HomeMy WebLinkAboutApplication Applicant 1/3/2024(City of Springfield
Development & Public Works
225 Fifth Street
Springfield, OR 97477
SPRINGFIELD -
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LAND USE COMPATIBILIITY STATEMENT (LUCS), DEPARTMENT OF
MOTOR VEHICLES (DMV) and ZONING VERIFICATION LETTER
Application form
Dept of Motor Vehicles -New: ❑
Land Use Compatibility Statement: X City: ❑
Dept of Motor Vehicles -Renewal: ❑ Zoning Verification Letter: ❑ UGB: ❑
Project Information
Applicant Name: Phone: 5L4 171q -L4),q0
Company: Q'-e,Gz-r\\0nJ' C VN'\C� C G.re— E-mail: (Lr-ec_m R_uC ., �, ►
Address: ,0510 \5t`^ Svrte� 01Z `i7'477
Pro ert Owner: �_\Y\&_G r, Phone: 54 0 5:,\ - 01111
Company: 2voe .\A C-)&rk-'nS nnb senP rnettorcl
Address: c1���•�a�ma4N
ASSESSOR'S MAP NO: =TAX LOT NOS : aq C 1
Property Address: i `l+ kD 16 fir, 5 ee;\• c 11,417
Description of proposal/request:
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Record Information (Staff to complete)
Record No:��"n ,
Date Received:
Application Fee: w(p`J•Z��
Technical Fee: $ �•a'
TOTAL FEES: $ -3,F-3. Assigned Planner:
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Prior to licensing, you must provide the Child Care Licensing Division with verification that your Early Learning
facility meets local planning and zoning, occupancy, and building requirements". and Care
.' Al 1 il/GW 'W4/ V I 1✓111141 4A16
Type of License Applying for.
QRegistered Family Child Care Home (RF)
Certified Family Child Care Home (CF)
Certified Child Care Center (CC)
0 Certified School-age only Center (SC)
Ages of Children Being Served:
Fvllnfants
Fv]Toddlers
WlPreschool
F] School Age
Site Address:
1810 15th Street Springfield 97477 Lane
(street address) (city) (zip) (county)
Verification of Compliance with city/county ordinances needed because:
F✓ 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, is 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 center that is not in a public school must meet building code and zonings requirements.
o be �qlle_d Out by the A prop= iat E Loc 1 Aga 1 i.
Planning and Zoning Approval
The proposed child care facility/home is in an approved zone
Signature of authorized representative of Planning and Zoning
■ Yes No
Date 01/03/2024
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(3) In instances where care that is subject to registration, as defined in subsection (2) of rule 414-205-0000. will no:
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.
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 414-305-0130(6)(a) Evidence that the certified child care center meets all applicable building codes and zoning requirements .
Certified School-age Center. OAR 414-310-0130(5)(a) Evidence that the school-age center meets all applicable building codes and zoning requirements
unless the center is in a public -school building.
Signature of Provider/Operator of Facility — Date P1 /03/2024
You are entitled to language assistance services and other accommodations at no cost tf you need help in your language or other
accommodations please contact the Child Care Licensing Division at 503-947-1400.
clear form
Oregon Department of Early Leaming and Care i Child Care Licensing Division I www.oregon.gov/DELC I OCC -010817/2023