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STRUCTURE INFORMATION: <br /> 1. Structure Dimensions 1.Structure Dimensions (continued) 2.Type of Construction <br /> � <br /> a. Length (ft.)= � Number of bedrooms= (�Wood!Frame <br /> � ❑ Masonry <br /> b.Width (ft.)= �O Number of garage stalls: ❑ Metal <br /> Attached = � !�, ❑ Pole Bldg. � <br /> Areas in spuare 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. '/Story = <br /> g.Total Area= (dA S/ � <br /> --b <br /> __ J <br /> REQUIRED SUBMITTALS: <br /> Ail of the information must be submitted in order for your application to be processed: <br /> N ot <br /> Enclosed A licable <br /> ❑ Permit A lication <br /> � dSl Pro osed Buildin Plans <br /> � MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> ❑ I Surve (meetin all re uirements <br /> � Stormwater Pollution Prevention Plan <br /> ❑ Hardcover Calculation s ' <br /> ❑ ' Se tic S stem Site Evaluation Re ort I <br /> � Access Permit <br /> � 6a Wetland Buffer Im rovement Plan <br /> ❑ En ineered Plans for Retainin Walls 4 feet or above <br /> ❑ t� 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 I <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 /> \ /'� q <br /> ApplicanYs Signature: �.�'l,(-�4 �7 - �ate: g °� 3 d / <br /> LastUpdated: 6/22/2009 <br /> - 20 - <br />