HomeMy WebLinkAboutApplication APPLICANT 12/31/2009
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[City of Springfield '.
Development Services Department
225 Fifth'Street . .
SpringfieldiOR 97477 ii
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Minimum Development Stan:<lards
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SPRINGFIELD
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Applicant Name: 'IEQ.E:S~ '\Jo02.\-06-SS Phone: 64/.z;',;l.\ .ffi7R
Icom~anv:KALLJ COF'-C:8tLorhDA~(L.{ . Fax: grl'(I)~(()"'&;X'(P I
IAddress: 34r)(i VtZA-r\\U--iniitsL-\jD. V Y.AJG-er\:e.. ,d2-- q71D~ " I
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IADDlicaniis Re~.: [Phone:
Ico~Danv: IF~X: '.
.IAddress: ~!
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I TAx LOT NOfS): 110-:'34-:2.., '7-():)lon
ProDertv Address: 3400 r-/Vt11J~UN DuJ 0 I
SizeofPrope.rtll: /. {j1 _ , Acres'\Zl S9uare Feet 01
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IASSESSOR'S MAP NO:
.1 ~~:~:i:::~n ~t If you are filling in this .f9rm b\ha~d, please attach your proposald~c~ptio~;O t~is application. .
.IE~istinQ Use:: r-O:~l2:\1.'., ~~~~'K~V61LC;:~O~~.. .
~natures: Plea~e sl9n and pnnt'your name and ~ate_lnth:" appro..!?n~~e_ box on the next
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Associated Cases:
'. Case No.: .De.c..w~-Oe034-. Ii IDate:I'2-'~('o"iIReview~d by: ],)'L
"._JAPPlication Fee: $ 7~,ov lec~nicaIFee: ;t;3(P.~' Ipostage Fee: $0'
ITOT~L FEES: $ -'(P~.~ .,~~r~-----T:-~OJ~b~~~-~~'~~~~--- '''~-~''.
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bate Received:
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Revis~ 1/1)08~.Mol'l~ .Marki3rian
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'. DEe 3;,). 2009
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Original submittal
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Signatures
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Appl;ca"" '~"~ 1"';""~;;;: .-~- m.. .w'-" ~OO_'M ""':"".
. '5i{' < " ~'. ' Date: '73{).C/j
51 lIature .' ~ .
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. Print
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. . Own~r:
If the applicant IS not the owner, the ~wner hereby grants permIssion for the applicant ~o act In his/her behalf.
(:3:fL'1-~ ' Dat~:'~~)~ d\' .
~ignCltu..e . . , ,I
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Print. . .... '. "....
I certify that! prepared the attached plot plan and that jt contains the information specified in the 5ubmit:ta1
reQuire-ments checklist.,. 1 certify't~at the plot'plan is accurate based_upi:m field locates and the best . <' .
<available information: I underst:and that City staff will rely' upon the plot pl,an in making any decisions
regarding the Minimum Development Standards, application. I accept_full responsib'i1ity and .lIability in the
. event that there are. any Ol'!lis~i.ons, rpistakes, o!," inaccuracies in the plot plan. " "
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Preparation:.. '),~~~ ,.
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Date:
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Date Received:
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DEe 1,12009 '
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.',Revised 1/1/08 Molly'Markarian
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".' Original S~bmittal,
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Minimum Development Standards .Submittal Requirements Checklist'-
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NOTE':'If.yci~ feef ari'it~m do~snotapply, please state the '~easo;'why a~dClfrach t~e' .
explanation '~o thisforrn.:' . , ."'.,' .
@ . 'APp,li~~iion ~ee~ /~fetto the DeV~/op";;ehtCO.de F~~ !;chedule for~beappropriate fee. ','
calculation formula., A copy of the fee schedule IS available at the Development Services,
. . Department. Any applicable application, technology; and postage fees are collecteciatthe
, .~ ,'/re-submittaland'sUbmittal stages.' , . . '. ',;'" ' . .;, . . . .
'& Minimum pevelop~ent'Standards Appiicati~.mFo~m
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Copy. of the Deed
Copy of a Preliminary Title Report issued within the, past30 d~ys documenting'
ownership and listing all encumbrances. ' .... . . ,"
, Right-of-Way Approach Permit Application provided where the' property has frontage
. on, an Oregon Department of Transportation (ODOT) facility. . .. . , '
, Detailed Written Exp!anatiori of the Proposal to Include:
~ Project na~e;:' "
'l2rSize and lotati~nof,prqpe~y
.l2J~oning and plan desi~nation of the site and adjacent properties'. .
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. ' . [J/Proposed ~se of the d~velopment area and scope of proposed development
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, [21' Access . . . . .
Ja"Proposed off-site improvements (i.e. .installation' of sidewalks, fire hydrants, sewer
" main', etc.) '. .' . .
g-cur~ent use 'onIle site and any existing improvements
...J~J:Specialsite features(i.e. w~tl~nd~, waterc~urses~ steep slopes,:etc:}; a general
statementaddresslng'soil ~ype.and drainage conditions .
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Jd Estimated quantities and type of rTlaterials inv,olved if any fill or excavation is proposed
~Number, type, arig size of any trees to be removed
.."[21' Explanation of any land to be, dedicated to the City
. , ;: ~oposed modifications b'e"iilgrequested . ' .
. j::d Additional planning ap\?lications required forproposed project
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n.nn_'~Q~ju-s1:ificai:icinfor-p~6pos'~dMD,S excepti?n~! . . .
J2rTime.line extensions being requested' . '... '. _ " .
ViVe(5) COPieSOfa:'PlotPlap Includin~ t~eFoUOWing:'Inform~tj~n:.' .,'
. 0 Proposed buildings and/or additions: location, dimensions, size (gross floor (lrea),
. . setbacks from property Unes, distance betvyeeiJ buildings,and height ."
, ' . . ',' ~ -,' - . '
,; 0 The scale appropriate to the .area involved. and sufficient to ~hQ~ de~i1' of.the alan and.
'. related. data, !3uch a~ 1" ==' 30',.1" == 50: or 1n = 100',' ,'. . uate. Kecelved: .'
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DN~.1~<lr[o:N:" ,:'/." ",.:DEC3.l:2009
, DOate.:.of preparation' , . . .
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. 0 Loc~tio~ ~f prop;sed 0;' existinci fence;, outdo~r e~Uipnien;:; st~rage:i:rash' recept~c1e~;c
. arid signs' '.' ..' '.., . ". .' _.- · . "
DL~c~tio~, dim~ri~i6ns a~d' n~mber~f t~pic~l; coinP~ct and d\s~bledparking s~aces; ,
,includirig aisles, landscaped areas, 'wheel bumpers; directional signs and striping.
Dan-site loading area;'andvehi~Ula~ ~ndped~striancircula~ion.. " ' '.
D Access to streets, alleys and properties to be served, inciuding the location and .
dimensions of existing. and proposed curb cuts and curb cuts proposed to qe.c1osed
. D Location'of streetlightlng .' ".',. '. .
, -0 Lo<<:ation, type and number of bicycle parking spa~~s'
.D r;:xisting and proposed.landscaping
o ConneCtions to pubiicutilities "
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. Copy of the Piot Pian reduced.to 8y," by 11" when fuli~sized plans are submitted above
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Date Received,
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DECl L 2009
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OriginarSubmittal.
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225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone'
'ity of Springfield Official Receipt
Oevelopment Services Department
Public Works Department
RECEIPT #:
3200900000000000835
Date: 12/31/2009
12:01 :20PM
Paid,By
RALLY COFFEE COMPANY
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
726.00
36.30
$762.30
Job/Journal Number
DRC2009.00054
DRC2009.00054
Description
CTY Minimum Dev Standards
+ 5% TechilOlogy Fee
Payments:
Type of Payment
CreditCard
Amount Paid
ddk
425785 In Person
Payment Total:
$762.30
$762.30
Date Received:
DEe 3,12009
Original Submittal
cReceintl
Page] of]
] 2/3 ] /2009
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CITY OF SPRINGFIELD
VICINITY MAP
DRC2009-00054
3400 Franklin Blvd
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Date Received:
DEe 3 1 2009
Original Submittal
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Map 17-03-34-32
Tax Lot ]00
North
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PLOT PLAN/MINIMUM . DEVElOPMENT. Sf ANDARDS .
RAllY c;OFfHCOMPANI'
30 60
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AcioRESS;J40~ FRAN<l.1'l f?l: v~, '
TAX LOT: . 17_-03-34".32/]00
ZONNG: 'LM (PER RLOJ
PREVIOUS
lAND USE: ;S1a9 OTHER MACf-lt\ffiy,
'. . EQUIPMENT 6" SL\?PLIES/'
,_WHSl~ ,(PER' RLID).
'PROPOSAL:" SITE USE'fOR'WHOlESALE:'
D1STRBUTION &. SUPPLIES/
, . ." CO:'FE~ _ RO~STNO. . ; .
'LOT~rz~:_~' ',4t,500 SF.
LOT COVERAGE: BLOGS - 17% "
. . LOOSCAPEJNA T~AL - ]9r.
PA\!NG. 13%'
GRAVEL. 'SlY.
OWi-E:R: SI<LLERN"INVESffi!ENTS ,,"'.
'P.O. BOX 714 '. ..
SPRiNGFn~, ffi 97477
APPLICANT: RALlS COfFEE CO!v?ANY
3400, fRAI\XLIN BLVD -.
EUGENE. OR 974D3 '. .
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NWNG (CURREN11\.. Y . NOT A V ALA8LEl
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PROPERn~OJlt,ER
EXllTJlO.$lTESlotl,
.~llTlNil I?OI m~i.TloN
, :;EXISTINGiMlThRV!EliERI'ImHOLE.'
" . 'EXllTIlO SIORHWhT~R HhNHQlE
EXISTIlOWAiERMETER
'~AmVALYE
~lI\E HyDRMT
. KAJ1JML.OhSVhL'iE
fOm?OLE _ "
EXISTING OVEBH:!Jl.eOItlIJHlCATlON~"
UlSTtlo ~Vl:RHEM POUR
~tW~O~~T10 ov;rE~~M~OC~ ~
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!2J . CON~RerE'~~EA' ,",.
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'EXISTlJ3lANOSCMEfflATIYEVEGETATlON
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. ,_FLOCO HAZARD N'O:. '_, .
"M-ST<; WlL eE USED FOR
WHOLESALE OtSTR'BUTICN AI'tl,
CQFFEE~QA$Tm - ". '.. .
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: Ti-EOIi..Y,fART OF T1--(S1TE ll-lATts .'
':WiO~~(8tvIT~~LE~T~~; .
PORTlON OF TrE PROPERTY, ';'. "
,., BASEDCNTHE:cf.TAl..ED'ffiMMAPS,m:SA.SEFLoOo"
rt&r~~~~~~I~ ~ooeoWES~AD~ftENT.
'GRA[!Ot-.EXT TO NIY ON art: EU.ONG,lS ASOVE433
M ENTRE SITE 5 MAPPED p,s ElENa WlTHt-l TI-E
ZeN:: X SOO'YE~ fl~~.N. -,' '
rrfRfWllffNOiJt\-ti rOR~'~
,irE fWER8At-K BE NI)'OEVElJ)Ft.ENT
, ~~Jt~'( ~~~'TW Of '
'~ET~~T~SI',hf.E WN-[RC~,1f6N~
WITH}I-E EXJS~N::; Z~t-lG, . .':-.'~
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< Ti-E SITE WlL Ef L&D AS C()fjfEE W~ESAlE
. 'rl-ERE A~E ~ MmJ"A~'rLflNG ~tJisT~ -
WASTES ASSOCIATED \\liTH TI-E SITE ,THAT ARE..'
A ca:a:RN. WlTH~ESf'EC~ TO}~~ATffi,~~.
~~~k.:CUrThfW~~~~~~ts . '--'.':
$l-EEU1.0~ AHJOOSPAT~~:m5? 11--E,g\~:'
", '()fEOOwNSPM IATTK NE ~ Cfll(~~~
:::- ; ;~\JvXJ{irrrJiT~R1:rEFbGl6~1fp~r~S
. pT~ATER Cl;N'-ECTIOf.JS TO rns ~~AlL. -
~i!~c~~W~L~Aa::AREAS'~E'PERV1OUS #!).' .-~
n-E'MA.lJR1TY'CR T~ PAVED ;AREASSl-EO.TO FRAH:<I..N - _ .'f'L-\NIfF('
~~ox~tl'L~.ISX~~'~J ~,~'~ ~GESSARY. ',02S~"-<
:p.rmX~ATa~O'O~ACRESS~~_T?,~ft:,.~A.~.'~~ ~"/- ~_c,:! __.
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MINIMUM DEVELOPMENT STANDARDS DEVELOPMENT APPLICATION
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'., ' ,RALLY COFFEE COMPANY .'. .'
3400 FRANKLIN BLVD, EUGENE, OREGON
.' (TAX L0T17-03~34-32/100)
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General Site Information:
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'SiteZoning:
LM
Adjacent Site Zoning:
LM
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Plan Designation:
LM
. Access:
Access isfrom Franklin Blvd. There is a 48 foot cUf:b cut'
located ,at the approximate center of the property that will ,
continue to.be used; the receniconstructiori of the existing
driveway was approved by ODOr There is anODOT.
acc~ss permit'in process.
. Current Use:
. Wholesale coffee;ecjuipment an,d supplies; Coffee roaster.
Previous Land Use:
(perRLID)
':5189 Other Machinery; Eql}ipmelit &: .S,upplies/Whsle"
There are no proposed off-site improvements. Proposed on-site landscaping iri1~roveinent's
include removal ofthe'3.5'x 6Q' long above ground woodplanter box and replacement with a 60'"
long row of arborvitae and ::m adjacent 7' wide landscape bed,. In addition, the' applicant is
. coordinating with L TDt<:> determine whattype 'of, arid how much,landscaping 'toinstalladjacent
, to the L TO platform...:. There is notany space to install any additionallandscaping betWeen'.
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Franklin Blvd and the existing parking spaces in front of the building. .' ".
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. No fill will be placed on the site. No trees will be reinoved.No dedication is prop?sed. No' ,
modific~tions or exceptions are proposed'"No (known)' additional planning applications are" .
<,\ssociated with thisMDSapplication. ' , . "
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There are no manufactuting or indnstrial wastes associated with th~ site n~e th~iare a concern,
, with respect to stormwater. Ali downsponts bnt orie drain onto the gronnd. The runoff froh-t said
downsponts sheet flows .md dissipates into the ground. One downspout (frC!m the northeast
. corner of the south building) extends into the groUnd arid extends tothe river bank; there' are no
other ~pparent connections to this outfall. .' "" .::
"Date Reckived:
.' .
DEe 3J2009
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grigjnill Submittal
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RETURN TO CASCADE TITLE co.
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. After recordillg return to:".. .
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. Skillern Investments Limited'
Partners~p ,F "
. P. 0, Bo~7i4
SPririgfield. OR 97477'
. Until a change is requested.
send tax statements to:
. Skillern InvestinentsLtm:lted
. Partnership
'Po O. Box 714 .
SpIingfleld. OR 97477 '
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. . sTATUTORY SPECIAL WARRANTY DEED
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Airgas - N~rpac;Inc.;,G~antor.herebyconveys ahd speci;illy .
warrants to Skillemlnvestinents Liu1it~4 Partnership. Grantee. the teal
proPerty described on .the attached E~bit A, free to' enclilllbrances
. . created or .suffered by tht: Grantor~ except those of reconl. and those ..
encumbrances seHorth on the ;J.ttached Exhibit B:, . .'
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.' THIS INSTRUMENT WILfNOTALLOW USE OF THE PROPERTY
DESCRIBED IN THIS INSIRUIv.u'A\I! IN.VIOLATION OF APPUCABLE.
lAND USE LAWS AND RECXULATIONS.BEFORESIGNING OR' .' .
. ACCEPTING THIS INS1RUMENT,'THE PERSON ACQUIRING GEE TI'I1-E
1D TIlE PROPERIYSHOULD CHECK WITH WE APPROPRIATECI1Y OF
COUNIYPLANNING DEPAJITMENTTOVERIFY APPROVED USESANl)"
1D DElERMINE ANY LIMITS ,ON LAWSurrsAGAINSTFARMING OR.. .
FOREST PRACTICES AS DEFINED IN' 0~7 30.930. ,........!: . "
The true considemtion for this cori;eyance is1WO HUNDRED
EIGH1YTHOUSAND AND NO/I00ths pOLLARS ($280,000.00), as paid'"
to or by an accommo.dator pursua]]t to IRC '.1 031. .
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. WITNESS the hand of said Grantor this 11th day of December,
2002. .' '
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GRANTOR:
'AIRGAS.- NOR PAC, INC. . .
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By:
Curtis Flanim, CFO
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Division of' ~hlef' 'Deputy Cl.~rk' .' ~OO~ l1li0073 '
:Lane County'Deed$ and' Records L L"V~
JJIIJIII I III mJII11II11111 1111111 II 11111 1\111111:. ':' . $41;00 ·
00369786201il2009887300400.<1 '.' '. .'.
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.RPR-DEED Cnt=1 Stn=6 CASHIER ,04' .
$~,QO$11,oo $10,00
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bate Received:.
DEC3J ,~009'
Original Submittal
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. Qn this 11th day of December: '2002, personally appeared the
abo'le named Curtis FlaIDm. who, being first duJyswom: did s.aytllat he
is the CFOof Airgas':' Nor Pac. Inc., a Delaware corporation, and tha.t.the
foregoingiIistrurnent was signed on pehalf ofsctid,co:fporationl:JY. ,
authority oqts board of directors; and aeknowledgedsctid, lnst;rume~t to
be itsv91untary ~ct ai).d.d~q., '. . .' , . . '. . .
.Before me:' ' '."
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IIOTARI' PU8lJC-OllEGOH
COMMISSIOH NO. 336163
M'l1U,OOSSIlJHlII'IRfSJUlY 23.lOl4 ",
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;EXIDBIT A'
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. LEGAL DESCRII''IiON,'
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BegiIiniDg at the intersection of the North right'ofway,line of Oregon State Highway No.
126 and the West line of Outlot No., 37, GLENWOpD PARK, as platted andrecorded in
Book T,.page'481. Lane County, oregon Deed Records,42.33. feet North 'of the . .' .
'Nortbea;;t correrof the Zara Sweet Donation Land Claim No. 68, ill Section 34; .
T?wnship17 South, Range'3 West of the Willamette Meridian; thence leaving said North
right of way North 25ipl feet, more orless, to the left: bank of we WillametteR)ver;'
. thence aiong said left bank. North 61 degrees 31' 42': EaSt 59.01 feet; thence North 51
degrees 20' 25uEast 121.66feet; thence North 67 :degrees JO' oou East 3.40feet; thellce
leaving s~d left bank South 336.55 feetto. the Northedy right of way of the Oregon State
Highway'No. 1.26; thence aiong said right of way South 82 degrees2(), 30" West 46,57 "
feet; thence South? degrees 39' 3()" East5.00feet; thenc" South ~2degrees 20',30" .' .
West 105.15feeij6 the point of beginning, in Laile County, Orego~.. . , ,
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DEe lJ,?009
Original Submittal' ,
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EXHIBIT'B . ~'i
(PERMITTE.P EX....~r.~ ~ONS)
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'Rights of the public and g':"v~~ umental bodies in aild to any
'portion of the 1" c.u.Jses herein'described lying below high water
mark 'of.th", Wiliamette River, including any ownership rights,' '
which Illay be cl~ed by the State of Oregon below high water .
. mark. .
. .. ." .
Any ad'yersecl,~ basedupori the assertion ~h!lt: '
a.' Sind land or any part thereof is now or a:t any time h,:u3 been
"'. below the~rdinary high Vlater mark of the Wl1lamette River.
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'b., Some pofuonof said l~d has been cr~ated by:artificial
. "m~aLl.s?r has accreted tosUCh:pOrtion so create4: .
c.. Some poi-tionofsaid land has been brought WithiIi ~e
. boundaries thereof by an avulsive illovement 'of the
Wl1la.ri:J.ette River, or has.been formed 1;>yaccretioritoaIlY
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Western Title&Escrow
Western Title & Escrow Company of Lane County
497 Oakway Road, Suite 340
Eugene, OR 97401
Office Phone: (541) 485-3588
Office Fax: (541) 485-3597
Teresa Voorhees
3040 Grand Cayman Drive
Eugene, OR 97408
Date Prepared: November 11, 2009
Report Number: 30386
Lot Book Service: $200.00
Local Government Lien Search: $15.00
LOT BOOK REPORT
We have searched our Tract Indices as to the following described real property:
SEE ATTACHED EXHIBIT "A"
and dated as of November 05, 2009 at 5:00 p.m.
We find that the title is vested in:
Skillern Investments Limited Partnership
We also find the following apparent encumbrances prior to the effective date hereof:
1. Unpaid taxes for the year 2009-2010
Original Amount: $2,756.88 DUE
Tax Lot No.: 1703343200100
Account No.: 0299329, Code 00428
Unpaid taxes for the year 2009-2010
Original Amount: $545.12 DUE
Tax Lot No.:
Account No.: 5526890, Code 00428
(Personal Property)
Date Received:
DEe 31,2009
Original SUb~ittal.
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Lot Book Report
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Western ,,""'."v,'"
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Page 1 of 3
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Lot Book Report
Order No.: 30386
2. The rights of the public in and to that portion of the herein described property
lying within the limits of roads and highways.
3. Any adverse claim based on the assertion that:
(a) Said land or any part thereof is now or at any' time has been below the
ordinary high water mark-of. Willamette River.
(b) Some portion of said land has been created by artificial means or has
accreted to such portion so created.
(c) Some portion of said land has been brought within or removed from the
boundaries thereof by a change in the location of Willamette River.
4. Rights of the public, riparian owners and of governmental bodies in that portion
of the above described property lying below the high water mark of Willamette
River as to the use of the waters and the natural flow thereof.
5. Glenwood Urban Renewal Plan Notice, including the terms and provisions thereof,
Recorded: December 14, 2004
Document No.: 2004-095229, Lane County Records
6. An easement created by instrument, including the terms and provisions thereof,
Recorded: January 13, 2006
Document No.: 2006-003003, Lane County Records
In favor of: Lane Transit District, Lane County, Oregon
This report is to be utilized for information only. Any use of this report as a basis
for transferring, encumbering or foreclosing the real property described will
require payment in an amount equivalent to applicable title insurance premium as
required by the rating schedule on file with the Oregon Insurance Division.
The liability of Western Title & Escrow Company of Lane County is limited to the
addressee 'and shall not exceed the premium paid hereunder.
Any questions concerning the Lot Book Report should be directed to Jerrilyn Egger at
541-431-3710, or email atje......erallwesterntitle.com.
Date Received:
DEe 312009
" ,
Original Submittal
Lot Book Report
Page 2 of 3
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Western Ti'''Hoc.",
Lot Book Report
Order No.: 30386
Exhibit "A"
Beginning at the intersection of the North right of way line of Oregon State Highway No. 126
and the West line of Outlot No. 37, GLENWOOD PARK, as platted and recorded in Book T,
Page 481, Lane County Oregon Deed Records, 42.33 feet North of the Northeast corner of
The Zara Sweet Donation Land Claim No.'68;in Section 34, Township 17 South, Range 3
West of the Willamette Meridian; thence leaving said North right of way North 256.31 feet,
more or less, to the left bank of the Willamette River; thence along said left bank North 610
31' 42" East 59.01 feet; thence North 51020' 25" East 121.66 feet; thence North 670 10'
00" East 3.40 feet; thence leaving said ieft bank South 336.55 feet to the Northerly right of
way of the Oregon State Highway No. 126; thence along said right of way South 820 20' 30"
West 46.57 feet; thence South 70 39' 30" East 5.00 feet; thence South 820 20' 30" West
105.45 feet to the point of beginning, in Lane County, Oregon.
EXCEPT that portion conveyed to Lane Transit District, Lane County Oregon by Document
recorded January 13, 2006, Document No. 2006-003004, Lane County Records, in Lane
County, Oregon.
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Date Received:
DEe ft. 2.009
Original Submittal
Lot Book Report
Page 30f 3
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Western T.!',," !Cwo',
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scrow
Compliments of W
This map is n t estern Title & E
for inaccuraci~s a survey and we a~~ow Company.
. ume no liability
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Date Received:
DEe 3\ 1'2009
Original Submittal
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".Oregon Department of Transportation
. '. Application for State. Highway Approach
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 application 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 authonze
the applicant as a designated agent. The appliCant must have the property owner complete the Authorization of
Designated Agent block on ihis form OR submit a signed letter from the property owner authorizing the applicant as
ihe 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 government. .
. A copy oflhe current Courity tax lot map for the property served by the approach.' Map must highlight all property that
would be served by the approach and list all owner name(s) on adjacent properties. Make a note on map if ownership
of adjacent property is same as subject property. Identify the location of the proposed approach on map.
. A copy of the recorded easeinerit(s), if the subject property has an existing easement(s) for access to the property..
. A cOpy of any existing state or local govemrnent approach permits for ihe property. '
, ~ . .
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 commonly used terms are in the attached brochure. The brochure is also available on the ODOT website
located at: htto:/lwww.oreoon.oovIODOTIHWYIACCESSMGTI '
WbiI'j",ljC:ant9ijfo.rm~ti9rC,;:;_LL2 '.''x;.,," ',,', ..." !c.",,;
Last Name:. V e()R-~
. Street Address: (~L) H'JlnIfJ J r{
City 9,.(<k en..e...
Mailing Address: ~
City: .'
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I First ilJame:
!3L-V [)
I State: 1YL
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. I Company. k'.fJ-~ {'x)yfeB-Cc
I Zip Code: '17103
I County:
LJrN6'
I'State:
61\ - Q4-a. 32?1{~
Cell Phone Number:' SkI - 69.\. SS7 B
E;~rnaiIAddress '.-t e,,-eSCL.8 (oj 1'1 c-o?Fee..(f>o..fJt .{..(s . Q0ft\.. .
Isapplicant wor1<ing as an Agent ofthe Owne:? <JrESPI NO:' 0 , . . " .
, , 'If YES, the owner must complete the Authorization of Designated Agent section below, OR A TIACH a letter from the
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-----'--- ----av..,"or '::Ii ,tl:)orizjng-applicimUO-aclaS-bislhec...ag""n+ .
Phone Number;,
I, Zip Code:, '.
I FAX Number:
I County:
9'f\. L,i\G~:y;;gi.c"
[J,).f"pFfriQiQffl~Q:~ijl@:ii~1.~ffill!Mi~:i~~~~~~tt~:;i1f~i~~M:r~~~f!:t~f~:~!}71~~1rt~t;~~fJj~lt~~i1igIA,1&:J.~ft~}t'@if~~~A~~~~~~t?~j
Highway Name - May be a statewide highway name such as Pacific Highway, or a'local name like East Main Street. .
ROU, Ie Number - The posted highy;ay \,~m~;,.<;'lI' 1-5 or US-84 '
High;Wy Name: fu*f1~/~ Route Number; I;?~ County: LA-r-i t:-
'Mile Poin!; . Side of Highway:' North)aSouth O' East 0 WestO
Is the highway in a national forest area?:: Yes 0 NO,~. ..". .
.Date. nceci>:e1:
734-2680 (8108)
Page 1 of4
DEe 3' 1'2009
-. .)
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. Original submitt""
~~u:tIiO'~iiatiQn;Q(j[)l:ilijglj);jted ,Agent..
I g}U _ St.; LLe.ff\
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my agent in-the malter of this highway approach pennit application. .
I Owner SigrtureyY'1 _ '5 ~ I Date:
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l~pi?li~an~Sl,g6at'lI~~'~*j,01~,&1~*~!~~ii[g~1~~,i;"'i\t~t~~~{fJ:t41;ii;;'~li;1~~)~~1Nti.~~:!~:~i~ll%&~;1;~t!ti~~~~1!~f1~ft~t~~'!~~~L~~:
NOTIFICATION TO APPLICANT: TheODOTDistrict 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, the application will be deemed complete. ,If your completed-application is approved, preliminary construction specifications
Will be issued. A performance bond and liability insurance will be required before any construction work can' begin on the highway right
01 way. . For the complete rules regarding approach permilting, see OAR Chapter 734 Division 51. . ..
The Appficimt dec/ares.,certifieS. and affirms under penalty of applicable state orfe<iera//aws that a/Unformation
prov;de~ onthis form and attachments are true and complete to Ire best ~fh,islh, . er knoWledge. . . ','
, Print~d Name: 'ff~ Yroek~ J Signature .~k1tJtc1!V~tf~1 Date5?/3 ',[Y1.
ni~a_~Oti,9~n~tl'~p.~91)~611iJfQnn:~ti:QQP~~i~~~h1~~f~tl~?i1~~~~:A~(~~~~]r~;k~1t~~~~;iiitto/if'~rl{j{~'iiJgi(~tt;~~~flli~(~liiW:4l!:m~;~~i~~
Application is a request for (check all that apply)
o New Approach - There is no existing Permitted or grandrathered approach road atthe location requested in this
application . .
o Temporary Approach ~ The approach requested will be removed after a specified period oflime
;;gr;Existing Approach _ This applic'ation affects, or may affect, an existing approach
o Restricted Use Approach - The approach requested is feir emergency services, government, utility access or similar
specific uses with limited traffic '
[v~_nlcte!ffiummmM~vEfOfe.nl$~~fI~~V,tf'1f~~~mt~tIf~~~~~1tii1~f~~~~Ji!~~%~~~~Ji4~~~lt':~1'K[J~r~~1{;;~~f;~~y~:~~&]b~1~~~~
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Iprinted name of property owner)'authorize
(printed name of applicant) to represent me as
.,
g-- ':>-00,
. Turn movements requested (check all that apply)
All movem:onts: D OR Right In: 0 Right Out: D Left In: D, Left Out: D
~i'9:p~~r;w;;~Wn~r4!li'fQnTiIi:tto.h('!wfie&hitti~rf'a'fj1>ii~niL" ...',.' , ."
Last Name: S KlU-..e:..(1\.. I First Name:' b! u....-
StreefAddress:, ~ PO., &::> x: 7/4-
City: Sfk:f-d' I State'ot_ I Zip Code: t(7"t77 I County:
Mailing Address:
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. City'
.I Phone Number:
I cell, Phone Number:
E-mail Address: ' .
Are th~re additional owners 01 the subject property? YES: D NO: 0
If YES, 'A rrACH the same contact infonnation as abovefor each of the cO-:owners on a separate sheet of paper.. .'
,~ei:QP~ftVZfi1tQrmli'f(qi1d<iitt~pti.a~aiii9fliiiR!3'@is);m#g,-cl;,js,ins\:)fficll[fllr"k".::,:, ,..
'Subject property address(es): ~.~ 34W f1tA.nLJ--i'fl . B u! f) _
City: '1MMA'\.L I Z;pCode: q74D~'1 County: /Jtr:{U
Township(s) 17' I Range(s) '-? Section(s) , 'I. I Tax ''1t(s) I . 'J, J'
. ~') . . .:?4- j,. 7/6'3-:<40':57" - oc
I Currentzoning:l",.h (. V'lL<....-- 11 \." ~'~ Proposedzonfng:" .1' '" A I, 'f ,. /1' 1, -,"" iiIA"L'
, ',.NI, \-o-r~, jH1-"'_I/",f..l. Ll,r, .' 1V\ r/.lc,...~ MC,.OIOo''' WJ,,,VSI:,,,,, .
hi the boxes below, describe the existing and propose land use(s) on the property, induding.square footage or acreage.
Existing: fL-4..J.JTAL! 02-T-A f.L +=,ojL Proposed: CbFF-"'tl., f"LoA")T~(L ~
~~ ~w'\'fL '-5 PO fL~<7L0 H (,)l..<7~<A-L'i.....'b IS TlZ-I.!?>U \~f-
Date Received:
I State:
91'1' 5t;;q. 4dd1
5'74-.4'MCJ
Zip C?de:
FAX Number:
I County:.
734-2680 (8/08) :
Page20f4
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DEe 3.1 2009
..
Original Submittal
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Has the local government approv~d a site plan or is the local government currently ~eviewing a plan for the
proposed land use?'
DYes (If yes;, attach a copy oflhe plans being reviewed by the local government.)
o No '
1:r"'r;>''''T"NS':'t'''''''''I-''~R''''4''-"'-~-'''''''t"''':'''t$''''''''';;''''~~'''''-'~~''''''~,'''''''''''!l'':~_''''''''''''''~''?"<ij_;;r,r",~"~",,,''~-m~ .
J!'-,~,~'~il5t __.I._e;rtii~_~_nl.~ eqg.1~em~q._$~~~'i~~~~_~;~~~_Wff~~\~~Bk~I'<i6-@,!f"'~t$~~~~g~-~~....~,~.i\i~"',._....,"~,<$f~tW-~.~~\~
Submit drawing(s) no larger than 11" x 17" in size. Site plan(s) shall. include all applicablei'nformation listed
belOw:
Property location and property lines, including:
. . North arrow : , . .
. Show all lots or parcels that are part of the property or development.with their corresponding tax lot
numbers identified
. Distance from the property lines to the center of the proposed approach
Using solid lines, show:
. Proposed approaches with requested width and tumi'ng movements shown'
. Proposed & existing buildirigs and struclures t6 be retained.
. Proposed use of existing buildings and struCtures to be retained
. Other proposed equipment or facilities ahd their proposed use
. Proposed access or "cross-over" easements INith neighboring properties . .
. . Nearest approaches on both sides of the highway within 500' of the proposed approach center-line
. Using dashed lines, show: .
. Existing approaches with width ana turning movements shown'
'. Place an "X" on approaches to be removed
. Existing buildings and structures to be removed'
. Existing equipment or facilities to be removed
. Other existing facilities to be removed
. Existing access or "cross-o~er" easements with neigh~oring properties
. ~ .,'
. Show proposed on-site circulation, including:
'. Travel lanes with travel directiohs indicated
. Travel lane widths,
. Parking spaces or parking areas
. Access locations to the parking spaces or areas
,
Show nearest'landmari<: or cross street: , '
. Provide 'nearest cross street name
. Distanc~ from the request~dapproach location to the nearest cross street
. '. All public streets th~t abut the' property(s)'
I"'\~t.. i=:l..,...h/~d'
,V34,26BO (8IOB}
Page 3 of4 .
, . DEe 3~.12009
,
Original Submittal,..
-'0';-
:' ' :".
'DATE RECEIVED" BY OooT
'CHAMPS 10 #
~ '.' .
'Oregon Department of Transportation
Land Use CompatibilitY Statement (LUCS)
What isa LUeS? A Land Use Compatibility Statement (LU'CS) Is the lonn OOOT uses to ensure that HighWay Approach Pennils are
consistent with !ocalland use requirements:
WhYis a LUes Re.<iuired? OOOT Coordination Rules, OAR 731-015, identify Highway Approach P~rinlts as pennits that affect land
uSe. State law requlres'OOOT activities that affect land use to be consistent with ackn9wiedged local compr~liensive plans...
. When is a LUCS Required? An OOOT LUCS must be submitted wilhevery OOOT Highway Approach Permit Application.
. How 10 Complete theLUCS: The applicant completes Section 1. Section 2 must be completed by the local jurisdiction, The
appilcant then submits the completed LUCS to ODOT as part 01 the Highway Approach Pennit Application, .
1P
,;'
..
,
~=;;!~!~:~~'~~~~~~!~~:;~:~'ll A~~I~~I ~Ign~t~re' '. ";IAAJ:ti:1gp:'2 ;~'.r/~';,{~:.~~:~
Properly owner name: -S\L-H.L'<?('"(\.' Y\ \I-L",m-c..."i<;; \i
Subject properly address: 34nn . F~"WL-i ,r-,} 1> LlJ t> m&.e..V"\~. DltL q71{Y<,
Site description:
Describe the proposed acti~itJ:. use, or development, including type and volume oftraffic itwill ge~erate.
TOWnship(s)
. Range(s)
Seclion(s)
Tax lot(s)
SECTION 2 must be filled out by a Local Planning Official
[~~~]!2~~l~:~~1~~_!~i1V)n~Jt2~~Q~~2:~f?]F~~cs~}fj!6E~~:~~~,~:~!1~{g~@:~~9:_~I~~m~[~t ,~: _od~~{~~~~1~?i~~~~t;rl~~~2;;~-~:I;JS~1:i~~~~~~j~
The subject property is: D Inside. D Outside City limits
D Inside DOutslde UGB
Current Comprehensive Plan designation: .. Current' zoning:
Is a Comprehensive Plan or zoning amendment proposed? YES D NO D
IrYES, list the proposed plan designation:. . proposed zoning:
Does the activity, use,-or development require land ~se review to determine compliance with land useregulations?- YES'd -NO 0
. .
. -' -
If NO, it means ,that ,no locaUand use review isneeded. Skip-to Local Phmriing OffiCiallnfon'natiori,below. '. ,
II YES: what i~ the status ol,the land use appliCation: D Approved D Denied D Under review D Not yel received
, , . , '
. '
Lislfile number\sj:' Is the decision final: 'YEsD NO'!]'
Comments: .
~EQC:al~l_a1in'in~l"~~ffi~ral~lijfQfmiiti9J:ii(R~liifce.d)1:1~~Y5jl2:}l~1:i1,~tigt~~E~D~!~&l~frr~i~J!Jfr~.f;fr,~\~{~ttii~~~~;i~~~~~!f.[fi~~~~~1
Jurisdiction:
- . Piiilfplanhing, 6ffiCiaJ:s.narrie and t(f:je:
Mailing Address:
City:
, Phone:, :
Email: "
I Zip Code:
I Fax:.
'.
~la~ni.ng Official'.s'Sig~ature:
'-'.
Date: . .
n~+<;, 0",,..,.;\,,,,1"'1'
- --- - ~-- - - .
734-26,80 (8/08)
Page 4 of 4"
DEe 3,12009
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'.
Original Subl11itt":
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