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STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a.Length(ft.)= Number of bedrooms= ❑Wood/Frame <br /> ❑Masonry <br /> b.Width(ft.)= Number of garage stalis: ❑Metal <br /> Attached= ❑Pole Bldg. <br /> Areas in sauare feet Detached= ❑ICF <br /> ❑On-site Prefab <br /> c.Basement= ❑Off-site Prefab <br /> d. 1$'Story = <br /> ❑Other(please speciry): <br /> e.2"�Story= <br /> f. YZ Story = <br /> g.Total Area= <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for our a lication to be rocessed: <br /> Not <br /> Enclosed licable <br /> ❑ ❑ Permit lication <br /> ❑ O Pro osed Buildin Plans <br /> ❑ ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> ❑ ❑ Surve meetin all uirements <br /> ❑ O Stormwater Pollution Prevention Plan <br /> ❑ ❑ Hardcover Calculation s <br /> ❑ ❑ Se tic S stem Site Evaluation Re rt <br /> ❑ ❑ Access Permft <br /> ❑ ❑ Wetland Buffer Im rovement Plan <br /> ❑ 0 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 Building Department; <br /> . Agrees to pay the Cky of Orono for engineering consultant review costs in excess of$500; <br /> • Certifies that the information supplied is true and coRect 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 alternative <br /> but to reject it until it is complete; <br /> • Acknowledges the Escrow Agreement is completed and signed; <br /> • Some or all of the information that you are asked to provide on this application is dassified by State law as either private or <br /> confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the data. <br /> Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and <br /> intended use of this information is to annually update our records and records of other govemmental agencies required by law. <br /> If you refuse to supply the information,the application may not be issued. <br /> ApplicanYsSignature: � /�/ Date: C�y- �7—/U <br /> � <br /> Last Updated: 9/29/2009 <br /> - 18- <br />