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� �. , <br /> STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a. Length (ft.)= ��c Number of bedrooms= � <br /> (�]Wood/Frame <br /> b.Width(ft.)= �_ Number of garage stalls: ❑ Masonry <br /> Areas in square feet Attached = C� ❑ Metal <br /> ❑ Pole Bldg. <br /> c. Basement= Detached = U ❑ ICF <br /> d. 151 Story = 3�`1 <br /> ❑ On-site Prefab <br /> e. 2"d Story= ❑ Off-site Prefab <br /> f. '/z Story = <br /> 3�� ❑ 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 /> Not <br /> Enclosed A licable <br /> fr] ❑ Permit A lication <br /> � ❑ Pro osed Buildin Plans <br /> ❑ �8 MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> ❑ Surve meetin all re uirements <br /> ❑ � Stormwater Pollution Prevention Plan <br /> [�1 ❑ 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 /> • 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 /> • 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 /> � � � ._...._.. � . <br /> ---�.,..._......_.__,_ G . <br /> ApplicanYs Signature: ��`��y'`�j�"�� Date: j � � � ' i z- <br /> Owner's Signature: Date: <br />