HomeMy WebLinkAboutApplication APPLICANT 1/8/2021City of Springfield
Development & Public Works
225 Fifth Street
Springfield, OR 97477
PERMIT REVIEW INTAKE FORM
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(City Staff completes form)
Permit Type
Dept of Motor Vehicles -New: ❑ Land Use Compatibility Statement: ❑ City: X
Dept of Motor Vehicles -Renewal: Zoning Verification Letter: ❑ UGe: ❑
Project Information
Applicant: Kelly Schrader
Phone- 541-999-0796
Company: Team Oregon Auto Group LLC
Cell:
Address: 2634 Wayside Lane, Springfield, OR 97477
Property Owner: Timothy L Morgan
Phone:
Company:
Cell:
Address: 1831 S A St, Springfield, OR 97477
ASSESSOR'S MAP NO: 17-03-36-31
TAX LOT NO(S): 7800
Property Address: 1831 S A St, Springfield, OR 97477
Description of Proposal:
DMV Co -locate
Record Information
Record No: 811-21-000004-TYPi
Date Received: Jan. 8, 2021
Application Fee: $343.00
Technical Fee: $17.15
TOTAL FEES: $360.15 Assigned Planner:
Revised 11.2.11 kl
10
11
APPLICATION FOR
THREE YEAR VEHICLE DEALER CERTIFICATE
eR is AS A DEALER OR REBUILDER OF VEHICLES
CUSTOMER NUMBERry' 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) ................................. $ 1,187.00
SUPPLEMENTALS
RENEWAL PLATES
Additional Locations @$350.00 ..................... $
(Supplemental Application Form 735-372 required for each
location) $ I08r00
ADDITIONAL PLATES
Additional plates 12" x 6" 2. or 7" x 4" $54.00...
TOTAL $
(Two sizes, standard and small, available) TOTAL = $ Ili S 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)
FEDERAL ID NUMBER (FEIN)
OREGON REGISTRY N(IF LLCOR CORPORATION)
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94.1300[10
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BUSINESS NAME (IF ASSUMED BUSINESS NAME, FILL IN REGISTRY NO)
OREGON REGISTRY NO,
BUSINESSTELEPHONE
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MAIN BUSINESS LOCATION(STREET AND NUMBER)
CITY
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ZIP CODE
COUNTY
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MAILING ADDRESS
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STATEZIP CODE EMAIL
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TYPE OF OPERATION If corporation, list the stare antler
CHECK ORGANIZATION TYPE:
❑
nRSlaess Is IncRmomred=
Individual [:]Partnership [YLLC —]Corporation:'*
I/we primarily sell: ❑ New Vehicles Used Vehicles
/we are a franchise dealer: ❑ Yes ❑[ No If "Yes," name the makes >
/we sell NEW RECREATIONAL VEHICLES: ❑ Yes [X 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. ORS 822.005 requires a vehicle dealer certificate, 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. The approval below should be based
upon whether the applicant can do ANY of the activities listed in (a) through (c) above under applicable ordinances, at the location
of the business given on Line 3. Pursuant to ORS 822.025, applicant shall meet requirements below.
As the zoning official for the jurisdiction where this business is lasted, I verify by my signature that the location of this business as stated on this application
complies with any land use ordinances of the jurisdiction pursuant to ORS 822.025.
❑ CITY OF: ❑ COUNTY OF:
TELEPHONE NUMBER
PRINT NAME
TITLE
SIGNATURE
DATE
X
7 Fact stamp or sw�w hones
❑ Check box if restrictions on the location
approval are in an attached letterfrom
the zoning authority.
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