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r2 - OcZILfif- IcIC l'� 1 .411 .«, A.ricultural or Forest Buildin• Exem,tion Certifi D Equine Facility Exemption Certification a V o 0. County Public Works-Building Inspection Digi, i Marion 5155 Silverton Rd.NE, Salem Oregon 97305 leu D Countyg `0 2022 Phone: (503) 588-5147 Fax: (503) 588-7948 Email: building@co.mario OREGON BULDNGIN PeO'' �f f j Site Plan is Required-see attached information p TI®N Owner/applicant name: ® / ( I / (45 � Phone: 5-03 g 7( 3'�Email: `r2U 6 Mailing address: I a2 jy/7e,t l�y „ne AJ City/State: ��oJGr� � (�K� Zip: q'd''( Job site address: / 2 Gf )1X-2,,,„((f i„ g City/State: f,)ooGe&.v',., 014 Zip: el7Q'' Parcel Information: Parcel Size: Parcel No.: Zone: Proposed Building Information Describe specific use of the building and items contained within ib rcA.rvv. Building Data: Length: o ' Width: /710 ! Area:47 v <64'4- Height: /y eve5 Type of Exemption: gricultural Building o Forestry Building o Equine Facility(Provide information below): What is the proposed maximum number of people(including employees, owners,etc.)that will be present in the building at any one time? ;t'/ Will this structure be used by the public at any time? oYes Is the proposed structure located within a floodplain? oYes Is the building located on/used in the operation of a farm? es o No Is the proposed structure a residential dwelling or manufactured home? oYes Is the use of the structure or the items within it used for any business or commercial activities? ❑No If yes,please explain: rtisrwn.. [1 5 eff e bt i•,/a imp.C- Agricultural/Equine Exemption Criteria-Select all that apply: torage,maintenance, or repair of machinery, equipment, and supplies used on this farm o Raising,harvesting, or selling crops raised on this farm o Feeding, breeding,management, or sale of livestock,poultry,furbearing animals, or honeybees o Dairying or the sale of dairy products produced on this farm o Other agricultural,horticultural, or animal husbandry used o Stabling,training,riding lessons, or clinics(Complete Equine Exemption Criteria) #of stalls/horses #of stalls/horses for personal use only #of stalls/horses used for commercial or trade purposes including boarding,training,rentals, clinics, shows, etc. Which of the following systems will the proposed structure have? Electrical es ❑No(Complete Electrical Wiring Criteria) Will there be a concrete slab either within or adjacent to the building? o No Will there be farm animals(poultry excluded)within the building at any time? oYes Will there be farm animals(poultry excluded)on the slab at any time? oYes Will the building be used for storage of feed,hay, or straw? oYes Will the building be used for major repair of motor vehicle equipment? oYes Heating/cooling/ventilation/mechanical oYes Septic oYes J2-1<-; (Any yes answer will require a separate permit) Plumbing(Please specify fixture type) ❑Yes .�No Page 1 of 5