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. <br /> STRUCTURE INFORMATION: <br /> 1. Structure Dimensions 1. Structure Dimensions (continued) 2. Type of Construction <br /> a. Length (ft.)= (��G Number of bedrooms=�_ �Wood/Frame <br /> ❑ Masonry <br /> b.Width (ft.)= `� � Number of garage stalls: ❑ Metal <br /> Attached = � ❑ Pole Bldg. <br /> Areas in square feet Detached= ❑ ICF <br /> �•Zd �-;ry,s� ❑ On-site Prefab <br /> c. Basement= ��,�5 t;,vi��n�51,• � ❑ Off-site Prefab <br /> d. 15t Story = 3oSS ❑ Other(please specify): <br /> e. 2"d Story= 9 a 3 <br /> f. '/2 Story = �--� <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 Applicable <br /> ❑ Permit A plication <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 /> ❑ Se tic S stem Site Evaluation Re ort <br /> ❑ �i Access Permit <br /> ❑ �. Wetland Buffer Im rovement Plan <br /> ❑ � En ineered Plans for Retainin Walls 4 feet or above <br /> K� ❑ Plan Review Fee <br /> ❑ O Other <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 /> • Some or all of the information that you are asked to provide on this application is classified by State law as either private or <br /> confidential. Private data is information which generally cannot be given to the p��blic but can be given fo the sub;ect ef;he da:a. <br /> Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and <br /> intended use of this information is to annually update our records and records of other governmental agencies required by law. <br /> If you refuse to supply the information,the application may not be issued. <br /> � <br /> PP 9 r � Date: I � '�� ` �� <br /> A IicanYs Si nature: <br /> � � , <br /> Last Updated: 9/29/2009 <br /> - 18 - <br />