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1�.r.��..,� : , , <br /> STRUCTURE INFO MATION: � <br /> 1. Structure Dimension :3 r. 1.Structure Dimensions (continued) ; 2. Type of Construction <br /> a. Length (ft.)= �`I C� ; Number of bedrooms=� �',,�Wood/Frame I� <br /> � 3 , � �asonry <br /> b. Width (ft.)= � . 5 i Number of garage stalls: I Metal I <br /> i Attached =� j Pole Bld <br /> Areas in square��tr '�3'S�r ! Detached =�J/� I ❑ ICF 9 <br /> � ❑ On-site Prefab ; <br /> c. Basement= pf� � '� ❑ Off-site Prefab ! <br /> d. 1 St Story = N/� � I ❑ Other(please specify): <br /> � � <br /> e. 2nd StOry= � I 'i I <br /> f. '/� - � <br /> \ <br /> . Total Area= � y7•j � <br /> SS tnoc.c <br /> 4 <br /> � <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> N ot � <br /> Enclos d Ap licable � <br /> � ❑ Permit A lication <br /> ❑ ' Pro osed Buildin Plans <br /> ❑ � MN State Ener Code Calculations and Mechanical Code Re uirements Form i <br /> ❑ Surve meetin all re uirements <br /> ❑ I Stormwater Pollution Prevention Plan i <br /> ❑ Hardcover Calcutation s <br /> 0 I 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 /> ❑ ❑ Plan Review Fee "1 i <br /> ❑ I ❑ 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 I <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 /> iiJ � <br /> � <br /> ApplicanYs Signature: J:a"(/� � I•� �L; ��"`'� Date: �L/ �— �L.� � �" 6 <br /> %;; <br /> �, <br /> Last Updated: 6/22/2009 <br /> -20 - <br />