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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.