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oc(., Yol - <br /> Rural or Forestry Building Exemption Certificatio <br /> Eq <br /> uine Facility Exemption Certification ir--D <br /> ion County Public Works—Building Inspection Division <br /> !Varian k 5155 Silvertort Rd NE,Salem Oregon 97305 A119 2 2024 <br /> counck <br /> one-(503)583-5147 Fax:(50")5138-7948 Email:buildinofrko marion.or.us <br /> • WV.9 - <br /> o E fv114.h1UN LOUNTY <br /> r BUILDNG TION <br /> Site Plan is Required—see attached information <br /> Owner/applicant name: Thmas J(Ilins°111 Alice Shama Tuff shod Phone: 9714284096 Fula- ashannonatufthericem <br /> Mailing address: 6500 NE Halsey St,Suite A CityiState: PortlanO,OR zip: 97213 <br /> Job site address: 7185 Lakeside DR NE CitviState- <br /> Salem;OR Zir 97305 <br /> Fame!Information: Parcel Size: 11.12 AC Parcel No.: 1200 zakw REST <br /> Proposed Building information <br /> Describe specific use of the building and items contained within Feed and equipment storage shed <br /> Building Datil...Length: 24' Width: 16 Area: 360 sq tt Heidt to 6-Peak height <br /> •Type of Exemption: Agricultural.Building a Forestry Building a 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? 2 <br /> Will this structure be used by the public at any time? aYes INo <br /> Is the propOsed structure located within a floodplain? °Yes I No <br /> Is the building located on/used in the operation of a Farm? !Yes a No <br /> Is the proposed structure a residential dwelling or manufactured home? uYes PI No <br /> Is the use of the structure or the items within it used for any business or commercial activities? uYes •No <br /> If yes,please explain: <br /> Agricultural/Equine Exemption Criteria—Select ail that apply: <br /> • I Storage,'maintenance,or repair of machinery,equipment,and supplies used on this farm <br /> Raising;harvesting,or selling crops raised on this farm <br /> a Feedinebreetlintt,management,or sale of livestock,poultry,furbt.vririg animals,or honeybees <br /> Dairying-or the sale of dairy products produced on this farm <br /> a Other agricultural,horticultural,or animal husbandry used <br /> Stabline:training,riding lessons,or clinics(Complete Equine Exemption Criteria) <br /> #of stallsihorst <br /> of stalls/horses for personal use only, <br /> of stallsihorscs 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 aYes a No(Complete Electrical Wiring Criteria) <br /> Will there he a concrete slab either within or adjacent to the building? IYes a.No <br /> Will there be farm animals(poultry excluded),within the building at any time? aYes •No <br /> Will there be farm animals(poultry excluded)on the slab at any time? aYes !No <br /> Will the building be used for storage of feed,hay,or straw? rites 1:7 Na <br /> • Will the building be used for major repair of motor vehicle equipment? aYes I No <br /> Heatingicodinetventilationfmechanical aYes !No <br /> Septic aYes PNo (Any yes answer will require a separate permit) <br /> Plumbing(Please specify fixture type) cries !No <br /> • Page 1 of5 <br />