HomeMy WebLinkAboutOccupancy Correspondence 1988-8-12 (2)
;:. CITY OF'SPRINGFIEL.
Qepartment of Planning and De pment
) Building Safety Division
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus. )726-3769 (Insp.)
OCCUPANCy'INSPEloN'
APPLICATION
,-2-11,'>>7. /VI~)'"1 -1J-' 07\ 1 ['3
DATE: "?"'/.2 -)',! ~ ~ ii Crtw~~ ~ <(OU
JOB ADDRESS:M.L7 _C;. A,..s/ cC;I>,.',,,V<1Fj,-/,f ('JR- 9JslJ?
.I tj /
OWNER: ffl1{jI., C);'i",.<:;n,P .
mVNERS ADDRESS:...L...t:' /7 ,~-..J!!I- sT" . c;"'''''''(j r,~'" /)~_ '9''}f/??
. J ' .
APPLICANT:R~h(!l-l:r 1"f"t;,.,&R, (R",-"vn s7e?TI3 P"'l'''''//'''' ..f,r>nT /i'J:p,,on )
APPLICANTS ADDRESS: /7.'M _<;. "L.:.s.:.-r')~iJ p,:'U , t' (' . 9''') '{L? '
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: '7Y 7- 68',29 t1JIclIFtr
R/I h..:"T:r L//TiME. r.:
?.>> -'J~',1;2'
PROPOSED USE:ffAvr>.//'-" EO/7~ ..##/1;' ,<;d/~,., "t..ll.E,',P/7,'R
/ ." ,-
A $ 35.00 INSPECTION FEE IS REQUIRED AT THE TIME
OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OlmER OF THE PROPERTY TO
BE INSPECTED.
...>
F PROPERTY O.VNER
FOR OFFICE USE ONLY
DATE OF INSPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
RECEIPT NUMBER:
DATE PAID:
/?-/V2.--
f..... , 2- -g-~
COMMENTS:
1_' . {Ir; ,/,//,.,0 f)".,tf.C_~""~
I S-ldJp _ ~ fJ1C ~ ~'1I_
~
~J .
~rn[U]w
A\W,",~
APPU.ON FOR TYPE I BUSINES.ERTIFICATE
AS A DEALER OR REBUILDER OF VEHICLES D ORIGINAL
NOTE: FAILURE TO ACCURATELY COMPLETE THIS FORM WILL CAUSE UNAVOIDABLE DELAY
PLEASE TYPE OR PRINT LEGIBLY WITH INK
!lI RENEWAL *
CERTIFICATE NO: ' ~;( r;',( )
1 NAME (COR':9!lATJONANQJ1l_ MED BUS'NESS NAME) _ I BUSINESS TELEPHONE
::.--::;'- ~.?7!Z?/"'_ ,..... ,'.< '/'{(?-/.JA 0/C 7~7-0cYJ
2 M~yt1S'NESS LOCATION (STREE.T A UMBER) CITY ZIP CODE I COUNTY
/, ///}~ Z ,SO /)1 \ Q.7'.&L.~PG/.6 97</77 /C"y"<'k
./'f ~'LlNGADDRESS CITY STATE I ZIP CODE
V\ (,,)/J/l(~
'-..::: _kSE~ SUPPLEMENTAL APPLICATION (FORM 372) MUST BE COMPLETED FOR EACH
ADDITIONAL LOCATION FROM WHICH YOU OPERATE YOUR BUSINESS.
41 CHECK ORGANIZATION TYPE: IIF COR~~AT10N. USTTHE STATE UNDER WHOSE LAW BUSINESS IS INCORPORATED
o INDIVIDUAL 0 PARTNERSHIP (:jaCORPORATION c'U<,'e:6-J.J
DO YOU SELL THESE VEHICLE TYPES?
5 MOBILE HOMES
MOTOR HOMES
CAMPERS
DYES JZI NO
DYES QSJ NO
D YES ~ NO
TRAVEL TRAILERS
MOTORCYCLE/MOPEDS
CLASS I A TVS
DYES 0 NO
DYES Qa NO
DYES C0 NO
SNOWMOBILES
DO YOU REBUILD
VEHICLES?
DYES 161 NO
DYES ,0 NO
61 ARE YOU A FRANCHISED OEALER? DYES J:& NO IIF "YES", NAMETHE MAKE(S):
I LIST NAME AND RESIOENCE ADDRESS OF ALL INDIVIDUAL OWNERS, PARTNERS OR PRINCIPAL CORPORATE OFFICERS
71 NAME /:,~\ Lt!_ /"..)/1 _.....,-:-::,/ '. n.O ~ TITL~i" DATE OF BIRTH .j RESIDENCE TELEPHONE 9'/C'
r7AJ-'/V -..../t""hY.A.J~ .u f-/K",C:S //-/.5-,,--r7 (Cd-?l 7"'..y'~-,.5.7/
81 RESIDE~Z/~DRE~t) ..r-JZ:JH' P-r: crr;~/,o<~.o0P<< ^. _ STATYQk' .__ ~?~~7,..-5'
91 NAME //.u il.4 ..:r;:;-"yA>,,J TIT:~Fr "k<:::'4S. DA~_O~I~~ "f~t~CE~~~N~''''~9 I
1 0 1 RESIDENCEADSl,RESS" -- .- ~ CITYq , 1 STATi;h, u, ZIP;;'07DE /"",0 I'
0,..-,.'" , ?l .."Z;,g,.., (. (:.r;.v/...,'6/-/6..c~') (( Ar (,J ." /,'J
111 NAME TITLE DATE OF BIRTH I RfSIDEN{ETELEPHONE I
121 RESIDENCE ADDRESS n.. n_ CITY n STATE_...,~ Z~PCODE~_, ,_.~__J
I CERTIFY THAT I AM THE APPLICANT OR AN AUTHORIZED REPRESENTATIVE AND THAT ALL INFORMATION ON THIS APPLICATION IS
ACCURATE AND TRUE. I CERTIFY THAT THE BUSINESS DOES OR WILL DEAL IN VEHICLES, OR REBUILDS VEHICLES AND IS OR WILL BE
ESTABLISHED AT THE LOCATION GIVEN.
I NAME /. ) ---- I TITLE ') l RESIDENCE TELEPHONE I
13 -(\,,1,(1''1/ -/(J:f/AJSt?) )Z-;t:'5.,<'. C..y;,."f) 7..y~-c J9/9
141 ADDRESS, CITY, STATE, Z'PCODE ..J \ ((1 I SIGNA~~'; ././
/'1 0 r;-; 1IY /'1 .", ,/ -r " . 97:'J-7"!:: ,~ ~ / /.
'7",(<:q L:O. 00 \'~ r,('//) h/-/t:;"t.1) ,,('. 7" / c.' X ./ .-- '-..::'______-
AGREEMENT TO ACT AS AGENT: (YOU MUST SIGN THis AGREEMENT IF YOU SELL./St.iOWM(l'BILES OR CLASS I ATV'S) . I
I (WE) WISH TO BE DESIGNATED AS A LIMITED AGENT FOR THE MOTOR VEHICLES DIVISION. I (WE) AGREE TO COMPLY WITH ALL APPLICABLE I
LAWS AND ADMINISTRATIVE RULES AND AGREE TO HOLD THE DIVISION HARMLESS OF ANY LOSS OR EXPENSE RESULTING FROM ANY ACTS OR
REPRESENTATIONS IN EXCESS OR IN CONTRAVENTION OF AGENT'S AUTHORITY, AND FROM INCIDENTAL EXPENSES DUE TO TERMINATION.
15[' SIGNATURE/ 0/' I TITLE ,I DATE ~ I
X ~C/J.;r/r) ';/0-.1/"),;),,..) ,(y/- 7Z'.,.<"> M'-o?2-g7
(APPRO)AL: I CERTlFY nfAT THE LOCATION SPECIFIED ABove COMPLIES -
16 WITH-ALL LAND USEOR BUS'NESS REGULATORY ORDlNANCESOFTHE BUSINESS CERTIFICATE FEE (INCLUDES ONE PLATE) $96.00
D CITY D COUNTY OF
r CERTIFY THAT I AM AUTHORIZED TO SIGN THIS APPLICATION AND AS
EVIDENCE OF SUCH AUTHORITY 00 AFFIX HEREON THE SEAL OR STAMP OF
THECITYORCOUNTY.
NAME
ADDIT'ONAL LOCATIONS @ $30.00 EACH
(SEE ATTACHED SUPPLEMENTAL APPLICATIONS)
ADDITIONAL PLATES ':) $11.00 EACH
17
~!i':'r;P( .,. ~
1 8 SIGNATURE \....L
x~",,<;;1,~ .
I \) u()
TITLE
r.:6V. ~
ACY-\J o.l
DATE
I/b/f!,~
TOTAL: $
~
* IF THIS ISA RENEWAL OF AN EXISTING CERTIFICATE USE THE
(P' ,~"OT ,,:. ~'-,~_,,_,,"nCI II ATTACHED BILLING LIST TO CALCULATE PLATE FEES.
AP-P-i,!'.f!:'n " THE BILLING LIST MUST BE SUBMITTED WITH YOUR RENEWAL APPLICATION
S ImT JOf~PIilDURET " BOND WITH ALL REQUIRED SIGNATURES AND FEES TO:
___..._w~ ~.~C""''''''' II liT. 1905 LANA AVE. NE. SALEM. OR 97314-2350
735-370 (9.87)
~
1.~[[)[U]wl
. APP~TION FOR BUSINESS CER~ATE
AS A DEALER c1II\EBUILDER OF VEHICLES (EXCEPT SNOWMOBILE~ AND ATV'S)
o ORIGINAL
~ENEWAL *
CERTIFICATE NO: I ::{;?Uj
NOTES: FAILURE TO ACCURATELY COMPLETE THIS FORM WILL CAUSE UNAVOIDABLE DELAY
PLEASE TYPE OR PRINT LEGIBLY WITH INK
DO NOT SUBMIT APPLICATION WITHOUT YOUR SURETY BOND AND THE REQUIRED FEE.
NAME (CORPORATION AND/OR A~MED BUSINESS NAME) .....----. I BU~;~~_EP~~,' '7, 9
-.C.tfp.(/I'l~/s UL-$/t:?&/IZ/AJ6 -'-A/r. /7'/- UI"),?,<
MAIN BUS'NESS LOCATION (STREET AND NUMBER) CITY I Z~~ / ~7 I COUNTY A./ N /J It
2 /;;17 1,.9-J. /J ,9,-r. SV'..<ifi.>6fi6',(1) '7/?' '/. MAJS
MAILING ADDRESS CITY I STATE I ZIP CODE
3 8/'1/7/6
LIST THE AOORESSES OF ALL ADOITIONAL BUSINESS LOCATIONS. A SEPARATE APPLICATION (FORM 371) MUST BE COMPLETED FOR
ANY ADOITIONAL LOCATIONS IN A DIFFERENT CITY OR COUNTY.
4 I STREET ADDRESS I CITY ZIP CODE COUNTY I TELEPHONE
5 I STREET ADDRESS I CITY ZIP CODE COUNTY I TELEPHONE
I CHECK ORGANIZATION TYPE: IIF CORPORATION, LIST THE STATE UNDER WHOSE LAW BUSINESS IS INCORPORATED
6 0 'ND'V'DUAL 0 PARTNERSHIP ~ORPORAT'ON ~t~(Y?.J
7 I LIST NAME AND RESIDENCE AODRESS OF ALL INOIVIOUAL OWNE;;;:PARTNERS OR PRINCIPAL CORPORATE OFFICERS
I NAME./17 ~ I TITLE DATE OF BIRTH RESIDENCE T~LE~ONE
8 - -;:;11/' FW ~~Usad 9~ //-/6'-5--/ t > 7~~ --3J77/"9
I RESIDE.!l'jE ADDRESS ..........-:: ;1/ CL.- I CITY/') ,~STAT~ ZIP COD~
9 '-1'0-8 & ' (JW-fl 1...Jf. l '-5Y'//,()6?5'h (( J/ Y'7r7g
10 INAME,L/ /J1)4 --:Jr.w/)S:?.J /T:~CC 'I- JZc;/b - 9:~5/
RESIDENCE ADDRESS I CITY STATE
11 3-<Jhlb
12 NAME IT'TLE I DATE OF BIRTH ~ESIOE~CETELEPHONE
13 I RESIDENCE ADDRESS I CITY I STATE ZIP CODE
I ARE YOU A FRANCHISED DEALER? DYES /'F, YES, NAME T"H, E" MAKE(S): j D C, HE, CK 'F YOU SELL MOBILE HO, MES
14 ,I;;H.c, . _.. ___ __ DC_HECK IF YOU REBUILQ_y,HICLES
--~--_._-- . --_.~..~-_.__._--- -------- ----
I CERTIFY THAT I AM THE APPLICANT OR AN AUTHORIZED REPRESENTATIVE AND THAT ALL INFORMATION ON THIS APPLICATION IS
ACCURATE AND TRUE. I CERTIFY THAT THE BUSINESS DOES OR WILL DEAL IN, OR REBUILDS VEHICLES AND IS OR WILL BE ESTABLISHED
AT THE LOCATION(S) GIVEN.
I NAME /.---: I TITLE
16 /J,.U,j)/i --v'a#"oSo.u SB:' V'j!J-_.Q~
I ADDRESS. CITY. STATE. ZIP CODE .A'/-f'1I ./l SIGNA~URE /J ' '1./'
17 91"1 q \.%. tt2'J.u '- 9p';::Zl> ((..J/ 97o/Z x ~/Y/7.J rY / .J//'-&-.J
AGREEMENT TO ACT AS AGENT: I (WE) WISH TO BE DESIGNATED AS A LIMITED AGEN,T~91(';'ItE MOTOR VEHI9'ES DIVISION. I (WE) AGREE
TO COMPLY WITH ALL APPLICABLE LAWS AND ADMINISTRATIVE RULES AND AGREE-TO H()J<O THE DIVISIO~'HARMLESS OF ANY LOSS OR
EXPENSE RESULTING FROM ANY ACTS OR REPRESENTATIONS IN EXCESS OR IN CONTRAVENT10N OF AGENrS AUTHORITY, AND FROM
INCIDENTAL EXPENSES DUE TO TERMINATION.
I SIG'jATURE.,;1 , (7/' I TITLE
19 X ~,..vJu) a~A~ ~ "}N-' ~ //~
~O~ L:' CERTIFY TH~CH LOCATION SPECIFIED ABOVE COMPLIES
~ L LAND USE OR USINESS REGULATORY ORDINANCES OF THE BUSINESS CERTIFICATE FEE (INCLUDES ONE PLATE)
20 ITY 0 COUN, OF '
RESIDENCE TELEPHONE
t ) ,QA/7C
ZIP CODE -
15
I RESIDENCE TELEPHONE I
( . ) 7~-<3'~-'/9
18
I DA~ - -r:;;fC
$96.00
ADDITIONAL LOCATIONS
@ $30.00 EACH
21
I CERTIFY THAT I AM AUTHORIZED TO SIGN THIS APPLICATION AND AS
EVIDENCE OF SUCH AUTHORITY 00 AFFIX HEREON THE SEAL OR STAMP OF
THE CITY OR COUNTY.
ADDITIONAL PLATES
@ $11.00 EACH
22
TITLE
~.~~
DATE
i/H,,/e1
TOTA' :&
23
* IF THIS IS A RENEWAL OF AN EXISTING CERT'-;;~ATE USE THE l
ATTACHED BILLING LIST TO CALCULATE PLATE FEES.