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a <br />';E': <br /> STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2. Type of Construction <br /> ��U ;;�7e `— <br /> a. Length (ft.)= �� Number of bedrooms= <br /> Wood/Frame <br /> b.Width (ft.)= L � Number of garage stalls: ❑ Masonry <br /> Areas in s4uare feet Attached= ��' ❑ Metal <br /> ,/� ❑ Pole Bldg. <br /> c. Basement= y_� Detached = ❑ ICF <br /> d. 15t Story = y 5`' <br /> ❑ On-site Prefab <br /> e. 2"d StOry= <br /> ❑ Off-site Prefab <br /> f. '/z Story = ❑ Other(please specify): <br /> g.Total Area= <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> x��' Not <br /> Enclos d 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 /> ❑ ❑ Hardcover Calculation s <br /> ❑ ❑ Se tic S stem Site Evaluation Re ort <br /> ❑ ❑ Access Permit <br /> ❑ ❑ Wetland Buffer Im rovement Plan <br /> ❑ ❑ En ineered Plans for Retainin Walls 4 feet or above <br /> ❑ ❑ Plan Review Fee <br /> ❑ ❑ Other: <br /> APPLICANT/OWNER ACKNOWLEDGEMENT: <br />�, • Agrees to provide all information required or requested by the Building Department; <br />�=v-;_: <br />�`_; • Agrees to pay the City of Orono for engineering consultant review costs in excess of$500; <br />,�. <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 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: ` /�-�--��'� � >-�^ Date: 2��z/z�i � <br />�° Owner's Signature: Date: <br />{_; . <br /> _�: <br /> <.: .;. <br />� , : <br /> .� ,: � ...: , ; <br /> . � ; <br /> . . <br /> � � ' � � , <br /> ' ; _ � <br />