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• <br /> t 5 ®ze_r— b©z3-70- <br /> Agricultural or Forestry Building Exemption Certification fiCte <br /> Equine Facility Exemption Certification <br /> Marion County Public Works—Building Inspection Divisi D <br /> EIF1 <br /> Mao n[ 5155 Silverton Rd.NE, Salem Oregon 97305 <br /> Phone: (503) 588-5147 Fax: (503) 588-7948 Email: building(aico.marion.or. <br /> o a,E c o N MAR 7 202 <br /> 4.pp DVIStPlan is Required-see attached information <br /> h=1 <br /> Owner/applicant name: - IC kVe-PIZA Phone:SD3—fit/—0 Cat 0( Email: e -t <br /> Mailing address: P O Ra,L. 3 IS City/State: <1 ve.v1-0 i C) Zip: 973a A <br /> Job site address: 3.(27(o I3riaar tr.4,411 City/State: fccsi'k i1(S ()it Zip: e77-3 ZS <br /> Parcel Information: Parcel Size: 2.1) aes4-S Parcel No.: Zone: <br /> Proposed Building Information <br /> Describe specific use of the building and items contained within w;t( pt. tc_ f tee._+ j pyto wf.w <br /> 44-'1i ZZ 5p► k v a /Q c..G. tee,,, - / Srb G&r!n 1 ,4. <br /> Building Data: Length: ,C ' Width: LAD ' Area: Vie)0 Stt Height: 2- <br /> Type of Exemption: '1.Agricultural Building XForestry Building ❑ Equine Facility(Provide information below): <br /> What is the proposed maximum number of people(including employees, owners, etc.) that will be present in the building at <br /> any one time? 3 <br /> Will this structure be used by the public at any time? oYes gNo <br /> Is the proposed structure located within a floodplain? oYes leNo <br /> Is the building located on/used in the operation of a farm? krYes o No p rct �=u+�•+� <br /> Is the proposed structure a residential dwelling or manufactured home? oYes �No <br /> Is the use of the structure or the items within it used for any business or commercial activities? oYes oieNo <br /> If yes,please explain: <br /> Agricultural/Equine Exemption Criteria—Select all that apply: <br /> Storage,maintenance, or repair of machinery, equipment, and supplies used on this farm <br /> o Raising,harvesting, or selling crops raised on this farm <br /> `Feeding,breeding,management, or sale of livestock,poultry, forbearing animals, or honeybees <br /> o Dairying or the sale of dairy products produced on this farm <br /> o Other agricultural,horticultural, or animal husbandry used <br /> o Stabling,training,riding lessons, or clinics (Complete Equine Exemption Criteria) <br /> #of stalls/horses <br /> #of stalls/horses for personal use only <br /> #of stalls/horses used for commercial or trade purposes including boarding,training,rentals,clinics, shows,etc. <br /> Which of the following systems will the proposed structure have? <br /> Electrical )(Yes o No (Complete Electrical Wiring Criteria) <br /> Will there be a concrete slab either within or adjacent to the building? )(Yes o No <br /> Will there be farm animals(poultry excluded)within the building at any time? R)Yes N No <br /> Will there be farm animals(poultry excluded)on the slab at any time? Yes ,No <br /> Will the building be used for storage of feed,hay,or straw? Ves o No <br /> Will the building be used for major repair of motor vehicle equipment? oYes �,No <br /> Heating/cooling/ventilation/mechanical oYes ` No <br /> Septic oYes % No (Any yes answer will require a separate permit) <br /> Plumbing(Please specify fixture type) oYes X.No <br /> Page 1 of 5 <br />