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Ick tib5Y7-At <br /> r`�\ tural or Forestry Building Exemption CertifiesEC _ V <br /> 9 Equine Facility Exemption Certification14T% <br /> v <br /> anon County Public Works—Building Inspection Division MAY 16 2019�1t112 5155 Silverton Rd.NE,Salem Oregon 97305 <br /> C Phone: (503)588-5147 Fax: (503) 588-7948 Email:buildingna .IAN COUNTY <br /> OREGON SPECTION <br /> Owner/applicant name: (.a)e7 . Alb/ Phone: $Z)3.9 04,07 Fax: <br /> Mailing address: /6902 _4/ Sor, c Ad pg City/State: 9/U4/fvn O R. Zip: 9 73$/ <br /> Job site address: I 090 Z ref.4 s2r hsl IUP NC City:sw uedon g Zip: 9 <br /> Directions to the site: `�vih I^ 4 cpr.45t ;4 l breve_c✓c„. <br /> Proposed Building Information <br /> 1. Site plan is attached(required):izfYes o No <br /> 2. Type of Exemption:/Agricultural Building o Forestry Building o Equine Facility(provide information below): • <br /> o Total number of stalls or equivalent number of horses: <br /> o Total number of stalls or equivalent number of horses limited to personal use only: <br /> o Total number of stalls or equivalent number of horses anticipated to be used for commercial or trade purposes <br /> inc.boarding,training,rental,haul-in,clinics,shows,etc.(consider future plans): <br /> 3. Is the use of the structure or the items within it used for any business or commercial activities? oYes 'No <br /> • If yes,please explain: ir+ USS <br /> 4. Describe use of the building and items contained within: A7 , 60,11- � "' 7S`a ' <br /> 5. Is the property in farm or forest deferral?XYes. o No <br /> 6. Is the proposed structure located within a floodplain? oYes ,No <br /> 7. Will the proposed structure have any of the following systems?(If yes,separate permits are required for each system): <br /> Plumbing oYes No If plumbing will be installed,what type of fixture(s)? <br /> Electrical oYes No <br /> Septic oYes No <br /> Heating/Cooling/Ventilation/Mechanical oYes No <br /> 8. Will this structure be used by the public at any time? oYes ,No <br /> 9. What is the proposed maximum number of people(including employees,owners,etc.)that will be present in the <br /> building at any one time? 3 <br /> 10. Where will restroom facilities be provided? w <br /> 11. Is the proposed structure a manufactured home? oYes .eeNo <br /> 12. Building Data:Length: 3 p Width: a4 Area: JO gO Height: a Y <br /> 13. Parcel Information:Parcel Size: j zlcd¢p Parcel No.: Zone: <br /> Page 1 of 5 <br />