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MARION COUNTY <br /> BUILDING INSPECTION <br />Community Development C~nter · 285 ChuzchSt. NB · Room 132 · Salcm~ Oregon97301 <br /> <br /> APPLICATION FOR EXE}~T STATUS <br /> FRO~ THE STRUCTURAL SPECI&LTY CODE <br /> FOR AN AGRICULTURAL EUILDIN~ ON A <br /> <br /> PROPOSED LO~TION= 12813 ~t ~ ~ TAX ACCO~4009~000 <br /> <br /> 1. IS this proper=y~ .... deferred? <br /> ~~ Ma~nty As~esso~'~'located ~n the Franklin <br /> Building, 495 State Street, Salem} <br /> <br /> 2. Are you located withiB th~ Urban Growth Boundary? Y N X <br /> <br />3. Describ~ in de%ail you= co~rcial farm ~nterprise= ~ge M~e~ ~er, shoe ~e~ <br /> <br />4. ~scribe in ~etall the use of a~d/or %o~o~ities stored in the proposed structure: <br /> ~%e pr~s~t~ zs a ~r~%~) for ~t r~, ou~itt~g <br /> <br /> 5. is tho proposed sgructure located within a flood plain? Y -- N X <br /> ~rop~truc~ ~he systems? <br /> Heat ins / COO ~ing/Vent i i at ion Y <br /> <br />7. ~ wi~room fac~rovlded* ~ <br /> <br /> will persons be working in the ~truoeure more than a gotal of 144 hours, durln~ any <br /> wsek of the y~ar? Y ~ N <br /> <br />9. I~ this struc~Bre used by the public ~t any t~me9 <br /> <br />11. <br /> <br />What is the distance from the <br /> <br />proposed stractsre to property lines and/or other <br /> Rear ~fl, 161/2acr~ Other structures <br /> Right Side <br /> <br />This appli=ation will not be considered complete without a site plan. See attached <br />site plan requirements. <br /> <br />I certify that I have read,his application and state that the information given is <br />correct. I~ree/to/~o~l~ ~th all statelaws and county ordinances relating to building <br /> <br /> SIGN~[}RF~~/~'' ~' N (Ple Se iht <br /> / ~-,~-f~ 131m~3 ~t ~;k=Ora,OR 97002 <br /> D~TE STREET'ADD~$S <br /> 50~678--126~ <br /> <br />0FFI~ U~E O~Y SI~S NO. ~= <br /> <br /> Validated ~y:__ Approved= ~ Denied: Date: ~'.~-~ <br /> <br />BUILDING DIVISION: / <br /> validated By: ~ Approved: Denied: <br /> <br />APPROVED: ~ DENIED: ~J~U_C_T~_._RAL PERMIT <br /> other permits required: ~,ctrica~/~lumbin~ Mechanical. <br /> <br /> <br />