HomeMy WebLinkAboutApplication APPLICANT 6/23/2022City of Springfield
Development & Public Works
225 Fifth Street
Springfield, OR 97477
PERMIT REVIEW INTAKE FORM
SPRINGFIELD
vwl�
(City Staff completes form)
Permit Type
Dept of Motor Vehicles -New: ❑
Land Use Compatibility Statement: X
City: X
Dept of Motor Vehicles -Renewal: ❑
Project Information
Zoning Verification Letter: ❑ UGB: ❑
Applicant Name:
Phone:
Company: Ana's Bilingual Daycare
and Preschool
Cell:
Address: 5660 Daisy Street
Space ace 80 Springfield, OR 97478
Property Owner: Leopoldo Guiterrez
Phone:
Com p an
Cell:
Address: 2798 Morse Street Eugene, OR 97402
ASSESSOR'S MAP NO: 17023334
TAX LOT NOS : 04613
Property Address: 464 S 53'" Street, Springfield OR 97478
Description of Proposal:
Land Use Compatibility Statement for Oregon Department of Education for Certified
Family Home where the operator is
not living in the home where care will be provided
Record Information
Record No: 811-22-000158-TYP1
Date Received: 6/23/22
Application Fee: $348
Technical Fee: $17.40
TOTAL FEES: $365.40
Assigned Planner:L. Miller
Revised 11.111 Id
Verification of City/County Approval , °`°`,-
Planning and Zoning, Occupancy, and Building Codes
Prior to licensing, you must provide the Office of Child Care with verification that your facility meets local In P"=
planning and zoning, occupancy, and building requirements."
be Filled Out by the Child Care
Type of License Applying for:
F-1 Registered Family Child Care Home (RF)
.Certified Family Child Care Home (CF)
�❑Certified Child Care Center (CC)
Site Address: 1� CoLi
Age Range of Children Being Served:
EInfants/Toddlers
Preschool
School Age
(street address) r (city)) (zip)
Verification of Compliance with city/county ordinances needed because:
®RF/CF Not living in the home where care will be provided
(only planning and zoning approval required)
❑RF/CF Home is converted or additional space, not part of the original living quarters, being used for child care
(only occupancy and building codes required)
❑CIF Home is not located in a commercial or residential zone
❑CC Building may/may not be zoned to operate a child care business
To be Filled Out by the Appropriate Local Authority
Planning and Zoning Approval I �/
The opo` d child care f cility/home is in a approved zone Yes ❑ No IT� �rQ(�� �R, la` I
JA
��LfM�IfA��(a�23LIZ
Signature of authorized representative of Planning and Zoning Date
Occupancy and Building Codes Approval
The proposed child care facility/home meets occupancy and building codes ❑ Yes [:]No
Signature of authorized representative of Occupancy and Building Date
*Registered Family: OAR 414-205-0150 414-205-0150(3) In instances where care that is subject to registration, as defined in subsection (2) of rule
414-205-0000, will not be provided in the provider's own residence, the applicant/provider must request and receive approval for an exception
prior to providing care at that location. In all respects, the location must appear and be arranged as a residence. 414-205-0020)7) To determine if
requirements are met, the applicant/provider maybe required to supply additional information or permit OCC, afire marshal, or a public health
official to assess the home and/or review child care records.
Certified Family: OAR 414-350-0130(2) A home that is not the residence of the provider or a home located in a zone other than residential or
commercial shall meet all state and local planning and zoning, occupancy, and building code requirements for a child care facility.
Certified Center: OAR 414-300-0010(12)(a) and (b) An operator shall provide verification to OCC that the center meets all applicable building codes
and zoning requirements that apply to child care facilities: (a) before the initial certificate is issued; and (b) Whenever the facility is remodeled.
Oregon Administrative Rules (OAR), Oregon Department of Education, Early Learning Division, Chapter 414, Divisions 205 Registered Famlly
Child Care Homes, 300 Centifigohild Care Centersand 0 Certified Family Child Care Homes. /?�,
r ��/ /
•
Signa ure of Provider/Operator of Facili Date
You ore entitled to language assistance services and other accommodations at no cost. If you need help in yourfanguage another
accommodations, please contact the Office of Child Care at 503-947-1400.
Oregon Department of Education • Early Learning Division • Office of Child Care • www.oregonearlylearning.com I OCC -0108 (6/2021)
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