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_ -«�— �.e:_,_r �.�,�. ___.1 <br /> y <br /> I <br /> STRUCTURE INFORMATION: ' <br /> i <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction � <br /> a. Length(ft.)= �_ Number of bedrooms= ❑Wood/Frame <br /> ❑Masonry ' <br /> b.�dth (ft.)= � Number of garage stalis: ❑Metal , <br /> Attached= ❑ Pole Bldg. � <br />� Areas in sauare feet Detached= I ❑ ICF ' <br />� c. Basement= ❑On-site Prefab ' <br /> ❑Off-site Prefab � <br /> d. 1�Story = ❑Other(please specify): I <br /> � <br /> e.2"d StOry= <br /> � <br /> f. '/z Story = � <br /> i <br /> g.Total Area= <br /> i <br /> � <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> Not <br /> Enclosed A ficable <br /> ❑ ❑ Permit A lication � <br /> ❑ ❑ Pro osed Buildin Plans � <br /> ❑ 0 MN State Ener Code Calculations and Mechanical Code Re uirements Form � <br /> ❑ ❑ Surve meetin all re uirements I <br /> ❑ � Stormwater Poliution Prevention Plan � <br /> ❑ ❑ Hardcover Calculation s i <br /> ❑ � Se tic S stem Site Evaluafion Re ort � <br /> ❑ 0 Access Permit � <br /> ❑ ❑ Wetland Buffer Im rovement Plan � <br /> ❑ ❑ En ineered Plans for Retainin Walls 4 feet or above ' <br /> ❑ ❑ Plan Review Fee � � <br /> ❑ 0 Other <br /> i <br /> APPLICANT ACKNOWLEDGEMENT: � <br /> � <br /> i <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 i <br /> are solely responsible for submitting a complete appfication being aware that upon failure to do so,the staff has no altemative � <br /> but to reject it until it is compfete; � <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. i <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 govemmental agencies required by law. <br /> If you refuse to supply the information,the application may not be issued. ; <br /> i <br /> � <br /> Applicant's Signature: Date: � ' 3"�� i <br /> I <br /> i <br /> Last Updated: 6/22l2009 � <br /> -20- � <br /> � <br /> I <br /> i <br />