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STRUCTURE INFORMATION: <br /> 1. Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a. Length(ft.)= Number of bedrooms= �-� ����b�� �Wood/Frame <br /> Z Ut,s�t�. ❑ Masonry <br /> b.Width(ft.)= Number of garage stalls: ❑ Metal <br /> Attached= 7 ❑ Pole Bidg. <br /> Areas in square feet Detached= � ICF <br /> �On-site Prefab <br /> c. Basement= ❑Off-site Prefab <br /> d. 15�Story - ❑Other(please specify): <br /> e.2"d StOry= <br /> f. '/z Story = <br /> g.Totai Area= <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> Not <br /> Enclosed A licable <br /> �1 ❑ Permit A lication <br /> � ❑ Pro osed Buildin Plans <br /> � ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form - �/V1 tl. <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 /> ❑ ❑ 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 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 public but can be given to the subject of the data. <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 /> -�- .- �� � �r <br /> ,��._. , .' CX <br /> �� � / .J ��2�(U <br /> ApplicanYs Signature: Zti!/ Date: <br /> Last Updated: 9/29/2009 <br /> - 18- <br />