HomeMy WebLinkAboutApplication APPLICANT 10/26/2021City of Springfield
Development & Public Works
225 Fifth Street
Springfield, OR 97477
PERMIT REVIEW INTAKE FORM
k
LD
(City Staff completes form)
Permit Type
Dept of Motor Vehicles -New: ❑ Land Use Compatibility Statement: ❑
City:
Dept of Motor Vehicles -Renewal: ® Zoning Verification Letter: ❑ UGa: ❑
Project Information
Applicant: Ruben Bahena
Phone: 541-579-9966
Company: Bahena's Family Auto Sales
Email:
Address: 3205 Main, Springfield, OR 97478
Property Owner: WISEASSCO LLC
Phone:
Company:
Cell:
Address: PO Box 310, Springfield, OR 97477
ASSESSOR'S MAP NO: 17-02-31-31
TAX LOT NO(S): 5600
Property Address: 3205 Main St.
Description of Proposal:
DMV Renewal
Record Information
Record No: 811-21-000279-TYP1
Date Received: 10/26/2021
Application Fee: $348.00
Technical Fee: $17.40
TOTAL FEES: $365.40
Assigned Planner: Drew Larson
Revised 11.2.11 Id
10
11
APPLICATION FOR
THREE YEAR VEHICLE DEALER CERTIFICATE
AS A DEALER OR REBUILDER OF VEHICLES
CUSTOMER NUMBER
EFFECTIVE DATE E%PIRATION 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 oneSUPPLEMENTALS
USE CALCULATION SHEET PROVIDED
Additional Locations
DO NOT FEE CALCULATOR ON
HENEWALPLATEB
(Supplemental Application Form 7.
location) APPLICATION, FOR NEW APPLICANTS
ADDITIONAL
PLATES
Additional plates 12" If 6" ONLY
TOTAL
$
(Twosizes, standard and small, available]
>
TEMPORARY
PLATES
BUSINESS NAME AND ADDRESS Any alteration of Line 3 voids location
approval.
ANT
LEGAL Na;FF AeCn (OWN6age.S�D.ORCORPORAnON NAME)
FEDERAL ID NUMBER (FEIN)
OREGON REGISTRY fIFLLC OH COBPORAPON)
tSn
BUSINESS NAME (IF ASSUMED BU NESS NAM ,FILL IN REGISTRY NO.)
OREGON REGISTRY NO.
BUSINESS TELEPHONE
LaCnYL.PJA.A f t a S r L L• e-
,S41
MAIN BUBINE55 LOCATION (B�REEE�� DNUMBER)
OITY
'2-u
ZIPCODE
COUNTY
95 g.ALA sk
S aN
Y-
La^-e-
MAILINGADDRESS
CITY
STATE
[IP CODE
EMAIL
TYPE OF OPERATION ff oMoiannn, list he slate under
rmich business is incoporatW:
CHECK ORGANIZATION TYPE: ❑ Individual ❑ Partnership LLC ❑ Corporation:
+.I/we primarily sell: ❑ New Vehicles d Vehicles
I'/ we are a franchise dealer: Yes
H "Yes," name the makes
I /we sell NEW RECREATIONAL VEHICLES:
[-]Yes o
IF "YES," SERVICE FACILITY LOCATION (STREET AND NUMBER)
CITY
ZIPCODE
LOCATION APPROVAL (If renewal, required only if dealer Is changing business location)
CertGcation 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 located, I verify by my signature that the location of this business as stated an this application
complies with any (and use ordinances of the junsdicclion pursuant to ORS 822.025.
CITY OF:
❑COUNTY OF:
TELEPHONE NUMBER
"t )3b_16D
PRIM NAMEssu.
TITL
yr
A
DATE
X
Dp
V Raps stamp or seall here V
❑ Check box if restrictions on the location
approval are in an attached letter from
Ap(>RpyEp
the zoning authority.
CITY OF 6PRINGFlEW
Paas
1 Cin