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HomeMy WebLinkAboutApplication Applicant 8/28/2024City of Springfield Development & Public Works 225 Fifth Street Springfield, OR 974771k SPRINGFIELD LAND USE COMPATIBILIITY STATEMENT (LUCS), DEPARTMENT OF MOTOR VEHICLES (DMV) and ZONING VERIFICATION LETTER Application form Wept OT motor venlcles-New: L_j Lana use Compatibility Statement: iJ City: ►J Dept of Motor Vehicles -Renewal: ❑ Project Information Applicant Name: r j M'1 Zoning Verification Letter: ❑ UGB: ❑ c Phone: 2-12 –//I� -2-ZZZ Company: ac N D E-mail: i-trmcw' v' Address: S� f f -\,R LC� q Property Owner: S tv Phone: .5(l %S4(- (Y V_ Company: E-mail: Address: ASSESSOR'S MAP NO: Property Address: 3 S Z 1 `ln &A TAX LOT NOS : k l ��"'j C--N_C. O c Description of proposal/ request: Record Information (Staff tocomplete) �I f Record No: o I Date Received: Z Application Fee: $ 00 Technical Fee: 0 225 TOTAL FEES: 3$3. z-� Assigned Planner: 1 /`? 1' IV- Revised 2023 04 04 slm • cow, APPLICATION TO CORRECT DEALER / REBUILDER otramneNr a ♦aaaewmanon VEHICLE DEALER CERTIFICATE n,xo.vF,rs� DEALER NUMBER EMAIL iws uwaave NL sa,n, onrron omu 1(o 2- 5 go, a 6rmu►u /1u)0sJ EFFECTIVE DATEEXPIRATION DATE CURRENT BUSINESS NAME //�'/Y Are AID PT L Check the reason for correction: ❑ Name Change 4WAddress Change ❑ Add / Remove Owners ❑ Org. / Structure Change Instructions: VALIDATION USE ONLY • The fee for a corrected certificate: $30. • Name change and/or address change: $30. Attach Bond Rider and Insurance Certificate. • Organizational structure change: $30. (e.g., Individual partnership or LLC to Corp.) Attach a bond rider and insurance certificate. • Adding/Removing LLC member or corporate officer: No Fee • Each new owner must complete and sign lines 12-16 or 17-21. • Each owner being removed must sign line 22 or 23. 0 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 busun� name, RII In Reg'stry Number -)OREGON BUSIH EGISTRY NUMBER F bi RAL EMPLO IDr.r•;TIFICATION NUMBER 2 Any alteration of Line 3 voids location approval. ADDRESS CHANGE NEW STREET ADDRESS WHERE BUSINESS w!LL BE.CONDUCTED []RESIDENCE ❑ PREVIOUS SUPPLEMENTAL BUSINESS TELEPHONE 3 352--1 bra eIt 9JVJ �s�l/ ) 313 3333 4 CITYIP CODE COUNTY 1 tie, q 7903_ 5 RESIDENCE ADDRESS CITY ZIP CODE EMAIL 6 MAILIN ADDRESS CITY �ZIPCODE PREVIOUS STREET ADDRESS OF BUS ESS LOCATION CnY ZIP CODE 7 ST S priz 4 LOCATION APPROVAL - Required on y 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. e zoning official or jurisdiction where this business Is a ieR, I verify by my signature below that the IocaGon o t is 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). 8 f TELEPHONE NUMBER LON CITY OF: S �l �� l COUNTY OF: ' ) L4i_ 2-3 I 9 PRIN N4M� (I L- t(J� 1 TITLP 10 SIGN TU X DA V 4— ❑ Restrictions on the location 1 here ■ approval are in an attached APPROVED letter from the zoning authority. CRY OF SPRINGFIELD nntrK, anA S; n� i rdudin l4qS r, ufr ('L Qrn�oiur S �n �rmt i- �v �r 1 i l d rpi i V13 1, oe"� 2A' 2' 24 25 26 27 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 nr nocennr 1 i�nnw mncf In. Innlhln If fho —.6.1 rn oAAr... nn fhn nhnfn Ill is /fi FV —f +k— fhn ranular.. — -,4,4--- listed below, submit a statement explaining why the addresses do not match. © Individual 0 Partnership ❑ LLC E] 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) I 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 CERTIFYING SIGNATURE OF OWNER SHOWN ON LINE 12 ABOVE DATE X PRINT NAME (MUST SIGN LINE 21) EMAIL TITLE DATE OF BIRTH DRIVER LICENSE NUMBER STATE OF ISSUE HOME PHONE NUMBER RESIDENCE ADDRESS CITY STATE ZIP CODE MAILING ADDRESS i CITY STATE 2W 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. CERTIFY OF OWNER TITLE .IUG.SIGNATURE X 0�f NEW BUSINESS LOCATION INFORMATION Property is (check one): 0 OWNED F-1 LEASED / RENTED: LEASE OR RENTAL PERIOD: If property is "Leased / Rented" complete the following: PROPERTY OWNER'S FULL NAME (As shown on County Properly Records) TELEPHONE NUMBER ) PROPERTY OWNER'S MAILING ADDRESS CITY STATE ZIP CODE Don't Forget! ti« For name change, address change and organizational structure, a bond rider from your bonding company and a new insurance certificate must be submitted. i One current owner MUST sign Line 24 CERTIFICATION CANNOT BE SIGNED BY PERSON BEING ADDED ON LINES 12 OR 17 • Location approval is required when changing a business location. A fee of $30 is required with the exception of a change of LLC member or Corporate officer which requires no fee.