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Home My WebLink AboutApplication APPLICANT 5/6/2022iCity of Springfield Development & Public Works 225 Fifth Street Springfield, OR 97477 PERMIT REVIEW INTAKE FORM SPRINGFIELD (City Staff completes form) Permit, - Dept of Motor Vehicles -New: ❑ Land Use Compatibility Statement: ❑ City: X Dept of Motor Vehicles -Renewal: X Zoning Verification Letter: ❑ UGB: ❑ Project Information Applicant Name: S&N Motors LLC Phone: 541-248-4288 Company: Cell• Address: 368 N Moss Street, Lowell OR 97452 Property Owner: Kryl Family Investments Phone: Company: Cell: Address: 3474 Spring Boulevard, Eugene, OR 97405 ASSESSOR'S MAP NO: 170231 TAX LOT NOS : 06600 Property Address: 3477 Main Street Springfield, OR 97478 Description of Proposal: DMV Renewal Record Information Record No: 811-22-000117 Date Received:5/6/22 Application Fee: $348.00 Technical Fee: $17.40 TOTAL FEES: $365.40 Assigned Planner:L. Miller Revised 11.2.11 Id 10 rol III APPLICATION TO CORRECT DEALER 1 REBUILDER VEHICLE DEALER CERTIFICATE uvsv,ewuwwm. DEALER NUMBER w L1IZ EFFECTIVE GATE EXPIRATION GATE CURRENT BUSINESG NAME - D N s Check the reason for correction: ❑ Name Change ❑x Address Change [-]Add/ Remove Owners ❑ Org. / Structure Change Instructions: VALIDATION USE ONLY • The tee Por a colrecox cert'dicate: $30. • Name change and/or address change $30. Attach Bond Rider and Insurance Cafforte. • Organizational structure change: $30. (e.g., Individual partnership or LLC to Corp.) Attach a band rider antl insurence certificate. • AddinglRemoving LLC member or corporate officer: No Fee • Each new owner must complete and sign lines 12-16 or 17-21. • Each owner being removed must sign line 22 or 23. •One owner must sign line 24. • Provide copy of valid photo 10 if changing residence address. • Dealer number and expiration data will stay the same. Submit the completed application to: DMV Business Licensing, 1905 Lana Ave NE, Salem Oregon 97314. NOTE: Ifthe dealership has been Sold, the new owners) must obtain their own vehicle dealer certificate using the Form 735-370 Packet since a dealer catfi a is nottransferable. NAME CHANGE NEW BUSINESS NAME (Ranum us,ness name, IlnarrWryNumEmJ OREGONBUSINESSRE LEMPL VEOLINTICATIONNUMBER Any alteration of Line 3 voids location approval. ADDRESS CHANGE NEW BIRSIT AQUNI WHERE BUSINESS WILL B E CONO REaMENCE I]PflEv0m ALPPLEMnNTAI BUSINESS TELEPHONE l (541)2WW-4U? Jr,rqi P`1°E e a E AD°IV It s vl ita Aft C}`nnf— (D/DSS ully LoQ /�7'�a 'al 1"1 E � !Aa NJ StfW--�5W LO •ell =IPG Ila aiR A°ORMOSS ESSL �� I1YL011,11I ZIPC LOCATION APPROVAL - Required only if dealer is changing business location Certification of Local Zoning and Business Regulatory Compliance. 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; 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 thejurisdiction allows the applicant ANY of the activities in (a) through (c) above under its ordinances, at the location of the business given on Line 3. As he mining official for the jurisdiction weret is business is local lverify by my signature below that the locationo The business as shown on this appFcation complies wird any land use ordinances or business regulatory ordinances of the jurisdiction pursuant to ORS 822.025(8). CITY OF:S it COUNTY OF: TE PHONE NUMBER LJ PRIM NA z TIT SIGNA X DATE S 2--2- Z❑ Restrictions on the location El - eaI here approval are in an allached APPROVED CRY OF SPRINGFlEID letter from the zoning authority. rol III 20 21 2 2 24 25 26 27 OWNERSHIP CHANGE 12 13 14 15 16 17 18 19 2 3 Check your organization type on Line 11, list all owners and provide other required information below. The dealer certificate number and expiration date will stay the same. If adding names, attach copies of ALL new owners, partners, LLC members or corporate officers' valid government-issued photo ID's (driver license, state issued identification card or passport). Copy must be legible. If the residence address on the photo ID is different than the residence address listed below, submit a statement explaining why the addresses do not match. ❑ Individual ❑ Partnership ® LLC ❑ Corporation is business incorporated?) (Ifcorporafion, under what slate • P P List each person being added as a partner, LLC member or corporate officer. PRINT NAME MUST SIGN LINE 16) TIRE DATE OF BIRTH DRIVER LICENSE NUMBER BTATE OF ISSUE HOMEPHONENUMSER c ) RESIDENCEADOREss clTr STATE IcoDE WILING ADDRESS CI Y STATE LP CODE CERTIFYING SIGNATURE OF OWNER SHOWN ON LINE 12 ABOVE DATE X PRINT NAME (MUST SIGN LINE 21) TITLE DATE OF BIRTH DRIVER LICENSE NUMBER STATE OF ISSUE /HOMEPHONENUM BER RCSIDENCEAODREBB CIN STATE ZIP CODE ADDRESS MAILING ADD LITV STATE ZIP CODE CERTIFYING SIGNATURE OF OWNER SHOWN ON LINE 17 ABOVE DATE X • List each person being removed as a partner, LLC member or corporate officer. PRINTNAME SIGNATURE TITLE X PRINT NAME SIGNPTU0.E TILE X CERTIFICATION False certification is a Class B misdemeanor under ORS 162.085, and is punishable by six months in jail, a fine of up to $2,500 or both. In addition, civil penalties and DMV sanctions against you or your dealer certificate may be imposed. With this in mind I CERTIFY I am an owner, partner, LLC member or corporate officer of this dealership and all information on this application is accurate. CERTIFICATION CANNOT BE SIGNED BY PERSON BEING ADDED ON LINES 12 OR 17. CERTIFYING SIGNATURE OF OWNER TIRE X N E-99—LD-CA—TION INFORMATION Property is (check one): ❑ OWNED 0LEASED I RENTED: LEASE OR RENTAL PERIOD: If property is "Leased / Rented" complete the following: PRO OWNER'S FULL NAME TELEPH E,N �MBER��_ ��• 'ipn PROP R ADDR i1 bt CI ung- AE ZIP CODE Don't Forgetl • For name change, address change and organizational structure, a bond rider from your bonding company and a new insurance certificate must be submitted. • One current owner MUST Sign Line 24. CERTIFICATION CANNOT BE SIGNED BY PERSON BEING ADDED ON LINES 12 OR 17. • Location approval is required when changing a business location. • A fee of $30 is required with the exception of a change of LLC member or Corporate officer which requires no fee.