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csy— Z�-d e/S S —AGc Agricultural or Forestry Building Exemption Certification Equine Facility Exemption CertificationMarion County Public Works—Building Inspection Division %tit% Cow 5155 Silverton Rd.NE, Salem Oregon 97305 Phone: (503)588-5147 Fax: (503)588-7948 Email:buildin• • co.mario '. `l OR EGO N Site Plan is Required—see attached information O�.,,�� S ► �•e(EIJ�, .�s�r �F Iti ��vt a -�j3`Z- '3S8 Owner/applicant name: Phone: - Email: o Co r• �n Mailing address: pa 3ok 6y City/State: S '71n3Q- •, v.er-( Zip: 1-7 ‘/73$J Job site address: 937 78TH AVE NE City/State: SALEM, OR Zip: 97317 Parcel Information: Parcel Size: 45 ACRES Parcel No.: Zone: Proposed Building Information Describe specific use of the building and items contained within hazelnut equipment storage Building Data:Length: 120 Width: 60 Area: Height: 18 Type of Exemption: A Agricultural 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? 5 Will this structure be used by the public at any time? oYes U No Is the proposed structure located within a floodplain? oYes I No Is the building located on/used in the operation of a farm? UYes o No Is the proposed structure a residential dwelling or manufactured home? oYes PI No Is the use of the structure or the items within it used for any business or commercial activities? oYes P No If yes,please explain: Agricultural/Equine Exemption Criteria—Select all that apply: I Storage,maintenance, or repair of machinery, equipment, and supplies used on this farm o Raisin harvesting, or sellingcrops raised on this farm g� P 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 oYes I No(Complete Electrical Wiring Criteria) Will there be a concrete slab either within or adjacent to the building? oYes PI No Will there be farm animals(poultry excluded)within the building at any time? oYes PI No Will there be farm animals(poultry excluded)on the slab at any time? oYes S No Will the building be used for storage of feed, hay, or straw? oYes IP No Will the building be used for major repair of motor vehicle equipment? oYes PI No Heating/cooling/ventilation/mechanical oYes IP No Septic oYes PNo (Any yes answer will require a separate permit) Plumbing(Please specify fixture type) oYes e No Page 1 of 5