HomeMy WebLinkAboutApplication APPLICANT 2/29/2008
City of Spnngfleld
Development Services Department,
225 Fifth Street
Spnngfield, OR 97477
Site Plan Review
PRE-SUBMITTAL REC'D
FEB 2 9 2008
Application Type (Applicant: check one)
Site Plan Review Pre-Submittal: ~ Maior Site Plan Modification Pre-Submittal:
Site Plan Review Submittal: O-Ma"or Site Plan Modification Submittal:
Applicant Name: Jim Barta
Icompany:
IAddress:
,
IAPPllcant's Rep.: Josh Gertsen
Icompany:
IAddress:
,
I Property Owner: Frank Collins and Gaynor Hintz-Representative Phone: 541-461-6888
ICompany: Emerald Square Dance Center Fax:
IAddress: 2095 Yolanda Avenue, Spnnqfleld, OR 97477
,
IASSESSOR'S MAP NO: 17-03-24-43 ITAX LOT NOeS): 2319
I Property Address: 2095 Yolanda Avenue, Spnnqfield, OR 97477
ISize of Property: 188 Acres ~ Sauare Feet D
I Proposed Name of Proiect: McKenZie
,
I Description of If you are flll109 In this form by hand, please attach your proposal descrrptlon to this application
Proposal: T-Moblle proposes a new, detached, stealth deslqn 80'-0" WTS faCility
I EXlstmq Use: Dance Hall
[New ImpervIous Surface Coveraqe (Includmq Bldq. Gross Floor Area): 900
Si natures: Please Sl nand nnt our name and date In the a nate box on the next
503-544-2429
T-Moblle West Corporation
1500 NE Irvlnq Street, SUite 530, Portland, OR 97232
Phone: 360-609-2399
SecuraSlte LLC
,Fax:
360-326-1540
1631 NE Broadway, PMB 100
sf
'. .
-. . . -
, , - -
ASSOCiated Applications: 1-0r-J 1007- - oooe; V>
Ipre-sub Case No.: Prt'z/lOD9 /" ocol r Date: J-b, I O~
Icase No.: '
Siqns:
nit>.
. l
Reviewed by: m 7. yYl
Application Fee: $
506
5D5
Date: Reviewed by:
[TeChnical Fee: $ D !postaqe Fee: $ {)
I PROJECT NUMBER: ~ y-r....; ~ 9J.s.o
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, -
,TOTAL FEES: $
I ~"'~.....~~__
ReVised 1/1/08 Molly Markarran
FR"jdtog-DOCl!::L a~1'- 3:.-.;\.'\ \9\\
I 1 of 10
Owner Signatures
This application form IS used for both the required pre-submittal meeting and subsequent
complete application submittal Owner signatures are required at both stages In the application
process An application without the Owner's orlgmal signature will not be accepted.
Pre-Submittal
The undersigned acknowledges that the information 10 this application IS correct and accurate for scheduling of the
Pre- Submittal Meeting
Owner:
<S:e..<?. C^-~Acll\~P~ nAA@X~llo;t- A')
Signature -
Date:
() /(),~ ~ Q
I
Prmt
Submittal
I represent this application to be complete for submittal to the City Consistent with the completeness check
performed on this application at the Pre-Submittal Meeting, I affirm the informatIon IdentifIed by the City as
necessary for processing the application IS provided herem or the information will not be provided If not otherwise
contained within the submittal, and the City may begin processing the appllcatron with the information as
submitted This statement serves as wntten notice pursuant to the requirements of ORS 227 178 pertaining to a
complete application
Owner:
Date:
Signature
Print
PRE.SUBMITTAL REC'O
FEB 2 9 2008
ReVised 1/1/08 Molly Markanan
2 of 10
City of Springfield
Development Services Department
225 Fifth Street
Springfield, OR 97477
Discretionary Use
Required Project Infor . n (Applicant:. complete this section)
Applicant Name: Jim Barta Phone: 503-544-2429
Icompany: T-Mobile West Corporation Fax:
!Address: 1500 NE Irving Street, SUite 530, Portland, OR 97232
,
IAPPlicant's Rep.: Josh Gertsen Phone: 360-609-2399
Icompany: SecuraSlte LLC Fax: 360-326-1540
IAddress: 1631 NE Broadwav, PMB, Portland, OR 97232
,
/property Owner: Frank Collins and Gavnor Hintz-Representative !Phone: 541-461-6888
Icompany: Emerald Square Dance Center IFax:
IAddress: 2095 Yolanda Avenue, Springfield, OR 97477
,
IASSESSOR'S MAP NO: 17-03-24-43 /TAX LOT NO(S): 2319
I Property Address: 2095 Yolanda Avenue, Springfield, OR 97477
ISize of Property: 1 88 Acres [;><.J Square Feet D
,
I Descnptlon of If you are flllln9 In thiS form by hand, please attach your proposal deScription to thiS application
Proposal: T-Mobile proposes a new, detached, stealth design 80'-0" WTS faCllitv
I EXisting Use: Dance Hall
Si natures: Please Sl
Associated Applications:
Icase No.:
IAPPlicatlon Fee: $
ITOTAL FEES: $
I ~ ~~
Revised 1/1/08 Molly Markarian
, . a _
Signs:
I Date: Reviewed by:
ITechnical Fee: $ I Postage Fee: $
I PROJECT NUMBER:
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PRE.SUBMITTAL REC'O
FEB 2 9 2008
1 of 4
Signatures
The undersigned acknowledges that the information In this application IS correct and accurate
Applicant:
[k~ Q1p~___
Sig(jature ~,
~us'"' (JN~<;I?M-
Prmt
Date:
~ /:9-.q /d~
If the applicant 1$ not the owner, the owner hereby grants permission for the applicant to act In his/her behalf
Owner:
Sou, o...-\-h;dI\OJ OlAA.(E;)(hlb;ff.\\ Date: ?-/11 /()~
Signature - - ./ I I ~
Prmt
PRE.SUBMITTAl REC'D
FEB 2 9 2008
Revised 1/1/08 Molly Markanan
2 of 4