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STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> � it <br /> a. Length (ft.)= �22^ � Number of bedrooms=� �Wood/Frame <br /> � tt ❑ Masonry <br /> b.Width (ft.)= �OQ — 1`0 Number of garage stal�s: ❑ Metal <br /> Attached=� ❑ Pole Bldg. <br /> Areas in square feet Detached = 2 ❑ ICF <br /> c. Basement= 1qC12 �Oqq ��nJ ❑ On-site Prefab <br /> �� ❑ Off-site Prefab <br /> d. 1 S`Story = 32.. �1yC,t,V t�CFis �a R.c,{�k ❑ Other(please specify): <br /> e.2"d Story= �_ <br /> f. Yz Story = �� <br /> g.Total Area= (�C�F1 F�N, <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 /> B ❑ Permit A lication <br /> � ❑ Pro osed Buildin Plans <br /> ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form.. o ���. <br /> a ❑ Surve meetin all re uirements p. � K, '�C�. <br /> � ❑ Stormwater Pollution Prevention Plan p 1,,��„�,s <br /> ■ ❑ Hardcover Calculation s T� <br /> � ❑ Se tic S stem Site Evaluation Report <br /> ■ Access Permit <br /> ❑ ■ Wetland Buffer Im rovement Nlan <br /> � # En ineered Plans for Retainin Walls 4 feet or above <br /> � ❑ Plan Review Fee � t�"riD �.C�n oy�..�-r <br /> ❑ O 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 alternative <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 governmental agencies required by law. <br /> If you refuse to supply the information,the application may not be issued. <br /> ApplicanYsSignature: �— Date: �� �(� 2c� Ic� <br /> Last Updated: 9/29/2009 <br /> - 18- <br />