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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 />PROPERTY OWNER:~_.,~_,~/~TZ~'~-/'~'~ ~.~"/~/ TAX ACCOUNT: <br /> <br /> rUILDING sITE Acres: <br /> <br />1. Is 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 /> <br /> Y .N,~ <br /> <br />3. BE SPECIFIC in describing your commercial farm enterprise, size of operation, and annual profit. Provide <br /> proof of farm income for the last three (3Lyears. <br /> <br />4. ~ in describing ~e use of an~or commodities that ~ill be stood in the proposed structure: <br /> <br />S. What is the size of the proposed building? LENGTH z-//4 WIDTH ~:~0 HEIGHT /,~ AREA <br /> <br />6. Is the proposed structure located within a flood plain? Y __ N /~' <br /> <br />7. Will the proposed structure hav.e any of the following systems? If yes- separate permits are required. <br /> Electrical Y lq ~ Plumbing Y N/%, Heating/Cooling/Ventilation Y N X,Septic Y <br /> / <br />8. Where will restroom facilities be provided? /~//~ <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 />1'. What is ~be distance fr(~m the proposed structure to property linesand/or other structures~ ~gS' 15o~3 <br /> Front/~ Rear'-/~:~) Le~side,~.Z9/ Right side //~ O~er A~ ~;~ <br /> <br />12. This application will not be consider~ complete without a site plan th~ includ~ the size of the bmlding.~ <br /> **See a~ached site plan requi~men~. ~, ~,~ <br />I cedi~ that I h~ve read this application and ~ate that the information given is corred. I agr~ to comply ~th <br /> <br />SIGNATURE <br /> <br />DATE <br /> <br />PHONE <br /> MC15-76-REV 4/99 <br /> APPROVED <br /> <br /> NAME (Please Print) <br /> <br /> STREET ADDRESS <br /> <br />FOR OFFICE use' ONLY <br />DENIED DATE <br /> <br /> <br />