE
31
MAILING ADDRESS(IF DIFFERENT) CITY STATE ZIP CODE
32 •
CERTIFYING SIGNATURE OF OWNER SHOWN ON LINE 29 ABOVE DATE
33 X
PRINT NAME OF OWNER,PARTNER,LLC MEMBER OR CORPORATE OFFICER TITLE RESIDENCE TELEPHONE NUMBER
34 ( )
DATE OF BIRTH DRIVER LICENSE NUMBER STATE OF ISSUANCE
35
RESIDENCE ADDRESS CITY STATE ZIP CODE
36
MAILING ADDRESS(IF DIFFERENT) CITY STATE ZIP CODE
37
CERTIFYING SIGNATURE OF OWNER SHOWN ON LINE 34 ABOVE DATE
38X
Page 3 (Over for Photo ID...)
,, Please attach (staple) copies of ALL owners, partners, LLC members or corporate officers
official photo ID's (driver license or state issued Identification card ONLY). If the residence
address on the photo ID is different than the residence address listed on Page 3, submit a
statement explaining why the addresses do not match.
Copy must be legible. C
Submit fees and these items to DMV together:
• Application (Form 735-370)
• Bond (Form 735-370B)
• Certification of Liability Insurance (Form 735-370B) or Certification of Exemption (Form
735-7024)
• Billing List (renewals only)
• Supplemental Application (if more than one location) (Form 735-372)
• Certificate of education completion or Certificate of Exemption from Motor Vehicle
Education Requirements (Form 735-370C).
• Copies of ALL owners, partners, LLC members or corporate officers official photo ID's
(driver license or state issued Identification card ONLY).
To: DMV Business License Unit Phone: (503) 945-5052
1905 Lana Ave NE In person office hours: 8 a.m. — 4:30 p.m. Monday — Friday
Salem OR 97314 (except for holidays)
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