HomeMy WebLinkAboutPacket, Pre PLANNER 3/30/2009
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PRE-SUBMITTAf
DISTRIBUXION'~lST:
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Date Distributed:
3-30-oQ
V Dave Puent - Building
~ Gilbert GordonlMelissa Fechtel- Fire
v Jon Driscoll- Traffic .
/' Matt Stouder - Public Works/Engineering
Dennis Ernst/Chris Moorhead, Surveying
Planner, ~L-
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DatEl Received: 0/12-+.9
Planner: ALr
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_ City of Springfield
. Development Services Department
225 Fifth Street
Springfield, OR 97477
541-725-3753 Phone
541.726-3689 Fax
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Pre-Submittal Meeting
Case Number Assigned: PRE2009-00008
Date Submitted:
3/27/2009
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Proiect Name:
1815 MAIN SITE PLAN
Project Description:
Pre-Submittal for 11,000 sf commercial warehouse buillIing at 1815 Main Street
Application Type:
Job Address:
Site Plan Review
Assessor's & Tax Lot #:
1815 MAIN ST
1703363107401
DISCLAIMER: Applications will not be exempt ITom Development Code or procedural amendments that may occur
between the time of the Pre-Submittal Meeting and Submittal of the Application for Development Revie~. Please contact our
office at 541~726-3753 with any questions or concerns,
A Planner will be assigned the following business day and will contact you to confirm the meeting date and time,
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Date Recelved:13p;VJ,701_
Planner: ' AL 1,' 7 .
PlanJobPrint.rpt'
3/27/2009
II :28:00Alv
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Jre-Su)mitta_ ~eeting
Development Services Department': '
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Room 615/616 I'
PRE-SUBMITTAL MEETINGDATE: Friday, April 3, 2009
1. PRE-SUBMITIAL MTG #PRE2009-00008 (Site Plan Review) CHAN
Assessor'sMap: 1-7-03-36-31 TL 74(H i'
Address: 1815 Main Street
Existing Use: Vacant building (former auto dealership)
Applicant submitted plans to convert into an 11,000 sq ft warehou~e commercial building
for (6) units. "
Meeting Date/Time: Friday, April 3, 2009 11:00 - noon DSD~16
Planner: Andy Limbird '
PRE-SUBMITTAl REC'O
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MAR 2 i 2009
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Date Recel~ed:~~h>01
Planner: AL
Site Plan Review
PRE.SUBMITTAl REeD
MAR 2 'i Z.009
, Date Received: 3f~h,f)o?
, Planner: AL
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:City of Springfield
Development Services Department
22"5 Fifth Street,
Springfield, OR 97477
Site Plan Review Pre-Submittal: IKl
ISite Plan Review Submittal: 0
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':343-4734
Applicant Name: Kit & Karen Chan Phone: ':968-8972 (cl
Icompanv: Kit & Karen Chan FamilvlFax: 343-4949'
!Address:' 2222'Hartin Luther King Blvd., Eugene, OR 97401
I I 895-4424
Applicant's Rep.: Wade Stevens' Phone: 'i7Q-442fi (("')
Icompany: WA Stevens .Construction IFax: 8'95-'-4424
!Address: P.O. Box 1078, Creswell, OR 97426 I'
Ip~operty Owner: Kit & Kare~ ~han Phone: P43-4734
Icompany: Kit & Karen Family Trust, LLC Fax: 3'43-4949
IAddress: 2222 Martin Luther King Blvd., Eugene, OR 97401
l,w-'w;,n%"'kir':~h"""""";"","'_;J"WMIM""''IKWiU~",,,*,,:)a:,,_;~,,!'''''''~.~'''=!<~'''''=,,,,,,,~1'_""";"::""""_"~"''''''mt,,;''''=m''''''''''''ml1'-'i%'Z1Wl'1~;01p.~!0:*m:;;7cm-:..;,0%Hr;;.''"'';::;;:'hH;~=lrt€."&."""~:"""'1'~"",.~Jii
IASSESSOR'S MAP NO: 17-03':'36-31 ITAX LOT NOfS): 7401
I Property Address: 1815 Main St., Sprinqfield, OR 97477
ISi~e of Propertv: .71 Acres [Xl SauareFeet 0
I Name of Proiect:
I Description of . If you are filling in this form by hand, please. att~ch your proposal description to ~riS application.
Proposal: 11,000 Sq. ,ft. warehouse commercial' spaces. (6, uni ts) .
IExisting Use: 'vacant (formerly auto dealership) i\
INew Impervious Surface Coveraqe fIncludinq Bldq. Gross Floor Area): 8642 sf
Si natures: Please si nand riate bok, on the next paqe,l
Associated Applications: (1:w. Ui::H - yO 2L' t ((fJ? I
\pre-sub Case No.: P/-(,/~G ,-~'t, Date:~/;(fIDor
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Case No.: Date:
IAPPlica~ion Fee: $3 .c.rG,,6\) ITechnical Fee: $
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TOTAL FEES: Ji<c,~ PROJECT.NUMBER:
Reviewed 'by:
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Reviewed by:
Ipost~qe Fee: $'
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2b~C(, 0:008
Revised 1/1/08 Molly Markarian
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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 original signature will riot be accepted.
Pre"'Submittal , .
Owner:
The undersigned aCknowledges that the j'nformation in this application,is correct and accurate for scheduling of the
Pre,Submitt Mee:,n: ~'Date;~ _ 3 '~67
Sig ~7h
prin~/7 ,l6)P1-/ (YtjAtJ
Submittal
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I represent this application to be complete for submittal to the City. Consistent with the completeness check
performed_of! this application at the Pre,.Submittal Meeting, l affirm the information identified by the City as
necessary for processing the application is provided herein or the information will not be provided if not otherwise
contained within the submittal, and the City may begin processing the application with the information as submitted.
This statement serves as written notice pursuant to the requirements of ORS 227.178'pert~ining to a complete' '.
application.
Owner: '
Date:
Signature
Print
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PRE.SUBMITTAlREC'D
II
MAR 2 72009'
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Date Received: ~;;I-I:,' 2wl
Planner; AL
Revised 1/1/08 Molly Markarian 2 of 10
CITY OF SPRINGFIELD
VICINITY MAP
PRE2009-00008
1815 Main Street
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Map 17-03-36-31
Tax Lot 7401
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PRE.SUBMITIAL REC'O
MAR 2 '1 2009
Date Received: 3/Bo}oof
Planner: AL: . '
NARRATIVE
Site Plan Review-
1815 Main St., Springfield, OR
Kit & Karen Chao
Prepared by GeOmax, Inc.
806 N Ninth St.
Cottage Grove, OR
Page 1 of 4
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PRE.SUBMITTAL REC'D ~ '
" MAR 2 7 2009
Date Rec~ived:~<!.fa b.oo~
Planner: AL ' /" F ~ ,
Narrative,
Kit & Karen Chan
March 6, 2009
Section 5.17-120 Submittal Requirements
A. General Requirements
i. Scale shown on each drawing,
2. street address and tax map and lot shown on Site Plan:
3. Dimensions and size oflot shown of Site Plan. '
4. Existing buildings paving, ea:sements and utilities shown on Existing Conditions
,Plan, Proposed building with dimensions and setbacks shown ~n Site Plan,
5. Existing fences shown pn Existing Conditions Plan, proposed f~n:ces and tr\lSh
locll;tionS Shown on Site Plan. No other outdoor equipment is planned, No
signage planned at present." ~ .
6. Number of employees is not known at this time: The proposed building is
planned for warehouse retail; No leases are have been signed at'present. The site
will not allow future expansion. :'
7. Total lot area is 31257 square feet. Existing impervious area is 22208 square feet
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(73%). Proposed imperVioUs area is 28261 square feet (90%)., '
8., Building will be greater than 50' in a north-south plane,
9. Extenor elevations attached. ~
10. No property will be conveyed, dedicated or reserved for public or semi-public
uSes except requested sanitary sewer easement relocation.
B. Site Assessment
1, No watercourses exist at or near the site. ,
,2, No floodplain: or floodwayboundaries exist at the site. (FEMA ranelII61) ,
3. The site lies outside the 10-20 year Time of Travel Zone.
4. No significant physical features exist at the site,
5. Soil type information shown on shown on Existing Conditions Plan.
6. The site is not in a natural resource protection area. ",
C, Access, Circulation and Parking 'I
1. Parking spaces; driveway aisles, wheel bumpers and striping are' shown on the
Site Plan, traffic flow and acCess are shown on the supplemental ODOT access
plan attached. '
2. Shown on supplemental ODOT access plan and Site Plan.
3. Shown on supplemental ODOT aCcess plan and Site Plan. ,
4. Exterior lighting shown on Site Plan. " :
5, ,Short term bicycle parking is provided at the front of the parking area. Two spaces
provided at each side of site. Long term bicycle parking will be:provided by
Date Received:
Planner: AL
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I: PRE.SUBMITTAl REC'D
MAR 2 7 Z009
Page 2 of 4,
Narrative
Kit & Karen Chan
March 6, 2009
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tenants in warehouse area of the space. " ~ ,
6. Gross floor arc;a of building: 11,000 square feet all of which is applied to parking
requirement. ' Required parking for warehouse sales is 1 space p~ 600 square feet.
ofspace. 19spacesniquired, 24 spaces provided. i;
7, Off-street loading zones will be at each warehouse storefront. '!
8, Eristing transit facilities are located on Main Street. No new transit facilities are
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proposed. " : ' ,
9. Two access approaches currently exist at the site. ~ Application has been made to
ODOT to eliminate both exis,ting approaches in favor of a single approach at the
center of the site providing fewer access pomtsonto Main Street and greater
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separation between approaches.
lO.No traffic impact sfudy has been done.
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D, Landscape Plan
1. ,Thesite shall be fenced,with 6' chain link fencing, Slats shall be installed at the
south erid of the site to provide site blocking for trash areas, No'residential '
properties adjoin the site. '.
2. Stormwatei treatment Will be through filtering catch basins,
3. Permanent irrigation plan is shown on the Landscape Plan.
4, Street Trees shown on the Landscape Plan replace existing trees to be removed ~
from the site. .
5, Irrigation shop drawings and final planting specifications shall1:le submitted and
approved prior to commencing work. " , 'I; .
6:, Description of planting methods shall be submitted prior to commencing work.
E., Improvements.'
1, Existing streets shown on plans.
2, Existing fire hydrants and utilities are shown on plans, Existing transformers are
pole mounted, 'utility poles are shown on plans. .
, 3, ' Existing sidewalks shown on plans, No new sidewalks proposed in this project.
New access shall comply with City standards, :r
,4. Existing utilities shown. on plans. Proposed changes to sanitary:sew-er easements
shown on plans. ' ' ~
F, Grading, Paving. and Stormwater management. ,
1. Roof drairiage is split equa.iJ.y to each side of site and is ,shown ~n Underground
Utility Plan. , .'
2. Impervious drainage patterns shown on Grading Plan. Perviousliareas are only' in
the planter areas. .
3. The Underground Utilities Plan contains details of storm water management on
Page 3 of 4
, Date ~eceived:
Planner: AL
3f~~;(
PRE.SUBMITTAL REC'D
MAR 2 7 2009
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. ~' Narrative
Kit & Karen Chan
March 6, 2009
the site inCluding treatment, piping and outfalllqcations. . :;
4, Existing and proposed elevations are shown on the Grading Plan..
5. Stormwater management system is shown on plans and attached ,documentation.
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G. No phased development is proposed.
H. On site lighting plan shown on Site Plan and attached doCumentation.
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I. Additional Information.
1. Property owner is applicant.
2. Vicinity map is on the Site Plan.
'3.. Not applicable. The site does not lie in an overlay district..
4, Discretionary use not applicable.
5. No tree felling will take place.
6. No annexation is required.
7, No wetlands present.
8. A copy of bDOT access application is attached. . , "
9. A geotechnical report isncit required. NRCS soils information ~:sattaclied.
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K:\Projects\2008\I182\WpdocsINARRAT1VE.wPct
Page"4 of- 4
PRE.SUBMITTAl REC'O
MAR 2 7 ZDOS .
Date Received: 3Ay"'"""L.
Planner:, AL 7,. .
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Depart~entofEnvironmental Quality
, Western Region,
1102 Lincoln
Suite 210
Eugene, OR 97401
(541) 686-7838
John A. Kitzhaber.. M.O:, Governor
January 17, 200 1 ,
Estate of Esther Nicholson '
c/o Mr. Wayne Helikson
Gaydos, Churnside & Baker, P.C. ,~
P,O, Box 1499
. Eugene, OR 97440
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~G'D JAN 23 200'1
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Re: '
LUST #20-90A059
Phillips Auto Mart ~, : DR'E'SUBMI'TIA' L REC' 'D
'1815 Main Street, Springfie](J. , . , ,~ .' ~ ~
No Further Action "MAR 27 L009
Dear Mr, Helikson:
The Department of Environmental Quality (DEQ) has receiv~d the ~ytica1 r~port from O~con'
Environmental. Management, dated January 9, 2001, for the soil sample requested ill the
Department's December 26, 2000, correspondence. A review of the report as well as a
comprehensive review of the underground storage tank cleanup file has b(:en ~mpleted.
I
The Dep~ent has determined' the investigation and cleahup of the petroleUm release meet the
requirements of the Oregon Administrative Rules (OAR) 340-122-205 tm;ough 340-122-360;
specifica1lyforthe requirements, of the Generic Remedy for Simple Risk-Bailed, Cleanups, and that
no further action is requij;ed ,at this time. This deteililination is a' result o(~ our evalu~tio:n and
judgIllent based oil theiegi.ilatioils'and facts as we now understand them, including the following.
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,1. Petroleum con~ted soil and groundwater was discovered at the subject site during the
~ removal of three gaSoline arid 3 diesel!stove,oil undergro:un4 storage taIlKS (USTs) in March
~ 1990. ' . , .' , ".:..::,",'N: ,I. '.
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2, Four initial sOil samples were, collected frofu the. gasoline UST 'excavatioDS located on the
northern half of the property. ' Each sample waS analyzed ~ for total petroleum hydrOcarbons
(TPH) by EPA method 418.1. Petroleum hydrocarbons were detected in1!one sample at 175
mgikg. Additional samples were collected adjacent to this sample and an~yzed for TFH and'
BTEX compounds. ,Petrol~umhy:drocarb()ns were detected at l46'mg/kg, No benzene was
detected at a detection l(:veI of 50'~g/kg. Ari'illitiaIgroundwater sampldrom water in the
'. ' . ". ~.,. \." ':. ,.' ' . ,', __,'i . <' ..' . . ".
excavation was collected and analyZed for BTEX compounds. No 'BTEX compounds were
detected. A second and thirdgro\1ndwatersample was collected ,near the gaSoline impacted soil '
and analyzedforBTEXcompounds. Benzenewas detectedat 118 f'g/I. : ,i ~ " '
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3. TWo initial soil sampleS were colleeted'frciinthe"diesel!si()ve oil USTexcavation located on the'
southern half of tho'prQperty. ,; Each s~'rr;pie:;';as ~yWfqr TPH.Petroleum hydrocarbons
were detected at 1,I70irig/l<:gand .1/2~0'mg!lcgt)<:iy(aclditi6nal samples viere collected from
the limits of the uST~x4v~tion:'andailltlYzOO-foi~R,i",f~troleuID hydroCarboDS were
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, , Date Received', 0D/~"r
-, Planner: AL
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DEQ/WR.101 4-98
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Mr. Wayne Helikson
January 17, 2001
Page 2
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detected in four of the samples ranging from 542 mg/kg to 3,570 mg/kg. .< Two worse case
samples were also analyzed for BTEX compounds. No BTEX compounds were'detected. A
groundwater sample waS collected from water in the excavation and ~yzed for BTEX
compounds. N~ BTEX compounds were detected. '
4. Several test pits' w.ere excavated in April 1990 to determine the extent, of the diesel
contamination. Soil samples were Collected from the test pits and analyzed fOIi:TPH. Petroleum -
, hydrocarbons were detected in three of the test pits at concentration ranging :from 2,020 mg/kg
. . ,I, .
to 2,310 IIlg/kg. ' . .. . , , , '
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5. Seven additional test pits were excavated on April 15, 1998. Soil samples w~re collected from
frve of the test pits' and. analyzed for diesel by DEQ method NW'f:PH.Dx. Diesel
concentrations ranged between 410 mglkg and 4,700 mglkg. Additional analyses for PAH
compouridS were completed on three samples. Several carcinogenic PAH compounds exceeded
generic risk-based concentrations. I,
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,6. Six borings were drilled December15, 1999, to further asseSs the contamination. Three of the
borings were completed a.S'tnonitoring wells. Soil samples were collected:l,from four of the
borings ,and analyzed for gasoline or diesel as,appropriate. Diesel was <k.~~ in boring B-3 at
a concentration of 1,120 mglkg, Lower levels of kerosene and lube oil were !lis<> detected. No
gasoline was detected. Groundwater samples were collected from borings iB-2and B-3 and
analyzed for BTEX and PAH compounds. All detected compounds wer~ below the most
stringent generic risk-based concentrations. " ~:
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7, Groundwater samples were collected from the three monitoring wells on January 25, 2000, and
analyzed for BTEXand PAH compomi.ds. No BTEX or PAH cOmpounds were detected,'
. . "', - . ,.
8. Approximately 745 tons of petroleum contaminated soil was excavated froIll"the southern half
of the property 'in August' 2000. The contaminated soil was transported ti? and disposed at '
Coffin Butte landfill in Corvallis, Oregon. "
9. Twelve,confrrmation soil samples were collected from limits. of the excavation and analyzed for
diesel. Diesel andlor.1ube oil was detected in 5 of the samples. 'The mixim:llm concentrations
were detected in sample NIC-OO-05 l!t 5,150 mglkg diesel and 5,240 mglkg I~be oil. Basedon
sampling results and 'observations, OmilioonEnviromnental Management estimates the
rem~inine contaminated soil to b~ approximately 30 cubic yards. Additioniil excavation was
not practicable due to on-site structures and utilities.
10. The Department requested an additional soil sample be collected in theviciItity of worse case
sample NIC-OO-05andanaIyzed fot BTEX and PAH compounds. A boring was advanced on
January 5, 2001, and soil sample collected. Detected conwmin.nt concentrationS were below
the most stringent generic risk-based cbncentrations. . PRE.SUBMrrrAl REC'O
Date Received:' ~b6/Lpf MAR 27 2009
Planner: AL ' ,
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Mr. Wayne Helikson
January 17, 2001
Page 3
11. All detected concentrations from retT1~ining soil and groundwater were compared to the DEQ's
fable of generic risk-based concentrations. All detected contaminonts were at or below the most
. stringent generic risk-based concentrations.
12. All conditions for closure using the Generic Remedy for Simple Risk-BaSed Cleanups have
been satisfied. " . "
The Department's determination will not be applicable if new or undisclosed facts show that the
cleanup does not comply with the referenCe rules. The Department' s determination also does not
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apply to any.conditions at the site other than the release of petroleum product sp'ecifically addiessed
. . .
in the report., We reconnend that a copy of this information be kept with the permaiJent property
reCords. ' ~ ~
Please note that pursuant to OAR340-122-360(2), a copy of your report must qe.retained until ten
, (10) years after the first transfer of the property. :
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. Your efforts to cOmply with the regulations to ensure that this propertY has been adequately cleaned
up have been appreciated. If you have any questions, please feel free to contaft me at (541) 686-
7838' ext. 232. '.'
Sincerely,
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Dave Belyea '
. Natural Resource SpecialiSt
\v\J% L~
Merlyn L. Hough
Regional Tanks Manager
Dl,Ul/drb
c:\drb\phillips.nfa
cc:
Fred Scalise,
OmniconEnvironmental Management
PRE.SUBMITTAL REC'O
I'
, MAR 2 7Z0H9
Date Received: ~ft~/Hof,
Planner: AL ' ~ ' ~'
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n I, I =;1 n ll~ PROPOSED LOT DEVELOPMENT
, m j '~ j ~ ~~ ~ i _~ ' ,KIT & KAREN CRAN ,
tV ~ 'I 'SITEPLAN '
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DATE RECEIVED BY ODOT:
CHAMPS 10#: ,:
]~",g'on
Oepllrtmt1nt of
TransportatlDn
LAND USE COMPATIBILITY STATEMENT:(LUCS)
What Is a LUeS? A Land Use Compatibility Statement (LUCS) is the form ODOT uses to ensure that Highway Approach
Permtts are consistent with local land use requirements,
Why IS,a LUeS Required?ODOT Coordination Rules, OAR 731-015, identify Highway Approad\ Permits as permits that
affect land use, State law requires ODOT activities that affect land use to be consistent with acknowledged local
comprehensive plans..,
When Is a LUeS Required? An ODOT LUCS must be submilted wi,th every ODOT Highway Approach Permit
Application, "
How to Complete the LUeS: The applicant completes Section 1, Section 2 must be completed by the local jurisdiction,
The applicant then submits the completed LUCS to ODOT as part of the Highway Approach PelTT),it Application.
I SEctlt)N1:App@a'iiiiiiid SltelrifCin,uitiCiil , , ' Ii
IApplicantname: liMnG: .It .5/(3V~~ ~ ' J-
IAPplicantsignature: X lA;r~ ~~ .J :.IDate:p!<lle9
I Property owner name: K iL....k A'ir:.J\\J (l ,~'A~III, I J LJ I-..l QJ,
I Subject property address: 19.1:)' Nf\ iN 5+. 5Pf(IN!:;'Fi"f.LD,.QR,: g'7/.f1'1
I Site description: n::.oPG1<:::rLI A.D'oiWx JSI"Y .d),{)qi fJD5()JfJ/AJC~ IVJlti,d:5-t.
Describe ,the prop~sed activity, us~ or de~elopment, including type ,and volume of traffic it will ge+rate: ' ,
, ,(0- "S1:)()PS\O~~i~"\ ~ILSldC,f'(rt.. 1'f\\1\::)\!-)vf\l:;\(\7fWEl<L-- J! ~
TIl)(., t TownShiP(s):. ' I Range(s): ' ISectiOn(S):, ITa~ lot(s):
L.oi:tf /1"{)3. 3/';'-51.-{f)Lfoj Section 2 must be completed by a Local Planning Official.
I SE:,q"it;lN2:D~t~rri\illatIOilClf COMpliance with Local Land Use Requirements ,
The subject property is: IXIlnside city 1i0000s 0 Outsi~e city limits 0 inside UGB 0 ~!SideUGB ': ':nn
Current Comprehensive Plan designation: LDI1'\1\'\Qr{( a1 Current zoning: \.:c:D /'VIm [(lIhl--CQrM frU<<z
Is a Comprehensive Plan or zoning amendment proposed? 0 Yes ,Il{f No !i 0
If yes, list the proposed plan designation: Proposed zoning:
Does the activity, use, or 'development require land use review to determine cpmpliance with regulations? ~ Yes 0 No
If no, it means that no local land use review is required, Skip to Local Planning Offic/allnformation section below,
~ If yes, what is the status of the land use application? tJ Approved 0 Denied 0 Under rev'iew ~ Not yet received
List file numbers: Is the decision' final? 0 Yes 0 No
~ I'
Comments;
I Local Piliriil,illl Offiolallnfonmition (Required)
I Jurisdiction: City Of ~ r ri I'\~ -l i -( lti_ ' ,
I Pianning official name and title: U 2.- N{ J~ I f,. \? I tV\ fl if"'-c
I Mailing address:;))'5 ,h)M\...S--tvu+- ' J '
I City, state, ZIP: "'(J(I f\O~j.fJt,.{ , OL l17Lf7l
IPhone:IJ:')4 I) '1.1Io--QJBj) I I jFax: /sLltl ~ I ).Ir 3fu'{/,! ICell/pager:
IE-mail: LIY\illr/l;JC;.J.rinaJ.I.frti.{Jr.L1 \;
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Planning official signatura: X IlJ '1M. JJ^-/ ~ ,'~
73+25.0 (9107) ~ Page 4 of 4
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;;IDate:~ /c21// (fi I
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Date Received:--=;I.?y,:u>&>1
Planner: AL
1/
P~E.SUBMlrrAL REC'O
MAR 27 2009
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Department of
rransportat~on
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APPLICATION FO~ STATE HIGHWAY ApPROACH
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Required Information "
The applicant must submit the following information with the Application for State Highway Approach, ODOT will notify
the applicant if additional information is required, "
. ' All attachments required by answers on the appiication form, including applicant signature.
. If the applicant is not the owner of the property to be served by the approach, then the property owner must authorize
the applicant as a designated agent. The applicant must have the property owner complete t~'e Authorization of
Designated Agent block on this form OR submit a signed letter from the property owner auth6rizing the applicant as
the designated agent. :
. Site plan and vicinity map approved or currently being reviewed by the local government. .
. A Land Use Compatibility Statement (LUCS) for a State Highway Approach (page 4 of this application) must be
completed by the local governm9nt.~'.
. A copy of the current County tax lot map for the property served by the approach, Map must highlight all propertY~ that
wouid be served by the approach and'listall owner name(s) on adjacent properties, Make a note on map ifownership
of adjacent property is same as subject property, Identify the location of the proposed approach on map.
. A copy of the recorded easement(s), if the subject property has an existing easement(s) for a:ceess to the property,
. A copy of any existing state or local government approach permits for the property,
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In addition to the above submittals, the applicant may be required to place stakes or markings near the highway shoulder
at the proposed approach location. ' ,
Definitions for co';'monly used terms are in the attached brochure, The brochure is also available on the ODOT website
iocated at htto:llwww~oreoon~oov/ODOT/HWY/ACCESSMGTI
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I A'ppllg~nF~f~i:ii!a#9H")':::',, ',., ,
I Last name: s-n::Jl=:I\.l::5 I First name: LV-f\D7=_
I Street address 3S J Y1 '5112./ "k. +li Ll iZD '
ICily: ~eE"SWE:J/ !State:C)R. IZIP:Cf74:JJ.t I County: ':L.4fJS I
I Mailing address: .::p, 0, tx) '>t I 01'7 9-,'_1
ICily: Q K'F,"SWE II State OR.. IZIP:q7.Lj.~ lo ICounty: lJ.JIf,JE I
IPhone:!)'L.J}- c::,JCf-lfLj. z.u' I Fax: 5L,l~- ~~-~~gB, !cell/pager:5i../)-'?)fJQ-L/-4:V4> I
I E-mail: Lt )R5:r:1\1 L -At: (l r,::: .STU RLFb:: I.. N Go T I
Is applicant working as an agent of the owner? J~ Yes 0 No , ,I ,
If yes, the owner must complete the Authorization of Designated Agent section below, OR the applicant attach a letter
from the owner authorizing the applicant to act as hislher agent.
IApi)ro~!l~I(;<i~#~iofiY';': , ., .. ,,~~. "," ~ " , ,'.', ,. .. ,~. I
Highway name - May be a statewide highway name, such as Pacific Highway, or a local name, such as East Main Street
Route name - The posted highway number, such as 1-5 or US-84. , .
Highway name: M 4i 1\\ Si:' Route number: County: 'L-tJ rV E
Milepoint: Side of highway: 0 North aSouth 0 East 0 West "
Is the highway in a national forest area? 0 Yes 1&1. No
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ICompany WA, -:5rf;v-ir:rs (f,tJ5j ~--rNQ" .
734.2680 (9/07)
Page 1 of 4
Date Received:
Planner: AL
3hO~(Jp
/ /
PRE.SUBMITTAL REC'O
MAR 2 7 'Z009
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'1 AlIihofi~~~O~o;~f:!i~#';lI'r1aiil.tlA~ellf;,'.,"
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. PRINT NAME OF PROPERTY OWNER
to represent me in the ma~.ter 0 is hi9hw;w';;PRfoach permit application,
I Owner signature: X f"y, L! /,!/ ......----- Date: ii/I~/rf11
fAppllc;an(Slgi\~tu~ . '.' ..-: ,~';~ ~.,' ~'.i'il' '" ~J
NOTIFICATION TO APPLICANT: The ODOT District Office will contact you when your application has been reviewed, If
additional documents are required to continue the application process you will be notified, When ~all of the necessary
documents have been received, Ihe application will be deemed complete. If your completed application is approved,
preliminary construction specifications will be issued. A performance bond and liability insurancei:will be required before any
construction work can begin on the highway right of way. For the complete rules regarding approach permitting, see OAR
Chapter 734 Division 51. I'
The Appli~nt declares, certifies, and affirms under penelty of applicable state or federal '~ws that all information
1:;;:;ji,:i~;::Z;<<f'~?1- ~11oq I
I ,~..PP .~.. ..",.." ... ,~, ~'."~ ,.' .." "../. " . , " I
D ~ New Approach - There is no existing permitted or grandfathered ap~roach road at the locati~on requested In this ~-~_.~,
application. :
D Temp6rary'Approach - The~ approach requested will be removed after a specified period of time.
~ Existing Approach - This application affects, or may affect, an existing approach, "
D 'Restricted Use Approach - The approach requested is for emergency services, government, utility access or similar
specific uses with limited traffic, ,', i: ,
I VehlcleJij'j'niiiij"'Moiiemelits',/,' "1
I TU~~ ~~~~~:~t,~~:q~:~te~: D All OR check all that apply: D Right D Right out ~ Left in Et Left out I
!Property;Owller,:lnformation'.... , ""'~:'" ,~" ", J
i~~:;:::r:~:~~i~~M~~~met~Sg. kA~~ 't() )companY:1rr~ k~t7iN?!hAN1A~rl~ LL~
ICity: E..0GntN'f IState: (If' . IZIP: ~ ICountylL.ANC: I
I Mailing address: "S A tJ i:: "I
I City: I State: I ZIP: I county:];_1
Phone: Fax: I Cell/pager: I: I
E-mail: , I
IAre there additional owners of the subject property? D Yes ~ No, :
If Yes, attach the same contact information as above for each of the co-owners on a separate sh~et.
I PrCipilitYJiifoi'rriatio'n
Subject property address(es): I B IS N\ 1'\ IN ST
CitY:I..~PJZjtJ~F;E:.Lb I State: QfZ. ZIP:<1'l4rJH ICounty:'.lJ'lNE
~TOWnShIP(S): I Range(s): Section(s): ITax lot(s):
Current zoning: Col'u\^^~ i A:L Proposed zoning: (1nI\JMt-n1l!xA,L
Iln the boxes below, describe the existing and proposed land users) on the property, including sq~are footage or acreege.
Existing: -A5Ar0b0r0'E-P Uv<'iP CY\ R. 0Jr' Proposed: l.JJ Or/-; ,U/5hops /
ct <3ryw;I/ o-ff'lU> ApplZ.DX IOOOyd. 1I/)OOp'J JODX ~/O 'x)lf
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authorize
{jJflD E .:sr'EYE Als
PRINT NAME Of APPLICANT
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Page 2 Qf 4
/ '1-03 -3D -3/ - O,/2fQU
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Date Received: 3/JojifDOf;
Planner: AL 7 :i
'i PRE.SUBMITTALREC'D
MAR 2 72009 '
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Has the local government approved a site plan or is the local government currently reviewing a plan
for the proposed land use? ,
~, Yes (If yes, attach a qopy of the plans being reviewed by the local government.)
o ~o '
i;@m!1l;t;l:~!!iIP!!:q'i;;"\:;~,;;i~;:;gn~itf;;J;)~~4;;~fj'fg$itl1~~~:~:;r!%;\~~Si!1u;i'JHi1;;[FP.~Vf":;'~;i!((;1:}\'R;~,;;[,[)[e7;;':(i;i"f']
Submitdrawing(s) no larger than 11" x 17" in size. Site plan(s) shall include all applicable
information listed below: "
Property location and property lines, including:
o North arrow ,
o Show all lots or parcels that are part of the property or development with their
corresponding tax lot numbers identified I
o Distance from the property lines to the center of the proposed approach :
Using solid lines,. show:
o Proposed approaches with requested width and turning movements shown
o Proposed & existing buildings and structures to be retained "
o Proposed use of existing buildings and structures to be retained
o Other proposed equipment or facilities and their proposed use
o .Proposed access or "cross-over" easements with neighboring properties ii
o Nearest approaches on both sides of the highway within 500' of the proposed approach
center-line
Using dashed lines, show:
o Existing approaches with 'width and turning movements.shown
o Place an "X" on approaches to be removed
o Existing buildings and structures to be removed
o Existing equipment or facilities to be removed ,
o Other existing facilities to be removed
o ,Existing access or "cross-over" easements with neighboring properties
Show proposed on-site circulation, including:
o Travel lanes with travel directions indicated
o Travel lane widths
o Parking spaces or parking areas ,
o Access locations to the parking spaces or areas
Show nearest landmark or cross slreet:
o Provide nearest cross street name
o Distance from the requested approach location to the nearest cross street
o All public streets that abut the property(s)
734,2660 (11/07 - District 5)
Page 3 of 4
PRE-SUBMITTAL REC'O
,
MAR 2 7 Z009
Date Received: 01).oof
Planner: AI.