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. . , <br /> STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a. Length(R.)= �_ Number of bedrooms=� Wood/Frame <br /> J Masonry <br /> b.Width(ft.)= `��� Number of garage stalls: ❑Metal <br /> Attached=� ❑Pole Bldg. <br /> Areas in sauare feet Detached=�_ ❑ ICF <br /> c. Basement= � ❑On-site Prefab <br /> ❑Off-site Prefab <br /> d. 1�`Story = ( ��7 ❑Other(please specify): <br /> e.2nd SiOry= ( ' l I <br /> f. YZ Story = <br /> g.Total Area= / r <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for our application to be processed: <br /> Not <br /> Enclosed A licable <br /> � ❑ Permit A lication <br /> � ❑ Pro sed Buildin Plans <br /> � ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> � ❑ Surve meetin all re uirements <br /> � ❑ Hardcover Calculation s <br /> � ❑ Se tic S stem Site Evaluation Re rt <br /> � ❑ Access Permit <br /> � � WeUand Buffer Im rovement Plan <br /> � ❑ En ineered Plans for Retainin Walls 4 feet or above <br /> ❑ O 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 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 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 govemmental agencies required by law. <br /> If you refuse to supply the information,the application may not be issued. <br /> ApplicanYs Signature: Date: � <br /> - 19- <br />