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t <br /> STRUCTURE INFORMATION: <br /> 1. Structure Dimensions 1. Structure Dimensions(continued) 2.Type of Construction <br /> a. Length (ft.)= 2q / Number of bedrooms= Wood/Frame <br /> b.Width ft. _ ���`�— Masonry <br /> ( ) Number of garage stalls: D Metal <br /> Attached = ❑ Pole Bldg. <br /> Areas in square feet Detached = 7 0 ICF <br /> J <br /> 0 On-site Prefab <br /> c. Basement= 61 S40R Off-site Prefab <br /> d. 1 S`Story �o- R.'D "bQ..a ' <br /> �, _ 61. 6, (�©SOther(please specify): <br /> / <br /> e. 2nd Story= - M---I-jr, / <br /> too2'r!r St De ; 5>(?2 <br /> f. �r�Story = (s - side _ /a x 26 <br /> g. Total Area= 19 72 <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 /> tea 0 Permit Application <br /> a 0 Proposed Building Plans <br /> ❑ 91 MN State Energy Code Calculations and Mechanical Code Requirements Form <br /> ❑ tili Survey(meeting all requirements) <br /> ❑ 61. Stormwater Pollution Prevention Plan <br /> ❑ g Hardcover Calculation(s) <br /> ❑ ®. Septic System Site Evaluation Report <br /> ❑ Access Permit <br /> ❑ tia Wetland Buffer Improvement Plan _ <br /> ❑ - Engineered Plans for Retaining Walls 4 feet or above <br /> ❑ 0 Plan Review Fee <br /> ❑ 0 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 inform- 'i n,the application may not be issued. <br /> / / - <br /> i..2,,,,,, <br /> , , <br /> Applicant's Signature: Date: „ /6 ZOO/ <br /> Last Updated: 9/29/2009 <br /> - 18- <br />