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Home My WebLink AboutApplication APPLICANT 11/6/2020City of Springfield Development & Public Works 225 Fifth Street Springfield, OR 97477 PERMIT REVIEW INTAKE FORM SPRINGFIELD I& #A, (City Staff completes form) Permit Type Dept of Motor Vehicles -New: ❑ Land Use Compatibility Statement X city: ❑ Dept of Motor Vehicles -Renewal: ❑ Project Information Zoning Verification Letter: ❑ UGB: ❑ Applicant Name: Andy Au Phone: 5412536399 Company: Octave Labs Inc Cell: Address: Property Owner: Black Label LLC Phone: Company: 79 Centennial Loop Cell: Address: Eugene, Or 97401 ASSESSOR'S MAP NO: 17-02-31-21 TAX LOT NOS : 2601 Property Address: 720 35`h Street Unit A Springfield 97478 Description of Proposal: LUCS for Hemp processing in HI zone Record Information Record No: 811-20-000213-TYP1 Date Received: 11/06/2020 Application Fee: $ 343 Technical Fee: $17.15 TOTAL FEES: $360.15 Assigned Planner: Drew Larson Revised 11.2.11 kl v Oregon Department of Agriculture A- HANDIER INFORMATION: 1. Registrant's Business 2020 HEMP REGISTRATION APPLICATION HANDLER Octave Labs INC 2. 2019 Hemp Handier Registration Number: (if applicable) AG—R 1 05863811"1 H (example: AG-R12345671HG) 3. Legal Status of Registrant: individual LLC other Corporation 4. Oregon Secretary of State Registration Number.153048393 (NOT your tax Id number) 5. Members"cers of Business:(if applicable) Name:Andy Au Title, President 6. Contact Person: Au Telephone Number: 949-668-5467 Cell: 6W-20'639 Malling Address: 720 35th Street, Unit A city, Springfield State, OR AP: 97478 Emaik andrew@octave-labs.com Oregon Deparrtment oJAgnculnsrq Hemp Proymm, Phone 503-9864652 Emuih Hemo0oda,stote.ocus 'Website: httos://oda.direct/HEMP • Rev. 11/25(2019 B. HANDLING SITE INFORMATION: (Address where Hemp Is being handled and processed.) 7. Street Address ]2075th Sheet. Unit City sorlma9ald County tae. State oreooe Zip 97478 _ Intended use of processed commodities (check all that apply): o Extractable oils and compounds X o (includes all phytocannabinoids and other phytochemicals) o Fiber(hurd, bast) o Grain (food, feed) o Hemp Biomass(biofuel, forage, etc) x o Seed for propagation o Usable Hemp Tissue (pre -rolls, etc.) o Other 8. SIGNATURE AND ACKNOWLEDGMENT: 8. Applicant for registration acknowledges and agrees that: - Any Information provided to the Department of Agriculture will be publicly disclosed and will be provided to law enforcement agencies without notice to the applicant - The Department of Agriculture may enter any field, facility or greenhouse used for production or handling of hemp or agricultural hemp seed and may take samples of the crop, including agricultural help seed, as necessary for the administration of the hemp laws; - All fees lawfully due to the Department of Agriculture are timely paid; - The information provided is true and correct and the applicant's signature is an attestation of that fact; If using irrigated water, applicant has or will obtain the appropriate water use permit. Information concerning wale use permits can be found at https.//Oda.fyi/WaterResources; - If leasing land for hemp production or pstacessing, applicant obtained permission from the land owner prim to applying to grow or process hemp. 1, (Print your name) M&-- agree to general conditions that in addition to meeting all laws and regulations pertaining to hemp growers and handlers, ORS 571.300 to 571.315, as amended by Oregon laws 2016, Chapter 71, Oregon Laws 2017, and Oregon Laws 2018, Chapter 531 and OAR 603-048-0010 to 603.048-2480, all production, storing, processing, handling, packaging, labeling, marketing and selling of agricultural hemp seed must meet all applicable seed laws. Regulation as specified In ORS 633.500 through 633.996 and seed regulations OAR 603.056-0490. By signature below I attest that the information in this applicatioryjosfn is true, correct and the above requirements are understood. "Keep a copy o/ this application Ord all ether records associcr.-c lw, :rr ben;;, recuired by Oregon Administrative RvIe. Oregon Dep rtmentefAgdculnrre, Hemp program, Phone 503-9864652 Email: Hempraodp.stste.or us 'Website: hapsWodedirect/HEMP- Rev. 11/25/2019 a 9. If registering via reciprocity attach a copy of your marijuana processor's license and hemp endorsement. E. END OF YEAR COMMODITY/PRODUCT REPORT. 10. If you processed hemp in 2019, please provide the type and amount of hemp commodities and products produced: a) Type Amount Produced b) Type T Free distallate Amount Produced 100 liters c) Type Amount Produced d) Type Amount CHECK BOX IF YOU DID NOT PROCESS HEMP IN 2019 1-1 F. FEEANDPAYMENT/NFORMATNNy: 11. IMPORTANTPAYMENTDETARS: DO NOT EMAR CREDIT CARD INFORMATION FEE FEES SUBMITTED ❑ Hemp Handler Registration $1,300.00 $ 1,300.00 ❑ Hemp Handler Reciprocity Registration $500.00 $ Registrations for Handler and Hemp Handler Reciprocity Registration are valid for a one-year (calendar year) term beginning January 1, 2020 and ending on December 31, 2020 unless revoked. FEES CANNOT BE PRO -RATED AND ARE NON-REFUNDABLE once a registration has been issued. For CHECKS and MONEY ORDERS. mail USPS only to: Oregon Department of Agriculture PO Box 4395, Unit 17 Portland, OR 97208-4395 For CREDIT CARD charges. read or fax to: Oregon Department of Agriculture 625 Capitol Street NE, Suite 100 Salem, OR 97301-2532 Secure Fax: (503)986-4746 Make CHECKS payable to: Oregon Department of Agriculture. All dishonored checks or electronic payments will incur a $25.00 administrative fee as per ORS 30.701. ........................................................................................ Oregon Department jAgntulture, Hemp Pmgmm, Phone 503-98&46S2 Email: Hemp@oda.state.ar.us "Website: httos://cda.dlrect/HEMP- Rev. 11/25/2019 A receipt is available by email or fax for credit card payments ONLY. If you would like to receive a receipt provide a valid email here: For Discover, Visa or Mastercard charges complete the following information: Name Address of Cardholder Taal Charges$ Card Number. / / / Expiration Date: / Oregon Depurbnenr ofAgricullum Hemp Pmgmm, Phone 503-9864651 Email: HemoldoCo.stote,or.us "Websrre: httw://oda.dire^,/HEMP • Rev. 11125/2.019 ® Oogn Department of A96wiwre LAND USE COMPATIBILITY STATEMENT (LUCS) FAQs WHAT IS A LUGS? The LUCS is the process the ODA uses to determine that ODA registrations and other approvals that affect land use are consistent with a local government conn prehensive plan. WHY 6 A LUCS REQUIRED? Oregon law required that state agency activities related to land use be consistent with local comprehensive plans in accordance with ORS Chapter 197.. WHEN S A LUCS REQUIRED? A LUGS is requires for many ODA registrations, some general registrations, and certain approvals for plans for related activities that affect land use. These activities are listed in this form. In cases where a source needs more than one ODA registration or approval, a single LUGS may be used. A LUCS is required for a registration modification when: • There is a physical expansion on the property or the use of additional land is proposed; • There Ise signiflcarrt increase in dischargeofwater; • There is a relocation of and outfall outside of the source property; or • Emission rate increase as defined in OAR 340-28-130. A registration renewal requires a LUGS if one has not been previously submitted or If one of the above four registration modification factors apply. HOW TO COMPLETE A LU6: • The LUCS form is included in the ODA registration application or approval packet. • The applicant fills out Section 1 of the 1-U6 and then submits it to the city or county planning office. • The local planning office determines if the business or facility meets all local planning requirements. • The local planning office must attach written findings of fact for local reviews or other necessary planning approvals that are required of the applicant. • The applicant includes the completed LUCS and attachments with the registration application. I SUBMITTED A COMPLETED LUIS WITH MY 2019 HEMP REGISTRATION APPLICATION. DO 1 NEED TO OBTAIN A NEW LUCS FOR SUBMISSTION WITH MY 2020 APPLICATION? As long as the LUGS you submitted in 2019 has not been revoked or expired and none of the four modification factors listed above apply, you to do not need to acquire a new LUCS. Simply submit a copy of your 2019 W6 with your 2020 hemp registration application. WHERE TO GET HELP: Questions on the LU6 are to be directed to ODA, Hemp Program, at 503-9864652. Oregon Department of Agriculture, Hemp Programs Phone 503-9864652 Emall: Hemp@odastao.or.us • Website: https://odaAImct/HRuP Rev. 11/13/2019 De,mmUment of Agriculture LAND USE COMPATIBILITY STATEMENT (LUCS) THIS FORM MUST ACCOMPANY THE HEMP HANDLERS CHANGE OF STATUS REPORT FORM. SECTION I—TO BE FILLED OUT BY APPLICANT Nanessname Odva lees lrs (,ontsctparson Jonflasa9awa Telephone Call phone s91113a90e Mailing address: Location address: 7WWVh Seeat Um1A WO SSNSewt UrkA Springfiete, Chw mBr4R Spr1rodO. Orepm 97srS Tex acct.# tssaeae Tax Lot# NO' Township 11 Range 32 Section St Latitude 44.9537 Longitude 122.9713 Properly 2oning 901Fd-hp phmmme 2. Describe the type of hemp business orfacility, and the services or products provided: A9 IW1d plomeskg fadliry. sterna, mart and prooee9g da9daae�rd Sega intludin9 ed nurNmi mato inMdAel hemp, SECTION 2 —TO BE FILLED OUT BY CITY OR COUNTY PLANNING OFFICIAL 3. The facility proposal is located: Inside city limits_ Outside UGB_ Inside UGB_ 4. Name of city or county that has land use jurisdiction: Burist iction means the legal enthythat is responslble for land use decisions for the subject of property or land use.) 5. The business or facility compiles with all applicable local land use requirements:Yes❑No❑ Sa. List all local reviews or approvals that were required of the applicant before the LUCS consistency was determined. (This does not include past requirements that do not relate to the gentling ODA registration requesq. Oregon Department of Agriwnure, Hemp Pmpam, phone 503-986 2 Email: Hemp@odastate.ocus s Website: haps://oda.dire"EMP nem. 11/13/2019 -OVER - 56. If no, identity reasons for noncompliance or list requirements that the applicant must comply with before LUGS consistency can be determined. 5c. Is local government currently processing remaining requirements to attain LUCS consistency? Yes No 6. Planning official reviewer's telephone number. SIGNATURES J Title Planning Official Print name Tide Date Planning Official Print name (depending upon city/county agreement on jurisdiction outside city limits but within UGB) ATTENTION: A LUGS approval cannot be accepted by ODA until all local requirements have been met. Written findings of fact for all local decisions addressed under 5 through 5b must be attached to the LUGS. Oregon Depert.nt of Agrkohure, Hemp Program, Phone 5039864652 E.11: Hemp�apda.nate.or.us • Website: httm.j/oda.di.d/HEMP Rev. 11/13/2019 IM020 Business Registry Business Name Seamb OREGON SECRETARY OF STALE 1 y ROME ia� Corporation Division oregi�� buslaens tniarma§ton center onb"nessgume Nft"l Sint businessreglstryirenewal forma -'fees noiarypubba an8orm cmMercial Cade unifann commercial coda search documents d data services Business Name Search New Search printer Friendly Business Entity Data 01-03-2020 08:06 Ed1RY _Type Entity Jurisdiction Status PRINCIPAL PLACE OF BUSINESS 1530483-93 DBC INA OREGON 1 02-26-2019 OCTAVE LABS INC. New Search Printer Friendly Associated Names Please click lee er for general information about registered agents and service ofprot . GT GISTERED AGENT PB PRINCIPAL PLACE OF BUSINESS 2-26- 019 fOR 07478 j 720 35TH ST UNIT A JOR P7478 I 0 35TH ST UNIT A SPRINGFIELD R P7478 I I JUNITED STATES OF AMERICA Please click lee er for general information about registered agents and service ofprot . GT GISTERED AGENT 20 35TH ST UNIT A 2-26- 019 fOR 07478 j NDY I JAU JOR P7478 I 0 35TH ST UNIT A SPRINGFIELD JOR P7478 P11ITED STATES OF AMERICA AL LING ADDRESS 20 35TH ST UNIT A SPRINGFIELD fOR 07478 j F71TED STATES OF AMERICA egwws.state.or.us ripkg_web_name_srcF mq.Mow_ded?p_be_mn=203962Mp_sr =BR INOSpydnt=FALSE 1Q SIDENT Y U 35TH ST UNIT A IDPRINGFIEID JOR P7478 I I NITED STATES OF AMERICA egwws.state.or.us ripkg_web_name_srcF mq.Mow_ded?p_be_mn=203962Mp_sr =BR INOSpydnt=FALSE 1Q 1/312020 Business Registry Business Name Search SPRINGFIELD JOR P7478 I I JUNITED STATES OF AMERICA New Search Printer Friendly. Name Please read before ordering ap ea. New Search Printer Friendly, Summary History About Us I AnnouncementsI Laws & Rules I Feedback Palicy I SOS Home I Qrggon Blue Book 10lgggn.gov For comments or suggestions regarding the operation of this site, please contact, gggporation.division@state.or.us egay.s za le.w.uWbrlpkg_web_name =F inq.st deg?p_be_m=203962Mp_s BR_INOapynM PALBE 212 Status g)TICLES OF 06-07-2019 FI ISSOLLMON i'jl TICLES OF 02-26-2019 FI Agent CORPORATION About Us I AnnouncementsI Laws & Rules I Feedback Palicy I SOS Home I Qrggon Blue Book 10lgggn.gov For comments or suggestions regarding the operation of this site, please contact, gggporation.division@state.or.us egay.s za le.w.uWbrlpkg_web_name =F inq.st deg?p_be_m=203962Mp_s BR_INOapynM PALBE 212 APPLICATION FOR REGISTRATION Corporaflon Division ({i p winny,filingimmiian mm OREGON SECRETARY OF STATE REGISTRY NUMBER 153432993 TYPE ENTRY NAME OCTAVE LABS BUSINESS ACTIVITY PROCESS INDUSTRIAL HEMP PRINCIPAL PLACE OF BUSINESS 720 35TH ST UNIT A SPRINGFIELD OR 97478 USA NAME & ADDRESS OF AVTHOM2ED REPRESENTATIVE ANDY AU 202 CHERRVBROOK LN . IRVINE CA 92818 USA - REGISTRANROWNER 153048393 -OCTAVE UBS INC. 202 CHERRYBROOK LN IRVINE CA 92818 USA COUNTIES LANE Rxm 1014 K"ipl% ORF(N)N DEPARTMENT OFAGRICCI TFRE h?i ('APITOL 57 NF. St ITE IIMI SAI I.\1, OR 977)1--2532 isle=, WM.sssn POST IN A CONSPICUOUS PLACE OCTAVE LABS INC CHRISTOPHER OLSON 720 35TH ST UNIT A SPRINGFIELD OR 97476 OCTAVE LABS INC 720 35TH ST UNIT A SPRINGFIELD OR 97478 LICENSE NUMBER DATE ISSUED DATE EXPIRES LICENSE AG-R10586381HH 03/21/2019 1M112019 Industrial Hemp Handler Registration PrinW. 0322i2sio SPRINGFIELD — Transaction Receipt Record ID: 011-20-000213-TYP1 OREGON IVR Number: 811894342180 htlp://w .springField-or.govldpWlCunenlDevelopment!) vsion.ham Workers address: 720 35TH ST, Springfield, OR 97478 Parcel: 1702312102601 Transaction date 1116120 1116120 Receipt Number: 476959 Receipt Date: 1116120 Fees Paid Units Description Accommodate 1.00 Ea Land Use Compatibility 100-00000-025002-1039 StatemenoZoning Verification Lefler - Pennit, City 1.00 Automatic Technology Fee 204-00000425605-0000 City of Springfield Development and Public Warks 225 Fifth Street Springfield, OR 97477 541-726-3753 Fax: 541-726-3689 permitcenter@springfield-or.gov Fee amount Paid amount $343.Do $343.00 $17.15 $17.15 Payment Method: Check number: 1214 Payer: Octave Labe LLC Payment Amount: $36D.15 Cashier. Drew Larson Receipt Total: $360.15 Printed 1116120 1'.24 pm Page 1 W1 FIN T2nsaclionReceipt_pr �t f Agriculture LAND USE COMPATIBILITY STATEMENT (LUGS) THIS FORM MUST ACCOMPANY THE HEMP HANDLERS CHANGE OF STATUS REPORT FORM. SELTON 1—TO BE FILLED OUT BY APPLICANT 1. Business name 0maelaink- Contactperson Jm Naxa9aea Telephone Cellphone s4rsrs.eoo0 Mailing address: Location address: M ssm seem. UMA 735035th srem UrAA spin,seu, ora9en 97478 sprhandd, Cream W478 Tax acrd.# V6u139 Tax lot#9m1 Township 17 Range 09 Section 31 Latitude ".0337 Longitude 19x.9773 Propertymning dmlwaWe nnerW 2. Describe the type of hemp business or facility and the services or products provided: lgnadW21 pmesan9r�liy. ypFp, Milne eM P�sdng Praenalurd gmEs inWbin9 M1m n@6mi1Mb IndiclruJ M1emp. SECTION 2 —TO BE FILLED OUT BY CITY OR COUNTY PLANNING OFFICIAL 3. The facility proposal is located: Inside city limits OO��ut��s`ide UGBp_cclnside UGB 4. Name of city or county that has land usejurisdicdon:(Jl'<-v, aF J ��aT,tl {jurisdiction means the legal entity that is responsible for lanr Ian s�edecislonrnaf e�¢ubjectof property or land use.) j(�� S. The business or facility compiles with all applicable local land use requirements: Yes[%No❑ 5a. List all local reviews or approvals that were required of the applicant before the LUGS consistency was determined. (This does not Include Past requirements that do not relate to the pending DDA registration s 0mgon Depanmem Pf Agricuhure, Hemp hmgram, Phone 503-986-0652 Emalk Hemp@oda.state-mus e Website: httpsWm1a d i.c /HEMP Rev. 11/1312019 -OVER - Sb. If no, identify reasons for noncompliance or list requirements that the applicant must comply with before LUCS consistency can be determined. Sc. is local government currently processing remaining requirements to attain LUCS mnsistency? Yes DOC No S. Planning official reviewers telephone number: .:/1"%16-/VaI rn A �r^Ttle p1 A"w t,f Date M W Z,6713 Print name Tide Date Planning Official Prim name (depending upon city/county agreement on jurisdiction outside city limits but within UGB) ATTENTION: A LUGS approval cannot be accepted by ODA until all local requirements have been met. Written findings of fact for all local decisions addressed under 5 through 51, must be attached to the LUR. Oregon Department ofAgrlwhpro, Hemp Program, Phone 503)86-0652 Email: Hemp@oda&mm.or.us • Website: httpc//oda., imdJHEMP R.. 11/13/2019