Business License Application

Step 1 of 7

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Business Name(Required)

Doing Business As

Business Address(Required)

Street Address Address Line 2 City State ZIP Code

Mailing Address(Required)

Same as previous

Street Address Address Line 2 City State ZIP Code

Corporate Phone Number(Required)

On Site Phone Number(Required)

Fax Number(Required)

Email(Required)

Website

Type of Business(Required)

Sole Proprietor

Ltd. Liability Co.

Partnership

Ltd. Partnership

Corporation

S-Corporation

Estate

Home Occupancy or Home-Based Business (additional application required if new - listed under Traditional Forms)

Trust

Other

Date Established in Wood Village(Required)

Business Activity: (Businesses that serve food must list their applicable Health Department Licenses)(Required)

Number of Full Time Employees(Required)

Number of Part Time Employees(Required)

Number of Seasonal Employees(Required)

Number of pinball Machines: $75 each(Required)

Number of shuffle, miniature pool, baseball or like devices: $25 each(Required)

Number of digger or crane machines: $75 each(Required)

Number of video, electronic amusement devices, or games: $75 each(Required)

Number of hobby horses or similar machines: $25 each(Required)

Number of any other amusement devices or machines: $25 each(Required)

Please add up all fees for all listed amusement devices and the total to your $50 annual fee. Payment options are listed once you complete the renewal application(Required)

Business Owner's Information

Business Owner’s Name and Title(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Fax

Onsite Manager's Information

Onsite Manager's Name(Required)

Manager's Phone Number(Required)

Property Owner's Information

Property Owner's Name(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone Number(Required)

Building and Fire Dept Review

Does your Business involve the storage or use of any flammable materials or supplies?(Required)

Yes

If yes, please provide the name and quantity kept at the business site

Does your business use any products or materials that could be hazardous to humans or the environment if released, or involved in a fire?(Required)

Yes

1. Have you ever received a form from the State Fire Marshal's Office for reporting hazardous materials for the business? If yes, submit a separate copy of the report(Required)

Yes

Does your company use/handle/generate or store any hazardous chemicals or chemical waste?(Required)

Yes

Does your business have a commercial kitchen or use water for:(Required)

Washing Vehicles

Washing Buildings

Washing Engines

Washing Equipment

Washing Pavement

Washing other objects that use soap, detergents, heat, grease, oil, dissolved metals, nutrients, microbes, soil or other particulates?

None

Are there floor drains, catch basins, sumps, sinks or outlets to the sanitary sewer or storm system in your manufacturing/production or storage areas? If yes,(Required)

Metalic

Color Dye

Soaps/Detergents

Amalgam

Alkaline

Toxic Organics

Fats, Oils, Grease

Medicine/Rx

Boiling Hot Water

Acid

None

Will the quantity of wastewater be greater than 25,000 gallons per day?(Required)

Yes

Is there stormwater runoff from areas where materials, chemicals or equipment are handled or stored outside that could be discharged to the public stormwater system? Stormwater discharges associated with certain industrial activities may require a DEQ 1200-Z /1200-COL permit(Required)

Yes

Including employees, patrons and the public, what is the maximum number of people you expect in your building at any one time?(Required)

What is the Building constructed of?

Wood

Masonry

Steel

Square footage of the building(Required)

Does the Building have a spinkler system?(Required)

Yes

Unknown

What was the previous use of the building

Does the building meet the American with Disabilities Act (ADA) requirements and Chapter 11 of the Oregon Structural Specialty Code?(Required)

Yes

Unknown

Has a Certificate of Occupancy been issued?(Required)

Yes

Unknown

What changes/additions/removals will be performed for this business site? List all structural, electrical, plumbing and mechanical work to be performed. Seperate permits may be required. Please contact the Building Dept for more information(Required)

Agreement

Agree

I hereby certify that the information contained herein is true to the best of my knowledge. I agree to abide by all laws and regulations and to correct any hazards or violations as they may pertain to the above business and future business activities. I acknowledge that issuance of this license does not constitute compliance with local and state laws and regulations including but not limited to the City of Wood Village Municipal Code, the Zoning and Development Code, and the Oregon Building Code. Failure by the Manager or Owner of this business to achieve or maintain compliance with all laws and regulations may result in a revocation of this Business License by the City.

By selecting the "Agree" button, you are signing this agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "Agree" you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or in accessing or making any transaction regarding any agreement, acknowledgement, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature. You also represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of this Agreement.

Full Name(Required)

Title(Required)

Comments or Special Notes(Required)

I intend to pay the $50 annual fee via(Required)

Check

Online

Cash

City Notification

After submitting your application, a copy your completed online Business License form will be emailed to the address provided on page one of this application. If you need a copy for your records, please print this email. If you do not receive an emailed copy of your application, please contact the City at Building@WoodVillageOR.gov.

This field is for validation purposes and should be left unchanged.

Business License Application

Business Owner's Information

Onsite Manager's Information

Property Owner's Information

Building and Fire Dept Review

Agreement

City Notification

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