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STRUCTURE INFORMATION: kejjo, (� X��S ip�,2 in scai•.�. / 6Q�/v,„t <br /> 1.Structure Dimensions 1.Structure Dimensionst�(c tinued) 2.Type of Construction <br /> a. Length (ft.) !`7 Number of bedrooms=_ Wood/Frame <br /> Masonry <br /> b,Width(ft.)= Number of garage stalls: a, ❑ Metal <br /> Attached= ( ❑ Pole Bldg. <br /> Areas in square feet Detached = ❑ ICF <br /> ❑ On-site Prefab <br /> c. Basement- ❑ Off-site Prefab <br /> d. 18 Story = • ❑ Other(please specify): • <br /> e, 2nd Story= <br /> f. '/2 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 /> fX ❑ Permit Application <br /> J� O Proposed Building Plans <br /> O MN State Energy Code Calculations and Mechanical Code Requirements Form <br /> ❑ .121' Survey(meeting all requirements) <br /> ❑ 13' Stormwater Pollution Prevention Plan <br /> ❑ Hardcover Calculation(s) <br /> ❑ IV Septic System Site Evaluation Report <br /> o Access Permit <br /> ❑ Wetland Buffer Improvement Plan <br /> O te' Engineered Plans for Retaining Walls 4 feet or above <br /> ❑ A� Plan Review Fee <br /> 52- ❑ Other r‘..-fv ro o. Lice, dtr� �� z` (( „v <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 applicatio, may not be issued. <br /> Applicant's Signature: Date: 7 ?//i) <br /> Last Updated: 9/29/2009 <br /> - 18- <br /> 8 d ZtiLI '°N S3�OIM3S 213AVdXVI OH 1/08S :O1 OIOZ 'L Mr <br />