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` ♦''K• Agricultural or Forestry Building Exemption Certification Equine Facility Exemption Certification Marion County Public Works—Building Inspection Division Marion 5155 Silverton Rd.NE, Salem Oregon 97305 Courtty Phone: (503) 588-5147 Fax: (503) 588-7948 Email:building@n,co.marion.or.us OREGOPt Site Plan is Required—see attached information Owner/applicant name: ld KEs l l I l 1-op Phone:S b 3 S.7 Z 2_3 Y L Email: Mi h yp 13®G tAct;I .c. Mailing address: 703 154 Fi'6Hof ?Yai ri E VA 10 City/State:51 o4& I ( 6 Zip: cr 7 37 Job site address: is City/State: '• Zip: Parcel Information: Parcel Size: 3 Sj &o Parcel No.: 512I S I Zone: Proposed Building Information L Describe specific use of the building and items contained wit6 (L� S't c91� C ✓17. vsc 5 Building Data: Length: �2 Width: 'RD Area: S 60 Height: 37 Type of Exemption: le Agricultural Building ❑ 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? Will this structure be used by the public at any time? oYes 7C No - AppEriwED Is the proposed structure located within a floodplain? oYes gr No u Is the building located on/used in the operation of a farm? izYes ❑No Is the proposed structure a residential dwelling or manufactured home? oYes gf No Is the use of the structure or the items within it used for any business or commercial activities? oYes ,efNo If yes,please explain: Agricultural/Equine Exemption Criteria—Select all that apply: tors a maintenance, or repair ofequipment, and supplies gP machinery, used on this farm o Raising,harvesting, or selling crops raised on this *Feeding,breedin ,management, sale o livestock, oultry, furbearing animals, or honeybees ❑ Dairying or the sa products produce on this farm o Other agricultural,horticultural, or animal husbandry used 4Stabling,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 /Yes ❑ No(Complete Electrical Wiring Criteria) Will there be a concrete slab either within or adjacent to the building? Oyes ❑No Will there be farm animals (poultry excluded) within the building at any time? AYes o No Will there be farm animals(poultry excluded) on the slab at any time? oYes tjz No Will the building be used for storage of feed,hay, or straw? g'Yes o No Will the building be used for major repair of motor vehicle equipment? oYes y'No Heating/cooling/ventilation/mechanical oYes No Septic oYes c'No (Any yes ans er will require a separate permit) Plumbing(Please specify fixture type) ` iNes Page 1 of 5