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STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1. Structure Dimensions (continued) 2.Type of Construction <br /> � <br /> a. Length (ft.)= � � Number of bedrooms= <br /> �ood/Frame <br /> b.Width (ft.)= (� � Number of garage stalls: ❑ Masonry <br /> Areas in spuare feet Attached=� ❑ Metal <br /> ❑ Pole Bldg. <br /> c. Basement= Detached= ❑ ICF <br /> d. 15t Story = �j �' <br /> ❑ On-site Prefab <br /> e.2"d Story= ❑ Off-site Prefab <br /> f. '/2 Story = ❑Other(please specify): <br /> g.Total Area= ��'; E% <br /> R�(,�I IIRFf,� �I,�AJIl�d��,$' <br /> All of the information must be submitted in order for your application to be processed: <br /> Not <br /> Enclosed Applicable <br /> � ❑ Permit A lication <br /> t�— � Pro osed Buildin Plans <br /> ❑ �— MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> � ❑ Surve meetin all re uirements <br /> ❑ 0� Stormwater Pollution Prevention Plan <br /> ❑ Hardcover Calculation s <br /> ❑ G3— Se tic S stem Site Evaluation Re ort � <br /> ❑ CC�-- Access Permit <br /> ❑ f3— Wetland Buffer Im rovement Plan <br /> ❑ C�— En ineered Plans for Retainin Walls 4 feet or above <br /> ❑ C� Plan Review Fee <br /> ❑ C3� Application Escrow&Agreement <br /> ❑ C� 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 /> Fa�� ^^�^�� ,,,5^^R�:�:� fC'�!�h!:?'.*:!ly 3 CQtT,C2�P.tP. <,^�plicatinn he�ng aNr�r�th�t ���on f�ilure to do so, the staff has no attemative <br /> �.,�.,.y r,,.. <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 /> aurpose 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 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 to ensure completion of the as-built survey and all site improvements. <br /> ApplicanYs Signature: �� �`E'� Date: <br /> Owner's Signature: � � � � Date: 0�-��`�� c`�O 1� <br /> I � II � <br />