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STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> � rr <br /> a. Length (ft.)= �0 � Number of bedrooms= <br /> � II ❑Wood/Frame <br /> b.Width (ft.)= �S � Number of garage stalls: ❑ Masonry <br /> Areas in square feet v Attached = ❑ Metal <br /> ❑ Pole Bldg. <br /> c. Basement= Detached= ❑ ICF <br /> d. 15'Story = ❑ On-site Prefab <br /> e.2"d Story= ❑ Off-site Prefab <br /> f. 'h Story = ❑ Other(please specify): <br /> g.Total Area= <br /> REQUIRED�SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> Not <br /> Enclosed Ap licable <br /> ❑ Permit A lication <br /> ❑ Pro osed Buildin Plans • <br /> ❑ ❑ MN State Ener Code Calculations and Mechanical Cod�Re uirements Form <br /> ❑ ❑ �Surve meetin all re uirements ' <br /> ❑ � ❑ Stormwater Pollution Prevention Plan • <br /> ❑ ❑ Hardcover Calculation s <br /> ❑ Se tic S stem Site Evaluation Re ort <br /> ❑ ❑ Access Permit <br /> ❑ �J Wetland Buffer Im rovement Plan <br /> ❑ ❑ En ineered Plans for Retainin Walls 4 feet or above <br /> ❑ ❑ Plan Review Fee <br /> 6d ❑ Application Escrow&Agreement � <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 thaf 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 /> � li/��� <br /> Applicant's Signature: ---- Date: <br /> Owner's Signature: ��`_,,.� „':� ,;; ��-�`'� Date: ��� 3 <br />