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! r "5 Sr- L``- op Cc. 1 16 -A6E frig, n/7 E 'cultural or Forestry Building Exemption Certification grai_ Elm �/ Equine Facility Exemption Certification mommir- on County Public Works-Building Inspection Division Mario o 5 2024 5155 Silverton Rd.NE, Salem Curs,�n � A�� Oregon 97305 Phone• 5 3) 588-5147 Fax: (503)588-7948 Email:building@a,co.marion.or.us O R E G O NlAI IGT4 CQUI`S f BUILDING INSPECTION Site Plan is Required-see attached information coM Owner/applicant name: � 1 '�( �z �-dd3 Phone:611 I.43g y?,3y Email: Q rrtAY BSc@Sc c'tiat Mailing address:111cl' Cros6t-i M L\E- City/State:Oe WO e>A‘...0-1-.A• Zip: '( o'` Job site address: St2k vyte. City/State: Zip: Parcel Information:Parcel Size: Parcel No.: Zone: Proposed Building Information Describe specific use of the building and items contained within 'oLJ imeYk `rOf 2 ✓ Building Data:Length: '50 Width: 1.4 3,0Area: Height: Type of Exemption: ry(Agricultural 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? 6 Will this structure be used by the public at any time? oYes KNo Is the proposed structure located within a floodplain? oYes %No Is the building located on/used in the operation of a farm? ),Yes ❑No Is the proposed structure a residential dwelling or manufactured home? oYes 0-No Is the use of the structure or the items within it used for any business or commercial activities? oYes ❑No If yes,please explain: Agricultural/Equine Exemption Criteria-Select all that apply: 'A-Storage,maintenance,or repair of machinery, equipment,and supplies used on this farm ❑ Raising,harvesting,or selling crops raised on this farm ❑ 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 0 #of stalls/horses for personal use only #of stalls/horses used for commercial or trade purposes including boarding,training,rentals,clinics, shows, etc. se Which of the following systems will the proposed structure have? Electrical ,Yes *No (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 I No Will there be farm animals(poultry excluded) on the slab at any time? oYes Ed-No Will the building be used for storage of feed,hay, or straw? oYes No Will the building be used for major repair of motor vehicle equipment? oYes 4-No Heating/cooling/ventilation/mechanical Wes ej'No Septic oYes pi:No (Any yes answer will require a separate permit) Plumbing(Please specify fixture type) oYes it-No Page 1 of 5