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MARION COUNTY <br /> BUILDING INSPECTION <br />Senator Building · 220 High Street NE · Second Floor * Salem, Oregon 97301-3670 <br />Office Hours: 8:00- 4:30 Phone: 588-5147 24 Hour Code-A-Phone: 588-7904 <br /> <br /> APPLICATION FOR EXEMPT STATUE <br /> (FROM T~E S~ItUC~O~.L SPECIALTY CODE) <br /> FOR ~ AG~IC~ BUILDING <br /> <br />1. Is this property classified as farm deferral by the ~ariOn county <br /> Assessor D~partment? (You must provide a copy of your tax statement <br /> showing the farm deferra%.) Y~ N ~ <br />2. Are you located within the Urban Gro~h Boundary? Y __ N ~ <br />3. Describe in detail the use of~d/or ~oditi~tored. in th~roposed <br /> <br /> 4. %~) the propose~ttucture located within a flood plain? Y __ N ~ <br /> <br />5. Does the proposed structure have any ~of the following system~? ~ <br /> Electr&cal ~ Plumbing __ Heatihg/Cooling/Ventilation <br /> <br /> 6. Where will restroom facilities be provided? ~ ........ <br /> <br />7. Will persons be working in the structure~ more than a total of 144 hours, <br /> d~ri~g any week of the year? Y .~ N~.~~ ~ <br />8. Is this structure used by the public a~ any time? Y N~ <br /> Explain= / <br /> <br />This application will not be considered ~omplete without a site plan. <br />see attached site plan requirera~n~{s. <br /> <br />What is the distance from the proposed structure <br />and/or other structures? Front Left Side <br />Right Side Rear Other structures <br /> <br />to property lines <br /> <br />I certify that I have read this application and state that the information <br />given is~ cor~-~. I agate comply with all state laws and county ordinances <br /> <br />OFFICE USE O~Y SI~S NO, ZOO; ~/=~ ~ ~O <br /> <br />COM/4ENTS: <br /> <br />7/91 <br /> <br />Building Division Validation By: ~ DATE: to-q <br /> <br />APPROVED: DENIED= STRUC~q~"'~RM~'IS P. EQUIRED <br /> <br /> Other permits required: Electrical, Pl~in~, Mechanical, Septic <br /> <br /> <br />