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BUILDING INSPECTION <br />3150 LANCASTER DR NE - SUITE C <br />SALEM OREGON 97305 503-588-5147 <br /> <br />APPLICATION FOR EXEMPT STATUS FROM THE STRUCTURAL SPECIALITY CODE <br />FOR AN AGRICULTURAL BUILDING ON A COMMERCIAL FARM <br /> <br />PROPOSED LOCATION: <br /> <br />PROPERTY OWNER: <br /> <br />BUILDING SITE ACRES: <br /> <br />Is this property classified by the Assessor as farm deferred? <br /> <br />Are you located within the Urban Growth Boundary? <br /> <br /> TAX ACCOUNT: <br />TOTAL~F AC~RMED: ~.~ <br /> <br />~ in describing your commercial farm enterprise, size of operation, and annual profit. <br />provide proof of farm income for the last three (3) years. <br /> <br />BE 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 ~'~)s WIDTH ~[~_ HEIGHT [~'~' IDJAREA <br /> <br />6. Is the proposed structure located within a flood plain? Y N X <br /> <br />7. Will the proposed structure have any of the following systems? If yes- separate permits are required. <br /> Electrical Y~_ N Plumbing Y N_~ Heating/Cooling/Ventilation Y NJLSeptic Y <br /> <br />8. Where will restroom facilities be provided? [V~ &14..~' <br /> <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 bythe public at any time? Y N X <br /> <br />1 i. What is the ~i~tance'fro~~ture to propert~ Jines and/or other structures? FrontallY_ Rear~~ Left side'gl~ Right side~.,~~ Other <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 />all state laws and county ordinances relating to building construction. <br /> <br />SIGNATURE <br /> <br />NAME (Please Print) <br />P.o. <br /> <br />STREET ADDRESS <br /> <br />MC15-76-REV 7/97 FOR OFFICE USE ONLY <br />APPROVED DENIED DATE <br /> <br /> <br />