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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 ~- .-....'W'~..~.; ~ P'Y"':_"'IoU.,'"" ...,....,.,...... .lI"',~'f""'>.1.1\'ll.-,"j ~ , - ,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: .... "'- ~ ~ ~".Ir -~ '~"1'9~ ,~ .A ~ .., .. '...."p..",.,..l'\Ih- "'- -W-~"'~"""-~'''''?-$jt:...ly2 PRE.SUBMITTAL REC'O FEB 2 9 2008 1 of 4 Signatures The undersigned acknowledges that the information In this application IS correct and accurate Applicant: [k~ Q1p~___ Sig(jature ~, ~us'"' (JN~<;I?M- Prmt Date: ~ /:9-.q /d~ If the applicant 1$ 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