HomeMy WebLinkAboutApplication APPLICANT 3/18/2022jCity of Springfield
Development & Public Works
225 Fifth Street
Springfield, OR 97477
PERMIT REVIEW INTAKE FORM
IL
6
(City Staff completes form)
Permit Type
Dept of Motor Vehicles -New: ❑
Land Use Compatibility Statement: ❑ City: M
Dept of Motor Vehicles -Renewal: M Zoning Verification Letter: ❑ UGB: ❑
Project Information
Applicant: Kellie Nelson Phone: 541-912-4332
Company: Wheeless Trailer Service & RV Repair
Email:
Address: 3560 Main, Springfield, OR 97478
Property Owner: Kellie Nelson
Phone:
Company:
Cel I:
Address:
ASSESSOR'S MAP NO: 17-02-31-31
TAX LOT NO(S): 2100
Property Address: 3560 Main, Springfield, OR 97478
Description of Proposal:
New Trailer Sales DMV License
Record Information
Record No: 811-22-000078-TYPI
Date Received: March 18, 2022
Application Fee: $348.00
Technical Fee: $17.40
TOTAL FEES: $365.40 Assigned Planner: Drew Larson
Revised 11.2.11 M
10
11
APPLICATION FOR
THREE YEAR VEHICLE DEALER CERTIFICATE
m AS A DEALER OR REBUILDER OF VEHICLES
CUSTOMER NUMBER
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
SUPPLEMENTALS
Original Certificate (Includes one plate)................................. $ 1,187.00
RENEWAL PLATES
Additional Locations @$350.00..................... $ 0.00
(Supplemental Application Form 735-372 required for each
location) $ 0.00
ADDITIONAL PLATES
Additional plates 12" x 6" or 7" x 4"_q$54.00 ...
TOTAL $
(Two sizes, standard and small, available) TOTAL = $ 1,187.00
> TEMPORARY
PLATES
BUSINESS NAME
AND ADDRESS Any alteration of Line 3 voids location
approval.
iEGA{NAME OF APPLICANT IOWNEPERSHIV COR VITON ME)
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FE/-DERAL ID NUMBER(FEIN) ORE/ONRIGISTRYOIF LLC Oq Cp�POPATIONI
BUSINESS NAME (IF ASSUMED BUSINESS NAME, FILL IN REGISTRY NO.) OREGON REGISTRY NO,
BUSSSIIINEESSS TELEPHONE
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(MAIN BUS ESS OCATION ($TRT NUMB)=R)
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TYPE OF OPERATION Ifcoryorthor,rsthe gate uxler
i CHECK ORGANIZATION TYPE: [:]IndtVidual ❑Partnership LLC ❑Corporation: which buslnees is incmpor#ed:
I /we primarily sell: New Vehicles ❑ Used Vehicles
I /we area franchise dealer: ❑ Yes ®No If "Yes," name the makes >
/we sell NEW RECREATIONAL VEHICLES: ❑ Yes V] No
IF "YES," SERVICE FACILITY LOCATION(STREET AND NUMBER)
CITY
ZIPCODE
LOCATION APPROVAL (If renewal, required only it 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 located, I Verily 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.
NJ CITYOF: ❑ COUNTY OF:
TELEPHONE NUMBER
PRINT NAME
U.
TITLE
Nr 3
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SIGNATURE`T
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7/ x'1308 Wamp or sed here
❑ Check box if restrictions on the location
approval are in an attached letter from
the zoning authority.
APPRO
CRY OF SPRINGFlEID