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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= 3 [�N/ood/Frame <br /> � ,, <br /> b.Width (ft.)= 7�-•� Number of garage stalls: ❑ Masonry <br /> Areas in square feet Attached= L ❑ Metal <br /> ❑ Pole Bldg. <br /> c. Basement= � � �Z Detached= ❑ ICF <br /> d. 151 Story = I �L�Z <br /> ❑ On-site Prefab <br /> e. 2"d Story= � b°v�3 <br /> ❑ Off-site Prefab <br /> f. 'h Story = ❑ Other(please specify): <br /> g.Total Area= 3� <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 /> ❑ Permit A lication <br /> ❑ Pro osed Buildin Plans <br /> JSI ❑ 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 /> ❑ L� Access Permit <br /> ❑ Wetland Buffer Im rovement Plan <br /> ❑ �'' En ineered Plans for Retainin Walls 4 feet or above <br /> 15� ❑ 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 hislher knowle�gc. Th�; ap�licart recognizes that they <br /> are solely responsible for submitting a complete application bein� aware that upon failure to do so, the staff has no aitemative <br /> � t�ui to re;ect i:until i?is�or�3{�le:e; <br /> � • r�cknowledge�the EscrobN Agr��3nerr#i�cUrr�plete��i ancl���rieci; <br /> � • Understands same or all of the in#ormation that you are asked ta provide on this application is classified by State la�v as either <br /> �;ivate ar ccnfi�er�tia�. �rivate data is irrfcrm�rio�� vrhic� �eneraliy ca�not bz given to the public bui can be given to the subject <br /> of the data. �onfidential data is information which generally cannot be given to sither the public or the subjeck of the data. Our <br /> purpose and intended use of this information is to annually update our records and records of�ther governmental agencies <br /> ,.:.,,�-�.., .s,,, �.,s„�..,.,a...., ..i„--„�n.. .,, �i r ,,,. } <br /> ... �_ ......< �p ..sx, ..� v�..._t. _ v , i�Y�.� .. �.�._ <.�... .... _- ..�.i,.., .. .�... v.� .._.._....... <br /> • r��P�.'c^:� C:taL iC3 ��t2 E.'L`E:tZ 2f3at WEBiti�� �C D°a�'i�6'Cffii'Sc'�i�106e� p'3CctT�t'i2 i�i2 car��sleuc�n c�ar a�-�uelt s�rsry a���v �ii3iL i8ia�. ': <br /> � Certf¢:rate �f�ecuparstiy i� r�qa�evt�d, � fer.^.�:�r�r��er�ifiGa�n of��cc:csarzcy snay be xssue� c���.^. s���`spt v#a ��`�.���� ' <br /> �SCCCy✓LC1£;'SSISF'p�n:r��'sc�t9a;�at i�e�s��€�i4f�M�ru��F an�f ai�siFe tr:i�r�vcr��^ts. <br /> i <br /> '__ _ _ _ _- _— _ __ _ ____ __ _ _ ___ _ --- _--. _ _______-- ------------- --� <br /> , <br /> -. ��-z��;��._v-_ �� l -�- l I- 2� - i z, <br />