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, . . . , � �.. . . - ��- - . . . . <br /> r <br /> ? <br /> STRUCTURE INFORMATION: <br /> 1. Structure Dimensions 1. Structure Dimensions(continued) 2.Type of Construction <br /> a. Length (ft.)= Number of bedrooms= [�Wood/Frame <br /> ❑ Masonry <br /> b.Width(ft.}= Number of garage stalls: ❑ Metal <br /> Attached= % ❑ Pole Bldg. <br /> Areas in square feet Detached = ❑ ICF "� <br /> � <br /> c. Basement= ❑ On-site Prefab � <br /> ❑ Off-site Prefab <br /> d. 15t Story = ❑ Other(please specify): � <br /> e.2"d Story= <br /> f. '/2 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$ed Applicable <br /> � ❑ Permit Appiication <br /> C� ❑ 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 /> ❑ ❑ Septic 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 /> ;> <br /> ::� <br /> APPLICANT ACKNOWLEDGEMENT: <br /> ,: <br /> • Agrees to provide all information required or requested by the Building Department; �� <br /> h <br /> • Agrees to pay the City of Orono for engineering consultant review costs in excess of$500; .k <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 agreement to ensure completion of the as-built survey and all site improvements. <br /> � <br /> . �� <br /> / /l-� <br /> ApplicanYs Signature: Date: � <br /> .. .. . ..i.- � . . . � , ._ li. . � � .. . . � . � ... <br />