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STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(contlnusd) T-Type of Construction <br /> a.Length(ft.)= Z ( Number of bedrooms <br /> Z Wood/Frame <br /> b.Width(ft.)= Number of garage stalls: <br /> ❑Masonry <br /> Areas in square feet Attached= ❑Metal <br /> c.Basement= I Detached= Z ( ❑Pole Bldg. <br /> d.1a Story = ElICF <br /> e.2'Story= � ❑On-site Prefab <br /> I %Story = ❑Off-site Prefab <br /> g.Total Area= I ❑Other(please specify); <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 /> ❑ Permit Application <br /> O Proposed Building Plans <br /> O -0 MN State Energy Code Calculations and Mechanical Code Requirements Form <br /> O Su (meeting all r uirements) _ <br /> 0 ❑ Stormwater Pollution Prevention Plan <br /> ❑ Hardcover Calculation(s) <br /> D ❑ Se tic S stem Site Evaluation Report <br /> O O Access Permit <br /> 0 Wetland Buffer Im rovement Plan <br /> 0 O Engineered Plans for Retaining Walls A feet or above <br /> O OPlan 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$5o0; <br /> • Certifies that the information supplied is tnie 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 soma 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 informal on 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 /> ` AOraes that In the event that weather or other conditions prevent the completion of on as-built survey at the time the <br /> CerMcate of Occupancy Is tygyested.a temporary CertMcate 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 Signature: Date: 2 - f- 13 <br /> Owner's Signature: Date: <br />