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MARION COUNTY <br /> BUILDING INSPECTION <br />Community Development Center · 285 C~ureh St, NE · Room 132 · Salem, Oregon 97301 <br /> <br /> APPLICATION FOR EEENPT STATUS <br /> FROM THS STRUCTURAL SPSClILTY CODS <br /> FOR AN AGRICULTURAL BUILDING ON A COmmERCIAL FARM <br />PROPOSSD LOCATION: [~a ~+~' TAX ACCOUNT, <br /> <br />(You must provide a computer printout verifyi~speciA~--ag~es~ment for farm use. <br />This can be obtained at the Marion County Assessor's office located in the Franklin <br />Building, 495 State Street, Salem) <br /> <br />Are you located within the Urban Growth Boundary? Y __ <br />Do~Zbo ~etail your commercial farm enterprise: <br /> <br />N~ <br /> <br />Describe i~l_dekail th~ use o~ a~or commqd~ties stgre~ in the_.pr)~posed structure: <br /> <br />Is the proposed structure located within a flood plain? Y __ N <br /> <br />Does the proposed structure have any of the following systems? <br />Electrical Y N ~ Plumbing Y N~ Heating/Cooling/Ventilation Y__ NO <br /> <br />Where will restroom facilities be provided? <br /> <br />Will persons be working in the structure more than a total of 144 hours, during any <br />week of the year? Y -- N ~ <br /> <br />Is this structure used by the public at any time? <br />Explain: <br /> <br />10. What is the distance from the proposed structure to property lines and/or other <br /> structures? Front Rear <br /> Left Side Right Side Other structures <br /> <br />11. This application will not be considered complete without a site plan. See attached <br /> site plan requirements. <br /> <br />I certify that I have read this application and state that the information given is <br />correct. I agree to comply with all state laws and county ordinances relating to building <br /> <br />construction. <br /> <br /> DATS <br /> <br /> PHONR <br /> <br />NAME (Please print)/.~ <br /> <br />~R~T ADDRESS <br />~ITY STATE ZIP <br /> <br />OFFICE USE ONLY SITUS NO.~ ZONE: ~'~//MAP: 3 <br />PLANNING DIVISION, <br /> Validated By:~ Approved: ~ Denied: ~,'Date: <br /> <br />COMMENTS: <br /> <br />BUILDING DIVISION, ~ Validated By: <br /> <br /> Other permits required: Electrical, pl,,~hin~, Mechanical, <br /> <br />MC 15-76 <br />REV ~94 <br /> <br />Approved, V/ Denied: Date, <br /> <br /> STRUC~uq~AL PERMIT IS ~QUI~D Septic <br /> <br /> <br />