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STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a. Length(ft.)= 76 '4 " `()al a,Number of bedrooms= "i g Wood/Frame <br /> / ❑ Masonry <br /> b.Width(ft.)= y4'G" Number of garage stalls: ❑ Metal <br /> Attached= 3 ❑ Pole Bldg. <br /> Areas in square feet Detached= p ❑ ICF <br /> E On-site Prefab <br /> c. Basement= /, 53a ❑ Off-site Prefab <br /> d. 1st Story = / S3� ❑ Other(please specify): <br /> e. 2nd Story= ii S!-1 <br /> f. 1/2 Story = N/A' <br /> g. Total Area= q, 5,8 <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 /> ,$ <br /> 0 Proposed Building Plans <br /> ❑ +k ❑ MN State Energy Code Calculations and Mechanical Code Requirements Form <br /> 0 Survey(meeting all requirements) <br /> ❑ �' Stormwater Pollution Prevention Plan <br /> ❑ 'k 0 _ Hardcover Calculation(s) <br /> ,� ❑ Septic System Site Evaluation Report <br /> ❑ 1ff Access Permit <br /> ❑ Wetland Buffer Improvement Plan (eV gtulATroAJ/ARsw2.)G Co,nPPEteb - SEE SaavFY) <br /> ❑ ,^$)" Engineered Plans for Retaining Walls 4 feet or above <br /> ❑ <br /> 0 Plan Review Fee <br /> ❑ Other <br /> SIE 5u4CoutitAcTO& w=CC j & ,i1 r <br /> W( NOT vEEbE1 ?ER ? Evsoas con, RsArr o.v w/ci TY <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; <OuWER coni ERZti6 7o CITY, <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 /> Applicant's Signature: /aC Date: <br /> Last Updated: 5/21/2009 <br /> -21 - <br />