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1 T <br /> � <br /> STRUCTURE INFORMATION: <br /> 1. Structure Dimensions 1. Structure Dimensions(continued) 2. Type of Construction <br /> � r <br /> a.Length (ft.}= G'� Number of bedrooms= � �y1lood/Frame <br /> b.Width ft. = 3� ❑ Masonry <br /> ( ) Number of garage stalls: ❑ Metal <br /> Attached= 1 ❑ Pole Bidg. <br /> Areas in sauare feet Detached= ❑ ICF <br /> c�l ❑ On-site Prefab <br /> c.Basement= �_ ❑ Off-site Prefab <br /> d. 1 S`Story = (�b� ❑ Other(please specify): <br /> e.2"d Story= <br /> f. '/2 Story = <br /> g.Total Area= <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> Not _ <br /> Enclosed APplicable <br /> � ❑ Permit Application <br /> ❑ Proposed Buildin Plans <br /> � ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> ❑ Surve meetin a�l re uirements <br /> � � Stormwater Pollution Prevention Plan <br /> � ❑ Hardcover Calculation s <br /> � ❑ Se tic S stem Site Evaluation Re ort <br /> � 4� Access Permit <br /> � ❑ Wetland Buffer Im rovement Pfan <br /> � En ineered Plans for Retainin Walls 4 feet or above <br /> � ❑ Plan Review Fee <br /> � ❑ Other <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agrees to provide all information required or requested by the Buifding Department; <br /> • Agrees to pay the City of Orono for engineering consultant review costs in excess of$500; <br /> • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they <br /> are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no altemative <br /> but to reject it until it is complete; <br /> • Acknowledges the Escrow Agreement is compteted and signed; <br /> • Understands some or all of the informafion that you are asked to provide on this application is classified by State law as either <br /> private or confidential. Private data is information which generally cannot be given to the public but can be given to the subject <br /> of the data. Confidential data is information which generally cannot be given to either the pubfic or the subject of the data. Our <br /> purpose and intended use of this information is to annually update our records and records of other govemmental agencies <br /> required by law. If you refuse to supply the information, the appfication may not be issued. <br /> • Agrees that in the event that weather or other conditions prevent the completion of an as-built survey at the time the <br /> Certificate of Occupancy is requested, a temporary Certificate of Occupancy may be issued upon receipt of a $10,000 <br /> escrow agreement to ensure completion of the as-built survey and all site improvements. <br /> i; <br /> .�'' � <br /> i � � <br /> ApplicanYs Signature: e: o7��lj ��� <br /> C <br />