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3--c-vL(-2G I N (E -, `h W Agricultural or Forestry Building Exemption Certificat�i n1E c E J/� [2 Equine Facility Exemption Certification I LJ1 Marion County Public Works—Building Inspection Dive i ii count 5155 Silverton Rd.NE, Salem Oregon 97305 J Li JUI] 0 2 2093 Phone: (503) 588-5147 Fax: (503) 588-7948 Email:building(a�co.marion.or.us O REGON MARION COUNTY BUILDING INSPECTION Site Plan is Required—see attached information Owner/applicant name: C2A14 - AlLiLA-, WA- Phone: 5 3" ' g' 2 51Email:'7A 1-511 1 9 Mailing address:12O1 Z pcgm DT A. lK L..1 City/State: 2 Zip:1: 2— Job site address: a-20 1 Z AC12-R17T 3• City/State: C� Zip: 7�Z- Parcel Information: Parcel Size: Parcel No.: Zone: Proposed Building Information Describe specific use of the building and items contained within i P�i t Z 1 f L(Vlt� ;G�i��-— Building Data: Length: jOt0/ Width: 101 Area: Height: .Llo Type of Exemption:gricultural Building ❑ Forestry Building ❑ Equine Facility(Provide information below): What is the proposed maximum number of people(including employees,owners, etc.)that will be present in the building at any one time? ' 4 Will this structure be used by the public at any time? ❑Yes. No Is the proposed structure located within a floodplain? ❑Yes .No ® � Is the building located on/used in the operation of a farm? es ❑No - Is the proposed structure a residential dwelling or manufactured home? ❑Yes No ! Is the use of the structure or the items within it used for any business or commercial activities? ❑Yes U"No If yes,please explain: . Agricultural/Equine Exemption Criteria—Select all that apply: • Storage,maintenance, or repair of machinery, equipment, and supplies used on this farm ❑Raisin harvesting, or sellingcrops raised on this farm g, g� P ❑ Feeding,breeding,management, or sale of livestock, poultry,furbearing animals, or honeybees ❑ Dairying or the sale of dairy products produced on this farm *Other agricultural,horticultural, or animal husbandry used ❑ 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 iricludirig boarding,training,rentals,clinics,shows, etc. Which of the following systems will the proposed structure have? Electrical ❑Yes iNo (Complete Electrical Wiring Criteria) Will there be a concrete slab either within or adjacent to the building?''es ❑No Will there be farm animals(poultry excluded)within the building at any time? ❑Yes`(No Will there be farm animals(poultry excluded) on the slab at any time? ❑Yes XNo Will the building be used for storage of feed,hay, or straw? es ❑No Will the building be used for major repair of motor vehicle equipment? ❑Yes No Heating/cooling/ventilation/mechanical ❑Yes No Septic ❑Yes 1No (Any yes answer will require a separate permit) Plumbing(Please specify fixture type) ❑YesNo Page 1 of 6