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STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> � i( <br /> a. Length(ft.)= �07 � � Number of bedrooms= 3 ❑Wood/Frame <br /> � I� ❑Masonry <br /> b.Width(ft.)= �'� � � Number of garage stalls: ❑Metal <br /> Attached=_� � Pole Bidg. <br /> Areas in sauare feet Detached=�� �ICF <br /> On-site Prefab <br /> c. Basement= �� � " ❑Off-site Prefab <br /> d. 15�Story = �;�-� <br /> s�.�;t, ❑Other(please speafy): <br /> e.2"d Story= I `G� S C���ri <br /> f. %2 Story = % l� �5 S42,�Y, <br /> g.Total Area= �� ����fi` <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for our application to be processed: <br /> Not <br /> Enclosed A plicable <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 C' <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 /> ❑ O Other <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agrees to provide al�information required or requested by the Building Department; <br /> • Agrees to pay the City of Orono for engineering consultant review costs in excess of 5500; <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 /> • 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 subjed of the data. Our purpose and <br /> intended use of this information is to annually 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 /> ApplicanYs Signature: Date: 7� — �� ' I� <br /> Last Updated: 9/29l2009 <br /> - 18- <br />