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. � � <br /> � « <br /> ' �STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a. Length(ft.)= -,�S L.S� Number of bedrooms=�c� �ood/Frame <br /> T Masonry <br /> b.Width(ft.)= � �-0�� l��c)'��� Numberofgar e�talls: ❑ Metal <br /> Attached=� �Sc!�� ❑ Pole Bldg. <br /> Areas in sQuare feet� � Detached = ❑ ICF <br /> ❑On-site Prefab <br /> c. Basement= � �C%75 ❑Off-site Prefab <br /> d. 15t Story = ��_'_T_�_S� ❑Other(please specify): <br /> e.2"d StOry= '�{.� `-' <br /> f. '/2 Story = —() -- <br /> g.Total Area= � � � � 3� <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 A lication <br /> ❑ Pro osed Buildin Plans <br /> ❑ ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> ❑ Surve meetin all re uirements <br /> ❑ ❑ Stormwater Pollution Prevention Plan <br /> ❑ ❑ Hardcover Calculation s <br /> ❑ ❑ Se tic S stem Site Evaluation Re ort <br /> ❑ ❑ Access Permit <br /> � ❑ Wetland Buffer Im rovement Plan <br /> ❑ ❑ En ineered Plans for Retainin Walls 4 feet or above <br /> ❑ ❑ Plan Review Fee <br /> ❑ ❑ 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 /> • Understands some or all of the inforrnation 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 information 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 /> • Agrees that in the event that weather or other conditions prevent the completion of an as-built survey at the time the <br /> Certificate of Occupancy is requested, a temporary Certificate 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 /> � � <br /> ,,,i ;/� � <br /> � - .Ic, <br /> �. �, <br /> ApplicanYs Signature: r ,�'��` �'. � � Date: <br /> � <br /> /'` <br />