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� , <br /> STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dlmenslona(corrtlnued) 2.Type of Construction '� <br /> a. Length(ft.)= I� Number of bedrooms= �ood/Frame <br /> ❑Masonry <br /> b.Width(ft.)= �2-.�9 Number of garage stalls: ❑Metal <br /> Attached= ❑Pole Bldg. <br /> Areas in sauare feet Detached= ❑ ICF <br /> ❑On-site Prefab <br /> c.Basement= ❑Off-site Prefab <br /> d. 1�Story = <br /> ❑Other(please specify): <br /> e.2"�Story= <br /> f. 'h Story = <br /> g.Total Area= 3�10 Sti �' <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for our a lication to be rocessed: <br /> Not <br /> Encl A Ilcable <br /> ❑ Permit A lication <br /> ❑ Pro d Buildin Plans <br /> ❑ MN State Ener Code Calculations and Mechanical Code R uirements Form <br /> 0 Surve meetin all uirements <br /> ❑ Stormwater Pollution Preverrtion Plan <br /> ❑ Hardcover Calculation s <br /> ❑ Se tic S tem Site Evaluation Re rt <br /> � Access Permit <br /> ❑ Wetland Buffer Im rovement Plan <br /> ❑ E ineered Plans for Retaini Walls 4 feet or above <br /> ❑ Plan Review Fee <br /> ❑ Other <br /> APPLIC�►RIT ACKRfOWLEDGEMENT: <br /> Agrees to provide all ir�formation required or requested by the Building Departmerrt; <br /> Agre�to pay the Clty of Orono for englneering coneulterrt revlew costs In ex�ss of$500; <br /> Certfies that the information supplied is true and coRect to the best of his/her knowledge. The applicant recognizes that they <br /> are solely res�nsible 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 compteted and signed; <br /> Some ar all of the ir�formation that you are asked to provide on this application is dassified 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 u�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 /> � <br /> Applicant's Signature: Date: �� <br /> Last Updated: 9/29/20Q9 <br /> -18- <br />