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1 J <br /> STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1. Structure Dimensions (continued) 2.Type of Construction <br /> ,� , <br /> a. Length (ft.)= Number of bedrooms= t' _ [�Wood/Frame <br /> b.Width (ft.)= 3�� Number of garage stalls: � ❑ Masonry <br /> Areas in spuare feet Attached = ti� ❑ Metal <br /> ❑ Pole Bldg. <br /> c. Basement= Detached= ❑ ICF <br /> d. 15'Story = ��� ❑ On-site Prefab <br /> e.2"d Story= 1' 3� <br /> ❑ Off-site Prefab <br /> f. '/2 Story = <br /> .� ❑ 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 /> Encl ed Applicable <br /> ❑ Permit A lication <br /> ❑ Pro osed Buildin Plans <br /> ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> ❑ Surve meetin ail re uirements <br /> ❑:- ❑ Stormwater Pollution Prevention Plan w�ll ' �k.�r� L q},� <br /> ❑ 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/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 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 $90,000 � <br /> escrow to ensure completion of the as-built survey and all site improvements. <br /> n �— <br /> ,� <br /> ApplicanYs Signature: � Date: �� (�� � <br /> Owner's Signature: ���.�U Date: y �1� <br /> _�L� <br />