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STRUCTURE INFORMATION: <br /> 1. Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a. Length(ft.)= 1_� Number of bedrooms=S� �Wood/Frame <br /> Masonry <br /> b.Width (ft.)= %3 Number of garage stalls: ❑ Metal <br /> Attached= c� ❑ Pole Bldg. <br /> Areas in square feet Detached=�_ ❑ ICF <br /> ❑ On-site Prefab <br /> c. Basement= ❑ Off-site Prefab <br /> d. 1S`Story = /�� ❑ Other(please specify): <br /> e.2nd Story= <br /> f. '/z Story = <br /> g.Total Area= � <br /> � <br /> .- i;��� � <br /> REQUIRED SUBMITTALS: <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 /> ❑ � Surve meetin all re uirements <br /> ❑ Stormwater Pollution Prevention Plan <br /> ❑ Hardcover Calculation s <br /> ❑ I� 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 /> �SI ❑ Other �n c � � <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 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 governmental agencies <br /> required by law. If you refuse to supply the information,the application may not be issued. <br /> . Agrees that in the event that weather or other conditions prevent the completion of an as-built survey at the time the <br /> Certificate of Occupancy is requested, a temporary Certificate of Occupancy may be issued upon receipt of a $10,000 <br /> escrow to ensure completion of the as-built survey and all site improvements. <br /> _� // /.z <br /> ApplicanYs Signature: /�� Date: � <br /> Packet Last Updated: 10-20-2011 <br /> -21 - <br />