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, � . <br /> STRUCTURE INFORMATION: I <br /> 1. Structure Dimensions 1. Structure Dimensions (continued) 2. Type of Construction <br /> a. Length (ft.)= 3'1 � � '� Number of bedrooms= � �Wood/Frame <br /> b.Width ft. = 6 � �� Q Masonry <br /> ( ) � Number of gar�e stalls: ❑ Metal <br /> Attached = �� ❑ Pole Bldg. <br /> Areas in square feet Detached =� ❑ ICF <br /> c. Basement= n ��� ❑ On-site Prefab <br /> ❑ Off-site Prefab <br /> d. 151 Story = / �J „� ❑ Other(please specify): <br /> e. 2"d Story= 11 '� <br /> f. '/z Story = P1� �- <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 A plicable <br /> � ❑ Permit A lication <br /> � ❑ Pro osed Buildin Plans <br /> � ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> � ❑ Surve meetin all re uirements <br /> � � Stormwater Pollution Prevention Plan <br /> A ❑ Hardcover Calculation(s <br /> � Se tic S stem Site Evaluation Re ort <br /> � � Access Permit <br /> � Wetland Buffer Im rovement Plan <br /> � �l 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 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 appfication 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 classified 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 governmental agencies required by law. <br /> If you refuse to supply the information,the application may not be issued. <br /> � � <br /> ApplicanYs Signature: �,�w T'��-- Date: `���� <br /> Last Updated: 9/29/2009 <br /> - 18 - <br />� , <br />