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. • ' ' <br /> STRUCTURE INFORMATION: � <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction � <br /> i �" <br /> a.Length(ft.)= 3� Number of bedrooms= LlSwood/Frame <br /> � ❑ Masonry <br /> b.Width(ft.)= � Number of garage stalls: ❑ Metal <br /> Attached= :Z ❑ Pole Bldg. <br /> Areas in souare feet Detached= ❑ ICF <br /> ❑On-site Prefab <br /> c. Basement= ❑ Off-site Prefab <br /> d. 15`Story = �7v _� Other(please specify): <br /> e.2nd Story= <br /> f. %z Story = <br /> g.Total Area= ,�� <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> Not <br /> Enclo d licab}e , <br /> ❑ Permit A lication <br /> ❑ Pro osed Buildin Plans <br /> ❑ MN State Ene 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 /> ❑ GY Wetland Buffer Im rovement Plan <br /> ❑ En ineered Plans for Retainin Walls 4 feet or above <br /> ❑ Plan Review Fee <br /> ❑ ❑ 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 altemative <br /> but to reject it until it is complete; <br /> • Acknowtedges 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 govemmental agencies <br /> required by law. If you refuse to supply the i�ormation,the application maq 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 agreement to ensure completion of the as-built survey and alI site improvements. <br /> � <br /> A plicanYs Signature: Date: �-� /�—�� <br /> ,w <br /> Last Updated: 1/26/2011 <br /> -20 - <br />