Loading...
HomeMy WebLinkAboutApplication Applicant 1/3/2024(City of Springfield Development & Public Works 225 Fifth Street Springfield, OR 97477 SPRINGFIELD - �f 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: qV4(�\`{� ^ `\ �V�� �\ \ \+\�V�-• \/ �VK/v\ ice./` i { / (4C,? 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: Revised 2023 04 04 slm (,v,"r U l -T) M •.'•- - • i.. R • 12-177711 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