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� , <br /> STRUCTIlRE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> r « <br /> a. Length (ft.)= �� '�' Number of bedrooms=� ,�Wood/Frame <br /> [3�Masonry <br /> b.Width (ft.)= 83 -� � Number of garage stalls: ❑ Metal <br /> Attached=� ❑ Pole Bldg. <br /> Areas in spuare feet Detached = ❑ ICF <br /> ❑ On-site Prefab <br /> c. Basement= Z2 Z� ❑ Off-site Prefab <br /> d. 1 S'Story = � 3 F ❑ Other(please specify): <br /> e.2�d Story = Z22� <br /> f. '/2 Story = <br /> g.Total Area= �� <br /> REGIUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> Not <br /> Enclosed A licable <br /> L� ❑ Permit A lication <br /> f�l ❑ Pro osed Buildin Plans <br /> � ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> � ❑ Surve meetin all re uirements <br /> O � Stormwater Pollution Prevention Plan <br /> Gd ❑ 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 io 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 reco�ds 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 /> i ��, _�� <br /> ApplicanYs Signature: Date: <br />