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STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a. Length(ft.)= v( � Number of bedrooms= �— [p�Wood/Frame <br /> ❑ Masonry <br /> b.Width(ft.)= j � Number of garage stalls: ❑ Metal <br /> Attached= — ❑ Pole Bldg. <br /> Areas in square feet Detached= — ❑ �CF <br /> ❑On-site Prefab <br /> c. Basement= � ❑Off-site Prefab <br /> ❑Other(please specify): <br /> d. 1 St Story = — <br /> e. 2"d Story= — <br /> f. '/z Story = — <br /> g.Total Area= �F� <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> Not <br /> Enclosed A plicable <br /> ❑ Permit A lication <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 /> �t ❑ Hardcover Calculation s <br /> ❑ CsR 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 inforrnation required or requested by the Building Department; <br /> • Agrees to pay the City of Orono for engineering consultant review costs in excess of a500; <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 altemative <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 /> , . � _ � �� � <br /> ApplicanYs Signature: � Date: <br /> Last Updated: 9/29/2009 <br /> - 18- <br />