HomeMy WebLinkAboutApplication APPLICANT 5/19/2023City of Springfield
Development & Public Works
225 Fifth Street
Springfield, OR 974771k
SPRINGFIELD
LAND USE COMPATIBILIITY STATEMENT (LUCS)r DEPARTMENT OF
MOTOR VEHICLES (DMV) and ZONING VERIFICATION LETTER
Application form
Dept of Motor Vehicles -New: ❑ Land Use Compatibility Statement: ❑ city: ❑✓
Dept of Motor Vehicles -Renewal: ✓❑ Zoning Verification Letter: ❑ UGB: ❑
Project• •
Applicant Name•Roberto Rodriguez Phone: 5411-654-5234
Company: GT Auto E-mail:
Address: 3403 Franklin Blvd, Eugene OR 97403
Property Owner:Brye Investments Phone:
Company: E-mail:
Address:33607 Mt. Tom Drive, Harrisburg, OR 97446
ASSESSOR'S MAP NO: 17023142 TAX LOT NO(S):00300
Property Address:3842 Main Street, Springfield, OR 97478
Description of proposal/ request:
DMV Location approval - GT Automotive to move from Glenwood loction to existing lot at 38th and Main Street
,Record• • tocomplete)
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Record No: Al I - [Q 1
Date Received:
Application Fee: $ J ` �'��i
Technical Fee: $
TOTAL FEES: $ Assigned PlannerA,M�L���
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APPLICATION TO CORRECT DEALER / REBUILDER
VEHICLE DEALER CERTIFICATE
DEPApTMENfOlPOpTATON
OgNER ANO vam RIOLE SERVICES
1COS LANA AVENE NLS VESAIEY ORECONiTJ10 DEALER NUMBER EMAIL
�A� `16 02 +ai'nLogr-c�ule i l l@�r1� 14,
EFFECTIVE DATE EXPIRATION DATE CURRENT BUSINESS NAME
`I E A+Ier l Ir i5e -5 LLC A 6-T A U -ho 6,ro 4,-'.
Check the reason for correction:
Name Change Address Change ❑ Add / Remove Owners ❑ Org. / Structure Change
Instructions: VALIDATION USE ONLY
s The fee for a corrected certificate: $30.
o Name change and/or address change: $30. Attach Bond Rider and Insurance Certificate.
3 Organizational structure change: $30. (e.g., Individual partnership or LLC to Corp.) Attach a bond rider
and insurance certificate.
s Adding/Removing LLC member or corporate officer: No Fee
■ Each new owner must complete and sign lines 12-16 or 17-21.
e Each owner being removed must sign line 22 or 23.
o One owner must sign line 24.
Provide copy of valid photo ID if changing residence address.
• Dealer number and expiration date will stay the same.
Submit the completed application to: DMV Business Licensing, 1905 Lana Ave NE, Salem Oregon 97314.
NOTE: If the dealership has been sold, the new owner(s) must obtain their own vehicle dealer certificate using the Form 735-370 Packet since a dealer
certificate is not transferable.
NAME CHANGE
NEW BUSINESS NAME (If assumed business name. fill in Registry Number.)
OREGON BUSINESS EGISTRY NUMBER
FEDERAL EMPL OYER I EN . LIFICATION NUMBER
Any alteration of Line 3 voids location approval.
ADDRESS CHANGE
NEtn STREETAD❑ E S WHERE BUSINIS8 WILL BE CONDUCTED I✓ RESIDENCE [] PREVIOUS SUPPLEMENTAL
_.3S
BUSINESSTELEPHONE
40
)(h+5o2
CITY
AP CODE
COUNTY
LAQF,
WZENCE ADDRESS
1
CODE
EMAIL
MAILINGADDRESS
CITY
ZIP CODE
PREVIOUS STREET ADDRESS OF BUSINESS LOCATION
CITY
ZIP CODE
03 �r < �vc
��740
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 the jurisdiction 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 the zoning official for the jurisdiction where this business is located, I verify by my signature below that the location of this business as shown on this application
complies with any land use ordinances or business regulation ordinances of the jurisdiction pursuant to ORS 822.025(6).
CITY OF: COUNTY OF: TELEPHONE NUMBER
PRINT NAME TITLE
SIGNATURE DATE
X _
■ Place stamp or seal here ■
Restrictions on the location
approval are in an attached
letter from the zoning authority.
735.371 (10-22)
11
12
13
14
15
16
17
18
19
20
21
22
23
OWNERSHIP CHANGE
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
(If corporation, under what state is business incorporated?)
• List each person being added as a partner, LLC member or corporate officer.
PRINT NAME (MuST SIGN LINE 16) EMAIL
TITLE
DATE OF BIRTH
DRIVER LICENSE NUMBER
STATE OF ISSUE
HOME PHONE NUMBER
RESIDENCE ADDRESS
CITY
STATE
ZIP CODE
MAILING ADDRESS
CITY
STATE ZIP CODE
DATE
CERTIFYING SIGNATURE OF OWNER SHOWN ON LINE 12 ABOVE
X
PRINT NAME (MUST SIGN LINE 21)
EMAIL
TITLE
(HOME PHONE NUMBER
DATE OF BIRTH
DRIVER LICENSE NUMBER
STATE OF ISSUE
RESIDENCE ADDRESS
CITY
STATE
ZIP CODE
MAILING ADDRESS CITY 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. Removing a
sole owner or member is not permitted. That requires a new (_original) dealer certificate.
PRINT NAME SIGNATURE TITLE
X
PRINT NAME SIGNATURE TITLE
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:
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 TITLE
24 X
NEW BUSINESS LOCATION INFORMATION
25 Property is (check one): ® OWNED ❑ LEASED / RENTED: LEASE OR RENTAL PERIOD:
If property is "Leased / Rented" complete the following:
26
ROPERTY OWNER'S FULL NAM (As shown on County Property Records) TELEPHONE NUMBER
( )
27 PROPERTY OWNER'S MAILING ADDRESS CITY STATE
Don't Forget!
• For name change, address change and organizational structure, a bond rider from your bonding company and a new
insurance certificate must be submitted.
e One current owner MUST sign Line 24. CERTIFICATION CANNOT BE SIGNED BY PERSON BEING ADDED ON LINES 12 OR 17.
r Location approval is required when changing a business location.
e A fee of $30 is required with the exception of a change of LLC member or Corporate officer which requires no fee.