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3 o0T AK' <br /> D (NEB <br /> Agricultural or Forestry Building Exemption Certification <br /> Equine Facility Exemption Certification <br /> Marion County Public Works—Building Inspection Division <br /> gout[a 5155 Silverton Rd.NE, Salem Oregon 97305 <br /> `! Phone: (503)588-5147 Fax: (503)588-7948 Email: building@co.marion.or.us <br /> Site Plan is Required—see attached information • <br /> t <br /> Owner/applicant name: peg rr:r7 w i/S a v? Phone:<5631c c/—/95,,mai1:1 i 1 S A f) e <br /> Mailing address: //y8 q A-21 4 j;Qi L OWC City/State: Nvb btrc7 0Q, Zip: 9703 z <br /> Job site address: . _Sci ,C City/State: Zip: <br /> Parcel Information:Parcel Size: G/.$3 Parcel No.: Zone: Z. <br /> • Proposed Building Information /cd <br /> Describe specific use of thebuildn and items contained within Li ve 5'- -k ySin14- / <br /> Building Data:Length: Vg Width: moo' Area: / /%'O 5r Height: /t E4 v't S <br /> Type of Exemption: o Agricultural Building o Forestry Building o Equine Facility(Provide information below): <br /> What is the proposed maximum number of people(including employees, owners,etc.)that will be present in the building at <br /> any one time? y-4, <br /> Will this structure be used by the public at any time? oYes e1<o <br /> Is the proposed structure located within a floodplain? oYes 'No <br /> Is the building located on/used in the operation of a farm? 4S'es o No <br /> Is the proposed structure a residential dwelling or manufactured home? oYes AfNo <br /> Is the use of the structure or the items within it used for any business or commercial activities? ,des o No <br /> If yes,please explain: L j✓es./e,G k/ pv &i/4y .er,�� <br /> Agricultural/Equine Exemption Criteria—Select all that apply: <br /> ,(Storage,maintenance,or repair of machinery,equipment,and supplies used on this farm <br /> u-Raising,harvesting,or selling crops raised on this farm <br /> an-Feeding,breeding,management,or sale of livestock,poultry,forbearing animals, or honeybees <br /> o Dairying or the sale of dairy products produced on this farm <br /> .a-Other agricultural,horticultural, or animal husbandry used <br /> o Stabling,training,riding lessons,or clinics(Complete Equine Exemption Criteria) <br /> #of stalls/horses <br /> #of stalls/horses for personal use only <br /> #of stalls/horses used for commercial or trade purposes including boarding,training,rentals,clinics,shows,etc. <br /> Which of the following systems will the proposed structure have? <br /> Electrical oYes re'No(Complete Electrical Wiring Criteria) <br /> Will there be a concrete slab either within or adjacent to the building? oYes a-No <br /> Will there be farm animals(poultry excluded)within the building at any time? ,eYes o No <br /> Will there be farm animals(poultry excluded)on the slab at any time? oYes 2rNo <br /> Will the building be used for storage of feed,hay,or straw? Ja7res o No <br /> Will the building be used for major repair of motor vehicle equipment? oYes z T o <br /> Heating/cooling/ventilation/mechanical oYes , To <br /> Septic . oYes.,ra'No (Any yes answer will require a separate permit) <br /> Plumbing(Please specify fixture type) oYes ,e1No <br /> Page 1 of 5 <br />