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� � <br /> STRUCTURE INFORMATION: <br /> '1. Structure Dimensions 1. Structure Dimensions (continued) 2. Type of Construction <br /> ���y r <br /> i <br /> a. Length (ft.)= �I ""�� Number of bedrooms= `,/Vood/Frame <br /> q � �Masonry <br /> b. Width (ft.)= `� / ,g Number of garage stalls: ❑ Metal <br /> Attached =_;� ❑ Pole Bldg. <br /> Areas in spuare feet Detached = ❑ ICF <br /> � ❑ On-site Prefab � <br /> c. (3asement= ❑ Off-site Prefab r <br /> d. 15t Story = �� ❑ Other(please specify): <br /> �. 2�d.St01�/_ � b �� <br /> r`. '/2 Story = � �`�-� <br /> g.Total Area= 4 l�� <br /> ����UIRED SUBMITTALS: <br /> All o,�th� information must be submitted in order for your application to be processed: <br /> Not <br /> Enc:losed Applicable <br /> ❑ Permit Ap lication <br /> ❑ Pro osed Buildin Plans <br /> G ❑ 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 reiect 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 annualty update our records and records of other governmental agencies required by law. <br /> If you refuse to supply the information, the application may not be issued. <br /> i ' <br /> ApplicanYs Signature: '/ Date: �/ � / � ��L� <br /> �� � � <br /> V U c.,,.�/�T L L '- [ � " tCJ <br /> Last Updated: 9/29/2009 <br /> - 18 - <br />