HomeMy WebLinkAboutApplication APPLICANT 2/22/2023City of Springfield
Development & Public Works
225 Fifth Street
Springfield, OR 97477
PERMIT REVIEW INTAKE FORM
Permit Type
k
(City Staff completes form)
Dept of Motor Vehicles -New: ❑ Land Use Compatibility Statement: X City: ❑
Dept of Motor Vehicles -Renewal: ElZoning Verification Letter: ElUGa: X
Project rnformation
Applicant Name: Mariela Castellanos
Phone: 541-654-2942
Company:
Cell:
Address: 1623 Menlo Loop, Springfield, OR 97477
Property Owner: Daniel and Katherine Davis
Phone:
Company:
Cell:
Address: 2635 Nova Street Springfield, OR 97477
ASSESSOR'S MAP NO: 17032244
TAX LOT NO(S): 4400
Property Address: 2635 Nova Street Springfield, OR 97477
Description of Proposal:
LUCS for Oregon Department of Education Early Learning Division for verification of City
Planning, Zoning and Building Codes
Record rnformation
Record No: 811-23-000036-TYP1
Date Received: 2/ 22/ 23
Application Fee: 395.00
Technical Fee: $19.75
TOTAL FEES: $414.75 Assigned Planner:L. Miller
Revised 11.2.11 kl
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
planning and zoning, occupancy, and building requirements.'
I u sure rIIICU wt uy the a,nuu i_are
Type of License Applying for: Age Range of Children Being Served:
0 Registered Family Child Care Home (RF)
Infants/Toddlers
Certified Family Child Care Home (CF) LLL'��
0 Certified Child Care Center (CC) Preschool
Certified School-age Center (St) Is School Age
Site Address: 7 A ,�
ac�3 s WMA sfi Seri li �,elc9 0r- 1 �
(street address) city) (zip)n1(county)
Verification of Compliance with city/county ordinances needed because: -Vt `
® 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)
CF Home is not located in a commercial or residential zone
CC Building may/may not be zoned to operate a child care business
SC School-age only center that is not in a public school must meet building code and zoning requirements
To be Filled Out by the Appropriate Local Authority
Planning and Zoning Approval
The proposed child care facility/home is in an approved zone O Yes ONO
Signature of authorized representative of Planning and Zoning Date
I Occupancy and Building Codes Approval
The proposed child care facility/home meets occupancy and building codes OYes ONO
{ Signature of authorized representative of Occupancy and Building Date
'Registered Family: OAR 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 applicaupprovider 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,
Certified Family: OAR 414-351)1 A Fame 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: CAR 414300-0010(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 caref llitlesa) Before the initial certificate is issued; and (b) Wheneverthe f rtyis remodeled
Certlfled5choolage Center OAR 41 3-0130(5)1)Evtlmarine school-age centermeets all applicableb'ld'g codes and zoning requirements, unlethe
center is in a public school b Itl g Ce
Oregon Administrative Rules( R Oregon Depa ut of Education Early Learning Division Chapter 414, Divisions 205 Registered Family child
Care Home, 300 Cemfied Chi C re Centers 3 -_ led Sc .1 -age Centers adi Certified Family Child Care Homes
Signature of Provideril erator of Facility Date .21i
You are entitled to language assistance services and other accommodations at no cost. If you need help in your language or other
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 (10/22)
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