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Home My WebLink AboutApplication APPLICANT 1/3/2014 ;City of Springfield SPRINGFIELD Development Services Department 225 Fifth Street6ir Springfield, OR 97477 / Site Plan Review Application Type (Applicant: check one) Site Plan Review Pre-Submittal: kj IMajor Site Plan Modification Pre-Submittal: ❑ Site Plan Review Submittal: ❑ I Major Site Plan Modification Submittal: ❑ Required Project Information (Applicant: complete this section) Applicant Name: Brandon Olsen Phone: 503-691-4998 Company: AT&T Mobility Email: bo2293@att.com Address: 19801 SW 72nd Ave, Tualatin, OR 97062 Applicant's Rep.: Steve Bodine Phone: Company. Lexcom Development Corp., For AT&T Mobility Email: Address: 9635 SW Washington St, Portland, OR 97225 steve.bodine@lexcomcorp.co Property Owner: Mr. Randy Cummings Phone: 541-913-6493 Company: TAJ Enterprises, Inc. Email: randyac@gmail.com Address: 19110 E. Poco Rio Drive, Rio Verde, AZ 85263 ASSESSOR'S MAP NO: 0188532 TAX LOT NOS : 1703220002603 Property Address: 2728 Pheasant Blvd, Springfield, OR 97477 Size of Property: 3.02 Acres ❑X Square Feet ❑ I Proposed Density: Proposed Name of Project: EG34-Gateway Mall East Description of if you are filling in this form by hand, please attach your proposal description to this application. Proposal: See Attached Existing Use: Property currently maintains a fitness facility on site New Impervious Surface Coverage (Including Bldg. Gross Floor Area): sf Signatures: Please sign and print your name and date in the appropriate box on the next page. Required Project Information (City Intake Staff. complete this section) Associated A lications: PRS 13"Wobk �3"OCC316 Signs: Pre-Sub Case No.: Date: Reviewed by: Case No.: Date: Reviewed by: 0�b Application Fee: $2 , +6 Technical Fee: $ Postage Fee: $ TOTAL FEES: J`C (060PRE-SUBMITC ��T NUMBER: I?J 5-o603 Revised 5/21/13 KL JAN " 3 2014 1 of 12 ,, ��., u Owner Signatures This application form is used for both the required pre-submittal meeting and subsequent complete application submittal. Owner signatures are required at both stages in the application process. An application without the Owner's original signature will not be accepted. Pre-Submittal The undersigned acknowledges that the information in this application is correct and accurate for scheduling of the Pre- Submittal Meeting. If the applicant is not the owner, the owner hereby grants permission for the applicant to act in his/her behalf. I/we do hereby acknowledge that I/we are legally responsible for all statutory time ' mation, r is and requirements conveyed to my representative. Owner: I Date: Signat e n Print (� Submittal I represent this application to be complete for submittal to the City. Consistent with the completeness check performed on this application at the Pre-Submittal Meeting, I affirm the information identified by the City as necessary for processing the application is provided herein or the information will not be provided if not otherwise contained within the submittal, and the City may begin processing the application with the information as submitted. This statement serves as written notice pursuant to the requirements of ORS 227.178 pertaining to a C?IAPlelydppt2a on. owner. Date: Signa re Print PRE•SUBWAL RECD JAN - 3 2014 Revised 5/21/13 KL 3 of 12 ,r City of Springfield SPRINGFIELD Development Services Department 225 Fifth Street Springfield, OR 97477 Discretionary Use Required Project Information (Applicant: complete this section) Applicant Name: Brandon Olsen Phone: 503-691-4996 Company. AT&T Mobility Fax: bo2293@att.com Address: 19801 SW 72nd Ave, Tualatin, OR 97062 Applicant's Rep.: Steve Bodine Phone: 503-544-9695 Company: Lexcom Development Corp., For AT&T Mobility Fax: Address: 9635 SW Washington St, Portland, OR 97225 Property Owner: Randy Cummings Phone: 541-913-6493 Company. TAJ Enterprises, Inc. Fax: N/A Address: 19110 E. Poco Rio Drive, Rio Verde, AZ 85263 I, ASSESSOR'S MAP NO: 0188532 TAX LOT NOS : 1703220002603 Property Address: 2728 Pheasant Blvd, Springfield, OR 97477 Size of Property: 3.02 Acres FX.1 Square Feet ❑ Description of If you are filling in this form by hand, please attach your proposal description to this application. Proposal: See Attached Existing Use: Property currently maintains a fitness facility on site Si natures: Please si n and print your name and date in thea ro riate box on the next a e. Required Project Information (City Intake Staff. complete this section) Associated Applications: Signs: Case No.: Date: Reviewed by: Application Fee: Technical Fee: FPO-stage Fee: TOTAL FEES: PROJECT NUMBER: Revised 1/1/08 Molly Markarian 1 of 4 Owner Signatures This application form is used for both the required pre-submittal meeting and subsequent complete application submittal. Owner signatures are required at both stages in the application process. An application without the Owner's original signature will not be accepted. Pre-Submittal The undersigned acknowledges that the information in this application is correct and accurate for scheduling of the Pre- Submittal Meeting. If the applicant is not the owner, the owner hereby grants permission for the applicant to act in his/her behalf. I/we do hereby acknowledge that I/we are legally responsible for all statutory time mation, r is and requirements conveyed to my representative. Owner: / Date: / Z6 4,3. signat e n W ' Print Submittal I represent this application to be complete for submittal to the City. Consistent with the completeness check performed on this application at the Pre-Submittal Meeting, I affirm the information identified by the City as necessary for processing the application is provided herein or the information will not be provided if not otherwise contained within the submittal, and the City may begin processing the application with the information as submitted. This statement serves as written notice pursuant to the requirements of ORS 227.178 pertaining to a m letcappflta6'on. Owner orf Date: Signa re Print Revised 5/21/13 KL 3 of 12 Discretionary Use Submittal Requirements Checklist NOTE: If you feel an item does not apply, please state the reason why and attach the \explanation to this form. J� Submitted Concurrently with Site Plan Review application, where applicable Application Fee - refer to the Development Code Fee Schedule for the appropriate fee calculation formula. A copy of the fee schedule is available at the Development Services Department. The applicable application, technology, and postage fees are collected at the time of complete application submittal. Discretionary Use Application Form Copy of the Deed �] Copy of a Preliminary Title Report issued within the past 30 days documenting \� ownership and listing all encumbrances. �J Copy of the Associated Site Plan Reduced to 81/2" by 11", which will be mailed as part of the required neighboring property notification packet. Narrative - explaining the proposal and any additional information that may have a bearing in determining the action to be taken, including findings demonstrating compliance with the Discretionary Use Criteria described in SDC 5.9-120. NOTE: Before the Planning Commission or Hearings Official can approve a Discretionary Use request, information submitted by the applicant must adequately support the request. All of the Discretionary Use Criteria must be addressed by the applicant. Incomplete applications, as well as insufficient or unclear data, will delay the application review process and may result in denial. Revised 1/1/08 Molly Markarian 4 of 4