HomeMy WebLinkAboutApplication APPLICANT 1/31/2012 s �
City of Springfield SPRINGFIELD
Development Services Department 6
225 Fifth Street
Springfield, OR 97477 /
PERMIT REVIEW INTAKE FORM (City Staff completes form)
' Permit Type '
Dept of Motor Vehicles-New. ❑ Land Use Compatibility Statement. ❑ City. V1
Dept of Motor Vehicles-Renewal: Zoning Verification Letter: ❑ UGB: ❑
Project Information
Applicant Name: -J-,l YYl Q,o 0 7Z Phone: ��� - 7a&- We
Company: — `/ ({ (� S I L�,/ Cell:
Address: 6 �1t � � 1.Ina / e, I . /L 7 y7 -T
Property owner: nves 1 ef� I S T hnc. Phone:
Company: J Cell:
Address: (� • �� 151J oi` 1 Q I Q �— 7 Ll 7 7
ASSESSOR'S MAP NO: I S I V TAX LOT NOS : 6� D DS
Property Address:
Description of Proposal:
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Record
Information
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Record No: m X OC) � Date Received: l �I Application Fee: /�� I 0 D Technical Fee:
TOTAL FEES: 0 l !s Assigned Planner:
Date Received:
JAN 3 1 2012
Original Submittal
Revised 11.2.11 kl
APPLICATION FOR CERTIFICATE NUMBER
SUPPLEMENTAL BUSINESS CERTIFICATE EXPIRATION DATE
AS A DISMANTLER OF MOTOR VEHICLES OR
°'^�"� °""°"•"' SALVAGE POOL OPERATOR
FEE: $90
• PLEASE TYPE OR PRINT LEGIBLY WITH INK_
• ANY ALTERATION OF LINE 2 VOIDS LOCATION APPROVAL. ❑ORIGINAL RENEWAL
6US�NESSNAME HUSME£STEt£PN�'`
1 A-1 Auto Supply, LLC. ( )
SUPPtEi TALLOCATA2Y t5 AND NUMeEA) +CETT Z{PCODE
2 825 S. 28th St. Springfield 97477
MALMADDRESS C[TY COUNTY zwcom
3 P. O. Box 1444 Springfield 97477
Wir. W AADDRE55 CRY COUNTY STATE PCODS
4
5 a) THE DIMENSIONS OF THE PROPERTY ON WHICH THE BUSINESS IS LOCATED ARE `f ft.X_ /a U fL
b) ORS 822.115(4) requires applicants to file a description of the location of the dismantling yard. Accordingly,
please file a plat map or other description of the location of the premises.
6 By signing this application you are also certifying that:
1. The right of way of any highway adjacent to the area proposed for approval to conduct the dismantling business Is
used for access to the premises and public parking;
2. You maintain a building or enclosure or other barrier at least six feet high for the purpose of conducting the
dismantling business;
3. You will not store any vehicles or vehicle parts or conduct the dismantling business outside of the building,
enclosure or barrier,
4. The business is hidden and adequately screened by the terrain or other natural objects or by plants, fences or
other appropriate means so as not to be visible from the main traveled way or the highway except as permitted by
ORS 822.135.
7 LOCAL GOVERNMENT APPROVAL(CITY/COUNTY)
By signing this application you are authorizing a dismantler business to be conducted at the location listed on Line 2 of this
application. if a dismantler business cannot be conducted at that location,or N any of the conditions below are not met,do
not sign this approval.
I CERTIFY THAT THE GOVERNING BODY OF THE CITY
OF HAS:
t��'t# (.
A) APPROVED THE APPLICANT AS BEING SUITABLE TO ESTABLISH, MAINTAIN OR OPERATE A MOTOR VEHICLE DISMANTLING
BUSINESS(ORIGINAL APPLICATIONS ONLY).
B) DETERMINED THAT THE LOCATION OR PROPOSED LOCATION MEETS THE REQUIREMENTS FOR THAT LOCATION UNDER OAS
822.110:
c) DETERMINEDTHAT THE LOCATION DOES NOT VIOLATE ANY APPLICABLE PROVISION OFORS 822.185.
D) APPROVED THE LOCATION AND DETERMINED THAT THE LOCATION COMPLIES WITH ANY REGULATIONS ADOPTED BY THE
JURISDICTION UNDER CRS 822.140. ..- .
®ate Received: ♦PLACESrAMP OR SEAL HERE
JAN 3 1 2012
Original Submittal
t ALSO CERTIFY THAT I AM AUTHORIZED TO SIGN THIS APPLICATION
AND AS EVIDENCE OF SUCH AUTHORITY DO AFFIX HEREON THE L'
SEAL OR STAMP OF THE CITY OR COUNTY. -
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