2013-00728 (new structure) - Laserfiche WebLink

Home Browse Search

STRUCTURE INFORMATION: 1.Structure Dimertsions 1.Structure Dimensions(conNnued) 2.Type of Construction '- j � � a. Length(ft.)= �� 3 g IVumber of bedrooms= �ood/Frame b.Width(ft.)= �t3`-S�� Number of garage stalls: ❑ Masonry Areas in sauare fee� Attached= � ❑ Metal ❑ Pole Bldg. c. Basement= ��S Dekached= Z �� ❑ ICF d. 1'`Story = ❑On-site Prefab e.2nd Story= �� ❑ Off-sfte Prefab f. '�Story = �— ❑ Other(please specify): g.Total Area= `�SS�7 REQUlRED SUBMITTALS: AN of the information must be submitted in order for our application to be processed: N ot Enclosed A Ilcable .k?' ❑ Permit A lication 0� ❑ Pro osed Buildin Plans ❑ MN State Ener Code Calculations and Mechanicaf Code Re uirements Form ❑ Surve meetin all uirements ❑ Stormwater Pollution I'revention Pian ❑ Hardcover Calculation s .l Se tic S stem Site Evaluation Re ort ❑ ❑ Access Permit ❑ ❑ _ Wetland Buffier Im rovement Plan ❑ ❑ En ineered Plans for Retainin Walls 4 feet or abo.ve ❑ ❑ Pian Review Fee ❑ ❑ Application Escrow&Agreemen# ❑ ❑ Other: APPLICANTlOWNER ACKNOWLEDGEMENT: • Agrees to provide all inforrnatfon required or requested by the Building Department; • Agrees to pay the Cfty of Orono for engineering consultant review costs in excess of S50D; • Certifies that the informafion supplied is true and co�rect to the best of hls/her knowiedge. The applicant recognizes that#hey are solely responsible for submitting a complete application being aware that upon failure to do so,the staff has no alternative but to reject it uMil it is complete; • Acknowledges the Escrow Agreement is completed and signed; • Understands some ar all of the information that you are esked to provide on this application is classified by State law as either private or confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the data. Confidenfial data is information which generally cannot be gi�en to either#he public or the subJect of the data. Our purpose and:intended use of this information is to annualfy update our records and records of other governmental agencies required by law. If you refuse to supply the information,the application may not be issued. • Agrees that in the event that weather or other conditions prevent the completion of an as-bullt survey at the tlme the Certificate of Occupancy Is requested, a femporary Certifvcate of Occupancy may be isaued upon receipt of a$10,000 escrow to snsure completion ot'the as�uilt survey and all slte improvements. ' �,��Gr-� �J/Z��3 Appl9cant's Signature: - '�`r Date: Owner's Signature: Date: