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e <br /> STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> i l i it <br /> a.Length(tt.)= Number of bedrooms= Wood/Frame <br /> J <br /> ❑Masonry <br /> b.Width(fL)= `�y Number of garage stalls: ❑Metal <br /> Attached= C _ ❑Pole Bldg_ <br /> Areas in square feetL p [ Detached=_L_ ❑ICF <br /> = 5 cl �XtS/lh�� El On-site Prefab <br /> c_ Basement <br /> ,/ B El Prefab <br /> d. 1u Story = X�S�I�II� �n'v*�1Qvtil� ci'G` El Other(please specify): <br /> e_2nd Story= ��F��1 GL (f rqi t"r <br /> f. 1/2 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 /> Enclosed Applicable <br /> L1 ❑ Permit Application <br /> ❑ ❑ Proposed Building Plans <br /> ❑ ❑ MN State Energy Code Calculations and Mechanical Code Requirements Form <br /> ❑ Survey(meeting allrequirements) <br /> ❑ 113. Stormwater Pollution Prevention Plan <br /> ❑ Hardcover Calculation(s) <br /> ❑ Septic System Site Evaluation Report <br /> ❑ Access Permit <br /> ❑ Wetland Buffer Improvement Plan <br /> ❑ Engineered Plans for Retaining 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 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 /> r <br /> Applicant's Signature: ` iDate: <br /> 3 <br /> Last Updated: 6/22/2009 <br /> -20- <br />