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STRUCTURE INFORMATION: <br /> FaLengthuft)= <br /> tructre Dimensions 1. Structure Dimensions (continued) 2.Type of Construction <br /> Number of bedrooms= Wood/Frame <br /> idth (ft.)= Number of garage stalls: ❑ Masonry <br /> ❑ Metal <br /> Areas in square feet Attached = <br /> ❑ Pole Bldg. <br /> c. Basement= Detached = ❑ ICF <br /> d. 15t Story = ❑ On-site Prefab <br /> e. 2nd Story= ❑ Off-site Prefab <br /> f. '/z Story = ❑ 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 /> Encl 'sed Applicable <br /> j ❑ Permit A lication <br /> ❑, Pro osed Buildin Plans <br /> ❑ MN S�(mee�tinqall <br /> de Calculations and Mechanical Code Requirements Form — <br /> ❑ Surve uirements <br /> rpNDAccess <br /> Stormwater Pollution Prevention Plan <br /> [� Hardcover Calculation(s) <br /> ❑ <br /> Septic S stem Site Evaluation Report <br /> ❑ Permit <br /> Wetland Buffer Improvement Plan13Engineered Plans for Retaining Walls 4 feet or above <br /> ❑ ❑ Plan Review Fee <br /> ❑ ❑ Application Escrow&Agreement <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 /> Applicant's Signatur : Date: �^ <br /> Owner's Sign <br /> atur Date: `�� <br />