Application for Oregon Industrial Site Certification

Application For Oregon Industrial Site Certification

/ Application & Instructions For
Industrial Site Certification
Site Certification Contact: Sierra Gardiner, Industrial Lands Specialist, Business Oregon, 775 Summer Street NE, Suite 200, Salem OR 97301–1280
503–986–0141, Fax: 503–581–5115, TTY 1–800–735–2900,
Please Note:See AppendixI For Acronyms

For your site to be fully reviewed and certified, you must answer all questions and furnish sufficient, formal substantiation, unless described as “optional”
Provide this application (signed originals) and associated information in 3–ring notebooks, using dividers with ‘lettered’ Tabs (A, B, etc.) as indicated below under documentary requirements for each set of materials

If something is too bulky for notebook tab, enclose or furnish separately but with executive summary and relevant findings in tab
All Maps & Aerials need to show—(a) scale, (b) directional arrow for north, and (c) clear, exact outline or shading for the area(s) in question

Before proceeding with this application, please contact Sierra Gardiner, Industrial Certification Specialist. She can coordinate determinations with other state agencies for you, for which it is essential that the applicant provide all relevant site data, such as maps, studies/plans and cadastral numbers (township–range–section).

Identification of Applicant and Site Proposed For Certification

[1] Applicant:
Check each that applies— Legal owner of record Authorized representative of owner *
Local economic development organization (private/nonprofit) Site developer with contract to buy/lease property *
City or county government in whose jurisdiction site is located Licensed broker with listing agreement *
Other **Include Evidence (for example signed letter, copy of agreement) in Tab–A

Name

Title

Organization

Street Address

/ PO Box

City

State

Zip

FAX Number

Telephone Number(s)

EMAIL

[2] Declaration By Applicant:
I swear to have examined this form and all accompanying materials, and to the best of my knowledge, they and the information provided herein are true, correct and complete. I will notify the department in writing of any errors or changes and will clarify, amend or supplement any information as requested by the department. I understand that certification of my site depends on the accuracy, completeness and veracity of the documentation herewith provided, and that such certification (if granted) is not indefinite and will necessitate affirmative steps for renewal. In submitting this application, I do freely participate in a program for the sole purpose of conveying reasonable confidence to prospective business investors about the quality of specific locations in this state for development and usage, and that determinations regarding certification by the state of Oregon are made at its sole discretion, are not appealable, and do not necessarily imply any other warranty or public benefit for a site. I therefore request certification pursuant to this application.
Signature
X / Date

Identification of Applicant and Site Proposed For Certification (Continued)

[3] Contact Person and Mailing Address (if different from [1] above):

Name

Title

Organization

Street Address

City

State

Zip

FAX Number

Telephone Number(s)

[4] Ownership of Property:
If applicant is not owner, or if there are other owners, fill out the following (use Tab–A for any extra information)—

Owner #1

Owner #2

Owner #3

Name

Address

City

State

Zip

STATE

Zip

Telephone

[5] Location and Definition of Land:

Name of Site

/ [Required]

Address/Location[*]

/ [Required]
Check here—that included in Tab–A is basic map of site’s overall land area, such as county map of tax lots[Required]
Check here—that included in Tab–A is complete listing of the township, range, section and lot numbers comprising site[Required]
Check here—that included in Tab–A is county legal description of the overall site area and constituent subdivisions[Required]
Check () If site is platted, and if so, include plat map in Tab–A showing site, as well
[6] Most Applicable Industry Profile—See AppendixII:
Select preferably just one but not more than three
A. Heavy Industrial/Manufacturing B. General Manufacturing
C. Food Processing D. High Tech Manufacturing/Processing (See Page 10)
E. Campus Industrial/Electronic and Computer Assembly (See Page 10) F. Warehouse/Distribution
G. Call Center/Business Services H. Rural Industrial (Do not combine with any profile A–F)
For Rural Industrial (H) specify all that apply: Manufacturing Food Processing Shipping/storage

Fundamental Attributes of the Site & Its Developability

(Leave checkbox blank when statement is false, but please note that except in cases where it starts off, “ if …” an affirmative check-off is mandatory for certification) / Documentary Requirements Notebook Tab
[1] Size of Property For Improvements and Utilization:
ACRES of overall site area (total acreage) / Map showing total acreage and clearly delineatingNet Contiguous Development Acres (NCDA)*—i.e., subset of overall site less area(s) that cannot be developed / B
 If site to be certified is only a portion (sub-area) of total acreage
If so— / ACRES of the certifiable portion—NCDA[†]
[2] Availability for Acquisition by Industrial Developer–User:
Check here—that owner has signed letter that site is for sale or for lease / Signed letter from landowner [option holder] stating: (a)unequivocal willingness to transact with any legal party to develop site consistent with selected industry profile, (b)person possesses full legal authority to transact and (c) specific expectation of pricing at present time; alternative: current real estate listing agreement may substitute for owner’s testimonial / B
 If applicant or other entity has valid option to buy land[‡]
 If for sale[§] / Price per acre / Total price
 If for lease‡ / Rent/yr./ac. / Total rent/yr.
[3] Official Support of Local Community:
Check here—that local government has issued letter of support for any development consistent with selected industry profile(s) / Original letter by chief elected official of municipality / C
[4] Situation Relative to 100–year Flood Plain(one and only one must be checked):
Check here—that NCDA is completely outside of flood plain, … or / Official (FEMA-based) map of site & environs; local Goal 7 land-use data may be source (If applicable, remediation plan by licensed engineer with cost estimate and timeline) / D
Check here—that some of it is in flood plain, but engineering plan exists to resolve and secure site from flood risk (elevate land) in 180 days or less
[5] General Slope and Terrain (suitability for building):
Check here—that grade (relative flatness) of site is described / Topographical (USGS) map and description (by applicant) of terrain; local land-use information; engineering plans w/cost estimate, if applicable / E
 If plan exists to make any more suitable in 180 days or less
[6] Geologic Stability (suitability for building or delicate operations):
Check here—that research has been done and all available information is provided for the site regarding issues of soil types, seismic vibration, fault lines, sinkholes, past undermining and comparable risk factors / Map/designation of seismic zone affecting building code, and any other relevant/available letter, data, maps, report, vibration analysis and so forth (USGS, DOGAMI, local land-use agencies or geo-technical firm) / E

Fundamental Attributes of The Site & Its Developability (Continued)

[7] Existing Structures at/on the Overall Site (certification is generally only for land that is essentially vacant):[**]
 If any improvements exist on site (except for utilities) / Clear, current aerial photograph of the entire site, with NCDA outlined, and list of all improvements, giving age and size; list of any special information for structures / F
 If there is any special information available about improvements
[8] Easements, Liens, Leases, etc., Affecting or Needed for Site:
 If there is any easement, lien, rental contract or similar encumbrance (legal or physical) on or with respect to the property / Illustrative Mapand description of all encumbrances (preliminary title search at least) from deeds, county records—ALTA survey strongly recommended
Plans/agreements to acquire needed easement or like / G
 If any easement, lease or license might be necessary to develop or use site for the selected industry profile(s)

Land Use Planning And Municipal Zoning Regulations

(Leave checkbox blank when statement is false, but please note that except in cases where it starts off, “ if …” an affirmative check-off is mandatory for certification) / Documentary Requirements Notebook Tab
[1] Compliance with State Laws (one and only one must be checked):
 If site is located inside an urban growth boundary (UGB) / Official letter of confirmation or relevant portion of acknowledged comprehensive plan/map from city/county jurisdiction
If applicable, a full record of process and county provisions for “exceptions” must be included / H
 If not in UGB, but in acknowledged unincorporated community boundary
 If not in UGB, but in area that successfully completed process for exception from applicable land use goals (including public utilities–Goal 11)
[2] Local Zoning Ordinance:
Check here—that selected industry profile(s) is/are outright permitted—consistent with expressively allowed uses and development standards under all applicable city/county zoning codes and ordinances—subject only to site plan review & building permit issuance that cannot generally be appealed / Official letter of confirmation from city/county, and highlighted excerpts from ordinances for zoning code and associated development standards, and the relevant portion of zoning map showing the site to be certified / H
[3] Planned, Ongoing or Pending Land-use Processes (administrative or judicial):
 If any known process could affect status of [1]/[2] above / Explanation/relevant evidence / H
[4] Surrounding or Neighboring Uses, Activity & Operations:
Check here—that existing or planned uses on all adjacent sites are specifically identified, as well as vacant lots that could be similarly developed / Maps & narrative/list (photos as useful)—360º immediately around site / H

Environmental & Cultural Protections

(Leave checkbox blank when statement is false, but please note THAT EXCEPT in cases where it starts off, “ If …” an affirmative check-off is mandatory for certification) / Documentary Requirements Notebook Tab
[1] Environmental Assessment (ground contaminants):
Check here—that Phase 1 environment study has been performed for site / Phase 1 (or levelone) environmental assessment report and supporting information based on ASTM standards by Qualified Environmental Services Professional (QESP—seeAppendixI) and DEQ letter/memo of review
Any materials and records in relation to AppendixIII (e.g.,Phase2 clean-up plan) / I
DATE that study was prepared[††]
Check here—that DEQ regional staff review letter or memorandum is included for the Phase 1 report, regardless if it contained significant findings
 If: (a)Phase I had significant findings, (b)DEQ issued determination of “No Further Action,” (c)Institutional/engineering controls are in place, or (d) There has been site activity since study, then—go to—AppendixIII
[2] Species Listed as Endangered or Threatened:
Check here—that all relevant state and (as necessary) federal agencies were effectively contacted regarding the potential presence of listed species / Formal record of response from authorized ODFW staff; ODA input for listed plant species on public land
[U.S. Fish & Wildlife Service (Department of The Interior) and National Oceanic & Atmospheric Administration (NOAA–for marine life/ocean-going fish–U.S. Department of Commerce)]
Written results/report of biological survey if applicable / J
Check here—that: either (a) All contacts indicated no such potential at site and in immediate vicinity, or (b) If so, subsequent biological survey found “suitable habitat” to be absent or made negative “affects determination”
[3] Wetlands and Waterways: The industrial Lands specialist can help you coordinate with the appropriate agencies
Check here—that wetlands “determination” has been conducted for site / Official DSL letter/report for determination (See AppendixIV for DSL request form requirements)
Any US Army Corp of Engineers feedback
Any materials in relation to AppendixIV (e.g., delineation); maps for/from delineation, etc. / K
DATE that determination was prepared
 If determination indicated presence of jurisdictional wetlands and/or other waterways—go to—AppendixIV or coordinate with the Industrial Lands Specialist.
[4] Archaeological Resources: the Industrial Land Specialist can help you coordinate with the State Archaeologist
Check here—that investigation by a qualified professional archaeologist concluded that intact, potentially significant remains are unlikely to be impacted by ground-disturbing activities—if not go to—AppendixV / Archaeological research/survey report
Any materials in relation to AppendixV / L
[5] Historic Buildings (above ground):
Check here—that overall site contains no structure more than 50 years old, or that an officially acceptable plan exists to address any relevant structure, including but not limited to removal or physical avoidance/buffering / Building photograph & (potential) listing on National Register of Historic Places; plan with timeline & est. cost / M

Transportation Infrastructure

(Leave checkbox blank when statement is false, but please note that except in cases where it starts off, “ if …” an affirmative check-off is mandatory for certification) / Documentary Requirements Notebook Tab
[1] Street & Highway Access (egress, ingress & route to nearest major arterial):
Check here—that there exists legal, functionally appropriate access points on/off site (and in/out of industrial park area) that are clearly illustrated / Map of site showing access points on to local streets
Area map of local streets and thoroughfares that highlights route(s) all the way to the nearest highways from the site location
Any access or immediatearea infrastructure improvement plans / N
 If secondary way exists to go to/from local public street system
Check here—that local street routes are fully described and mapped
 If readily executable plans exist to enhance access to the site[‡‡]
[2] Traffic Flow, Impacts and Regulation:
 If vehicle trips per day are in any way proscribed under the local comprehensive plan, zoning ordinances or development standards / Explanation of how vehicle trips are regulated, if at all, including restrictions, maximums allowed and trigger points for special study, etc., including copy of relevant excerpts from local traffic ordinances
Formal communication & input from ODOT and local city/county public works agency
Copies of any TIS/TIA (applicable to site/vicinity), specific regulations
Relevant parts of “Transportation System Plan” (TSP)
Plans & account of site/traffic mitigation & system improvement / N
 If TIS/TIA relevant to selected industry profile is needed for certification:[§§]
If needed– / Check here—that one is/has been done and is included
If unneeded– /  If actual project, based on selected industry profile(s), might trigger TIS/TIA requirement for site development
 If entitlements to develop property will potentially depend on highway or street system improvements to mitigate impacts or enhance accessibility
 If readily executable plans exist to mitigate traffic problems*
 If any relevant (minor/major) system improvement is underway/imminent
[3] Freight Rail Service:
 If site is served by rail, or if there is a readily executable plan to develop the necessary rail spur and connections to serve it* / Site map showing rail connection, letter from railroad or rail extension plan/easement / N
[4] Proximity to Major Conduits of Commerce (road travel distance to nearest facility):
MILES to intermodal container facility (loading/unloading) / Optional: Area wide maps or aerial photography with markers for selected destinations and primary routes, aswell as estimates of true travel time from any formal advisory source / N
MILES to marine port
MILES to international airport (e.g., PDX)
MILES to commercial airport /  If international cargo service

Transportation Infrastructure (Continued)

Highway Name

MILES to nearest state/US highway or principal arterial / Mileage numbers at left should only increase in value; leave box blank if the next box below is for the same destination / N
MILES to major connecting state/US highway (see NOTE below)
MILES to 4-lane/limited access highway continuous to interstate
MILES to nearest access onto actual interstate freeway system

NOTE: Besides interstate freeways, “major connecting highways” include: US 20 (Newport-Sweet Home & Sisters to I-84), US26 (Forest Grove–Vale), US30 (Astoria-I-405), US39, US42, US95 and US97.

Public and Private Utilities

(leave checkbox blank when statement is false, but please note that except in cases where it starts off, “ if …” an affirmative check-off is mandatory for certification) / Documentary Requirements Notebook Tab
[1] Water Supply:
 If community water system that is in regulatory compliance or is not in moratorium can serve site—if not go to—AppendixVI for assistance / Formal specification/letter from water system (company, district, service provider) about current site connection, system capacity
Formal indication from fire marshal, fire protection district chief or similar authority
Any materials in relation to AppendixVI / O
Name of Service Provider
GPD—total water system capacity
Gallons—current average daily use of the system
Gallons—actual maximum daily use of the system
 If water service is currently at site—if not go to—AppendixVI for assistance
GPD—peak flow volume available at/for site
INCHES—smallest water line size between site and source
PSI (lbs/in2)—water pressure available at site
 If adequate service (flow/pressure) exists at site for selected industry profile(s)’ fire suppression needs—if not go to—AppendixVI
[2] Wastewater & Sewer:
 If community sanitary sewer treatment system that is in regulatory compliance can serve site—if not go to—AppendixVII / Formal specification/letter from sewer system (service provider) about current site connection, system capacity
Any materials in relation to AppendixVII / P
Name of Service Provider
GPD—total water system capacity
Gallons—current average daily use of the system
Gallons—actual maximum daily use of the system

Public and Private Utilities (continued)

 If sewage service is currently at site—if not go to—AppendixVII / [Wastewater/sewer continued] / P
GPD—peak sewerage flow volume available at/away from site
INCHES—smallest sewer line size between site and treatment plant
[3] Electrical Power:
Name of Service Provider / Formal specification/letter from electrical utility representative about current site connection/plans
Any materials in relation to AppendixVIII
MW = 1,000 kVA (kilo voltsampere) / Q
MILESto nearest substation (straight-line, zero ‘0’ if adjacent)
 If electricity service without the need for infrastructure improvements is currently available at the site—if not go to—AppendixVIII
MW—peak load capacity available at site
 If electricpower redundancy is currently available for site—if not but required for profile, go to—AppendixVIII
[4] Natural Gas:
Name of Service Provider / Formal specification/letter from gas utility representative about current site connection/plans
Any materials in relation to AppendixVIII / Q
 If natural gas service without the need for infrastructure improvements is currently available at the site—if not go to—AppendixVIII
INCHES—gas line size / PSI available at site
[5] Telecommunications:
 If “T1” service without the need for infrastructure improvements is currently available at the site— if not go to —AppendixVIII / Formal specification/letter from telecommunication service provider representative(s) about current service at/for site and/or plans
Description of advanced services, including existing capacity relative to site/selected industry profile(s), plans for implementing final connection to site, routing or upgrades, and the nature and degree of route diversity & alternative providers—as relevant
Any materials in relation to AppendixVIII / Q
Name of ‘All’ Leading Service Providers / Service Type
Advanced Service For/At Site /  If Readily Available /  Route/Provider Diversity Exists
Fiber Optic or Equivalent (microwave)
“T3”
Satellite/Commercial-grade Wireless

Miscellaneous/Other