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STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions (continued) 2.Type of Construction <br /> a. Length (ft.)= 6-{0 Number of bedrooms= / —/3 a ood/Frame <br /> ❑ Masonry <br /> b.Width (ft.)= 2 72 Number of gar a #ails: / ❑ Metal <br /> Attached = El Pole Bldg. <br /> Areas in square feet Detached = ❑ ICF <br /> On-site Prefab <br /> c. Basement= (2 SO ❑ <br /> ❑ Off-site Prefab <br /> d. 1st Story = ❑ Other(please specify): <br /> e.2nd Story= <br /> f. 'h 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 /> ❑ ❑ Permit Application <br /> O 0 Proposed Building Plans <br /> O 0 MN State Energy Code Calculations and Mechanical Code Requirements Form <br /> ❑ 0 Survey(meeting all requirements) <br /> ❑ 0 Stormwater Pollution Prevention Plan <br /> ❑ 0 Hardcover Calculation(s) <br /> ❑ ❑ Septic System Site Evaluation Report <br /> O 0 Access Permit <br /> ❑ 0 Wetland Buffer Improvement Plan <br /> ❑ 0 Engineered Plans for Retaining Walls 4 feet or above <br /> ❑ <br /> 0 Plan Review Fee <br /> ❑ <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 information,the application may not be issued. <br /> Applicant's Signature: Date: ///, .//a <br /> Last Updated: 9/29/2009 <br /> - 18 - <br />