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D ECEIIVER, <br /> . `�•,,,, Agricultural or Forestry Building Exemption Certificate <br /> .= Equine Facility Exemption Certification MAY 3 a 2019 <br /> Marion County Public Works—Building Inspection Division <br /> Co n 5155 Silverton Rd.NE, Salem Oregon 97305 MARION COUNTY <br /> Phone: (503)588-5147 Fax: (503) 588-7948 Email: building@co.maBbii bf)J JG INSPECTION <br /> OREGON 0 0 <br /> Owner/applicant name: Nancy Titus 503-319-4474 503-319-4474 Fax: <br /> Mailing address: PO Box 953 City/State: Silverton/OR Zip: 97381 <br /> Job site address: 19542 Jack LN SE City: Silverton/OR Zip: 97381 <br /> Directions to the site: down jack In and second OR third driveway on the left <br /> Proposed Building Information APPOgyEe <br /> 1. Site plan is attached(required): eYes ❑No <br /> 2. Type of Exemption: s Agricultural Building ❑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 e No <br /> If yes,please explain: <br /> 4. Describe use of the building and items contained within: tractor/cow/hay storage <br /> 5. Is the property in farm or forest deferral? eYes o No <br /> 6. Is the proposed structure located within a floodplain? oYes e 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 eYes ❑No AT A LATER DATE /4%/ <br /> Septic oYes r No j <br /> Heating/Cooling/Ventilation/Mechanical oYes •No <br /> 8. Will this structure be used by the public at any time? oYes in 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? 4 (family only) <br /> 10. Where will restroom facilities be provided? n/a <br /> 11. Is the proposed structure a manufactured home? oYes e No <br /> 12. Building Data: Length: 48ft Width: 36ft Area: Height: 14ft <br /> FT <br /> 13. Parcel Information: Parcel Size: 7'95 Parcel No.: 602 Zone: <br /> Page 1 of 5 <br />