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i <br /> I. <br /> ,� . <br /> . <br /> � , . 1- , � <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 sauare feet Detached= ❑ iCF <br /> ❑ On-site Prefab <br /> c. Basement= ❑ Off-site Prefab <br /> d. 15�Story = . � ❑ Other(please specify): <br /> e.2"d 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 /> Enclased licable <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 /> 0 ❑ Hardcover Calculation s <br /> ❑ ❑ Se tic S stem Site Evaluation Re ort i. <br /> ❑ ❑ Access Permit � <br /> i <br /> ❑ ❑ WeUand Buffer Im rovement Plan <br /> ❑ ❑ En ineered Plans for Retainin Walls 4 feet or above <br /> ❑ ❑ Plan Review Fee � <br /> ❑ ❑ Other <br /> i <br /> � <br /> APPLICANT ACKNOWLEDGEMENT: '', <br /> • Agrees to provide all information required or requested by the Building Department; I <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 i, <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 /> • Acknowledges the Escrow Agreement is cotnpleted and signed; ' <br /> G <br /> • Understands some or all of the information that you are asked to provide on this application is classified by State law as either ��I <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 I <br /> required by law. If you refuse to supply the information,the application may not be issued. y <br /> I <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 j' <br /> escrow agreement to ensure completion of the as-built survey and all site improvements. � <br /> i�l <br /> j <br /> ApplicanYs Signature: Date: <br /> ; <br /> Last Updated: 1/26/2011 I <br /> -20- <br /> '� <br /> � <br />