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Y 3 <br />� STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br />, , <br /> a.Length(ft.)= __�__� Number of bedrooms= � <br /> . � �,Wood/Frame <br /> b.�dth(ft.)= � � Number of garage stalls: ❑ Masonry <br /> Areas in sauare feet Attached= � ❑Metal <br /> ❑Pole Bidg. <br /> c. Basement= — � Detached= � ❑ ICF <br /> d. 1�Story = o�y � ❑On-site Prefab <br /> e.2"d Story= ❑Off-site Prefab <br /> f. %Z Story = ❑Other(please specify): <br /> � <br /> g.Total Area= �-2�n <br /> REQUIRED SUBMIITALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> Not <br /> Enclosed A licable <br /> .�' ❑ Permit A lication <br /> ,� ❑ Pro osed Buildin Plans <br /> ❑ ,� MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> ❑ �f' Surve meetin all re uirements <br /> ❑ Stormwater Pollution Prevention Plan ° <br /> ❑ �l 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 /> ❑ Application Escrow&Agreement <br /> ❑ ❑ Other: <br /> APPLICANT/OWNER 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 corre�t 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 altemative <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 information 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 govemmental agencies <br /> required by law. If you refuse to supply the information,the application may not be issued. <br /> � <br /> • Agrees that in the event that weather or other conditions prevent the aompletion of an as-built survey at the time the <br /> Certificate of Occupancy is requested, a temporary Certificate of Occuptancy may be issued upon receipt of a$10,000 � <br /> escrow to ensure completion of the as-built survey and all site improverhents. <br /> � � <br /> � ���`�l� -�� � <br /> Applicant's Signature: � � Date: <br /> � <br /> Owner's Signature: � Date: � ' � � �� <br /> , <br /> � <br /> - ----- --- �----- - -- - - -- -- <br />