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� <br /> . . <br /> STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions (continued) 2.Type of Construction <br /> a. Length (ft.)= �� Number of bedrooms= � <br /> ��,q �'Wnod/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 = ' <br /> ❑ On-site Prefab <br /> e.2"d Story= <br /> ❑ Off-site Prefab <br /> f. '/z Story = <br /> ❑ Other(please specify): <br /> g.Total Area= <br /> REQUIRED SUBMITTALS: <br /> All of the infor�r��tion musi be subnlitfied in order for your application io be prai:essed: <br /> Not <br /> Enclosed A licable <br /> ❑ ❑ Permit A lication <br /> ❑ ❑ Pro osed Buildin Plans <br /> ❑ ❑ MN State Ener Code Calculations and Mechanical Code Requirements 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 /> ❑ ❑ 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 4hat 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 /> req��ired 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 af Occupancy is requested, a temporary Certificate of Occupancy may be issued upon receipt of a $10,000 <br /> escrow to ensure completion f the as-built survey and all site improvements. <br /> Applicant's Signature: Date: L� ���"( � <br /> r'" <br /> Owner's Signature: �7 Date: ��� <br />