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, . � � � _ _ .. <br /> � �� � r �a.?' .. . . .. .. � . . . � . . � . . . .. � .. : <br /> STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1. Structure Dimensions (continued) 2.Type of Construction <br /> a. Length(ft.)= � Number of bedrooms= �e�/Frame <br /> b.Width (ft.)= (.-� Number of garage st�lls: �ilasonry <br /> Areas in square feet Attached = ❑ Metal <br /> ❑ Pole Bldg. <br /> c. Basement= � Detached = ❑ ICF <br /> d. 151 Story = ,��U ❑ On-site Prefab <br /> e. 2"d Story= ❑ Off-site Prefab <br /> f. 'h Story = ❑Other(please specify): <br /> g.Total Area= :x(JC�L� <br /> T-- <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 Energy Code Calculations and Mechanical Code Re �irements Form <br /> ❑ , ❑ Surv� meetin all re uirements • <br /> i7 ❑ Storm�vater Pollution Prevention ""�n <br /> ❑ ❑ Hardcover Calculation s <br /> ❑ ❑ Se tic S stem Site Evaluation Re o�t -►- <br /> ❑ ❑ Access Permit � <br /> ❑ ❑ Wetland Buffer Im rovement Plan �� <br /> ._ .F <br /> ❑ ❑ En ineered Plans for Retainin Walls 4 feet or above <br /> ❑ ❑ Plan Raview Fee <br /> G-� ❑ Application Escrow&Agreement <br /> ❑ ❑ Other: <br /> APPLICANT/OWNER 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 alternative <br /> but to reject it until it is complete; <br /> • Acknowledges the Escrow Agreement is completed and signed; <br /> • Understands some or all of the information 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 public 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 governmental agencies <br /> required by law. If you refuse to supply the information, the application may not be issued. <br /> • Agrees that in the event that weath�r 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 to ensure completion of the as-built survey and all site improvements. <br /> .�' <br /> ApplicanYs Signature: Date: � '' � '' l <br /> Owner's Signatu : / Date: <br /> s • <br /> , <br /> � ,. � <br /> � _ . _ _ <br />