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BUILDING INSPECTION <br /> 3150 EANCASTER DR NE- SUITE C <br />__ SALEM OREGON 97305 503-588-5147 q <br /> <br /> APPE,C^T,ON EOR EXEMP S ATUS <br /> FOR AN AGRICULIURAL BUILDING ON A COMMERCIAL FARM <br /> <br /> BUILDING SITE ACRES: <br /> <br />1. ls this property classified by the Assessor as farm deferred? <br />2. Are you located within the Urban Growth Boundary? <br /> <br />TOTAL# OF ACRES FARMED:~.~___ <br /> YV/N <br /> Y__N~ <br /> <br />3. BE SPECIFIC in describing your commercial farm enterprise, size of operation, and annual profit. If applicable, <br /> provide proof of farm income for the last three (3) years. <br /> <br />4. BI- SPECIFI~C in describing the use of and/or commodities that will be stored in the proposed structure: <br /> <br />5. What is the size of the proposed building? LENGTH~_ WIDTH ~HEIGHT 10 AREA~,I~..~O <br /> <br />6. Is the proposed structure located within a flood plain? Y N / <br /> <br />?. Will the propo/~ed structure have any of the following systems? If yes- separate permits are required. <br /> Electrical Y ~/ N Plumbing Y N Heating/Cooling/Ventilation Y N__Septic Y __ <br /> <br />8. Where will restroom facilities be provided? ~'~c..~ ~ ~ <br />9. What is the maximum number of people present in the building at any one time during the year?~__ <br /> <br />10. Is this structure used by the public at any time? Y N / <br /> Explain <br /> <br />N <br /> <br />11. What is the distance from the pr.,oposed structure to property lines and/or other structures? <br /> F ton t~;]~z Rear~-~) Left side]~' Right side~bther <br /> <br />12. This application will not be considered complete without a site plan that includes the size of the building. <br /> **See attached site plan requirements. <br /> <br />I certify that I have read this application and state that the information given is correct. I agree to comply with <br /> <br />PHONE <br /> <br />to building construction. <br /> NAME (Please Print) ~ <br /> STREET ADDRESS <br /> CITY STATE/ZIP CODE <br /> <br />MC15-76-REV 7/97 FOR OFFICE USE ONLY <br />APPROVED DENIED DATE <br /> <br /> <br />