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STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a. Length (ft.)= ��o•� Numberof bedrooms= �J <br /> �Wood/Frame <br /> b.Width(ft.)= .72 Number of garage stalls: ❑ Masonry <br /> Areas in sauare feet Attached= 2 ❑ Metal <br /> ❑ Pole Bldg. <br /> c. Basement= �S�3 Detached= Z ❑ ICF <br /> d. �5'story = l$0 3 <br /> ❑On-site Prefab <br /> e.2"d Story= Z✓03 ❑Off-site Prefab <br /> f. '/Z Story = — <br /> ��� ❑Other(please specify): <br /> g.Total Area= <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your ap lication to be processed: <br /> Not <br /> Enclosed A licable <br /> $L ❑ Permit A lication <br /> � ❑ Pro osed Buildin Plans <br /> ❑ ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> � ❑ Surve meetin all re uirements <br /> ❑ �. Stormwater Pollution Prevention Plan <br /> -$l ❑ Hardcover Calculation s <br /> ❑ � Se tic S stem Site Evaluation Re ort <br /> ❑ � Access Permit <br /> ❑ �1 Wetland Buffer Im rovement Plan <br /> ❑ I,� En ineered Plans for Retainin Walls 4 feet or above <br /> ❑ ❑ Plan Review Fee <br /> ❑ ❑ Other: <br /> APPLICANT/OWNER 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 altemative <br /> but to reject it until it is complete; <br /> • Acknowledges the EscrowAgreement 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 govemmental 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 o the as-built survey and all site improvements. <br /> Applicant's Signature: Date: '4 ' �� ' � 3 <br /> Owner's Signature: Date: <br /> Packet Last Updated: 03-06-2012 <br /> -22- <br />