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„4. Agricultural or Forestry Building Exemption Certificati C E _ Equine Facility Exemption Certification Marion County Public Works—Building Inspection Divisin NOV 2021 Marion t 5155 Silverton Rd.NE, Salem Oregon 97305 l hone: (503) 588-5147 Fax: (503) 588-7948 Email:building(co.maricM d ON COUNTY Erb:1 i�1„ _ BUILDING INSPECTION Vc) N A !�,, Site Plan is Required—see attached information j)�V F(L�2 76 Owner/applicant name: P X 44 it Phone:50 3-13Z' Z7Email: q 1h s� (.t-ta►M Mailing address: P C) B 2 3 City/State: f.4'✓t O 1� Zip: �'736 Z. Job site address: 75 3 7 c,wt 3 (r J City/State: ,� Zip: 9 73)7 t3' � P Parcel Information: Parcel Size: ioarcel No.: Zone: Proposed Building Information Describe specific use of the building and items contained within ett e Pr17* / W1.a we r Building Data:Length: Z d Width: ZO Area: 400 Height: 9G ” lb /0i9'0 Type of Exemption:>rAgricultural Building o Forestry Building o Equine Facility(Provide information below): What is the proposed aximum number of people(including employees,owners, etc.)that will be present in the building at any one time? Will this structure be used by the public at any time? oYes ArNo Is the proposed structure located within a floodplain? oYes 1 No Is the building located on/used in the operation of a farm? )(Yes o No Is the proposed structure a residential dwelling or manufactured home? oYes *'No Is the use of the structure or the items within it used for any business or commercial activities? oYes X,'No If yes,please explain: Agricultural/Equine Exemption Criteria—Select all that apply: XStorage,maintenance, or repair of machinery, equipment, and supplies used on this farm ❑Raising,harvesting,or selling crops raised on this farm o Feeding,breeding,management, or sale of livestock,poultry, furbearing animals, or honeybees o Dairying or the sale of dairy products produced on this farm o Other agricultural,horticultural, or animal husbandry used o Stabling,training,riding lessons, or clinics(Complete Equine Exemption Criteria) #of stalls/horses #of stalls/horses for personal use only #of stalls/horses used for commercial or trade purposes including boarding,training,rentals, clinics, shows,etc. Which of the following systems will the proposed structure have? Electrical oYes XNo(Complete Electrical Wiring Criteria) Will there be a concrete slab either within or adjacent to the building? oYes >(No Will there be farm animals(poultry excluded)within the building at any time? oYes veNo Will there be farm animals(poultry excluded)on the slab at any time? oYes WNo Will the building be used for storage of feed,hay, or straw? oYes Atho Will the building be used for major repair of motor vehicle equipment? oYes Heating/cooling/ventilation/mechanical oYes .ir<o Septic ❑Yes ao:No (Any yes answer will require a separate permit) Plumbing(Please specify fixture type) oYes to Page 1 of 5