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MARION COUNTY <br /> BUILDING INSPECTION <br />Senator Building · 220 High Stree: NE · Second Floor · Salem. Oregon 97301-3670 <br />Office Hours: 8:00 - 4',30 Phone', 588-5147 24 Hour Code-A-Phone; ~88-7904 <br /> <br />~PPI,ICATION FOR EXEMPT STATUE <br />(FROM THE S~RUCTTJRAL SPECYALT¥ CODE) <br />FOR ~ AGRIC~ BUILDINO <br /> <br />1. Is this property classified as farm deferral by the Marion County <br /> Assessor Department? (You must provide a copy of your tax statement <br /> showing the farm deferral.) Y y~ N <br /> <br />Are you located within the Urban Growth Boundary? <br /> <br />Describe ~n detail the use of and/or commodities stored 'in the proposed <br /> <br />4. Is the proposed structure located within a flood plain? Y N ~0 <br />5. Does the pro~gsed structure_ ~ave any of the following systems? , <br /> Electrical ]~0 Plumbing ~ ~eatieg/Cooling/Ventilation ~ <br />6. Where will res:room facilities be provided? ~M ~O~R ~L~o /~Z/4~/~, <br /> <br />7. Will persons be working in the structure mo~e than a total of 144 hours, <br /> during any week of the year? Y N <br /> <br /> 8. IS this structure used by the public at any time? Y N ~O <br /> <br />9. This application will not be considered complete wlthou~ a site plan. <br /> S~ attached site plan requirements. <br /> <br /> 10. What is the distance from the proposed structure to property lines <br /> and/or other structures? Front ~ ~r Left Side ~ <br /> Right Side ~D ~ Rear ~ F~ Other structures /d0 F~ <br /> <br />I certify that I have read this application and state that the information <br />given is correct. I agree to comply with all state laws and county ordinances <br />relatin~ to bui~n~ construction. <br /> <br />SIGNATURE <br /> <br />DATE <br /> <br />PHONE <br /> <br />OFFICE USE ONLY SITUS NO. <br /> <br />Planning Division Validation By: <br /> <br />COMMENTS: <br /> <br />NAME (Please print~ <br /> <br />CITY STATE ZIP <br /> <br />Building Division Validation By: <br />COMMEN~ ~hyv~,_~ 'karl <br />APPROVED: DENIED: <br /> <br />DATE: <br /> <br />STRUCTURAL PERMI~ IS REQUIRED <br /> <br />Other permits required: Electrical, Plumbinq, Mechanical, Septic <br /> <br /> <br />