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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= Wood/Frame <br /> � Masonry <br /> b. Width (ft.}= � Number of garage stalls: ❑ Metal <br /> Attached = ❑ Pole Bldg. <br /> Areas in square feet Detached = ❑ ICF <br /> ❑ On-site Prefab <br /> c. Basement= ❑ Off-site Prefab <br /> d. 151 Story = ❑ Other(please specify): <br /> e. 2"d StOry = <br /> f. '/ Story = <br /> g. Total Area= <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> N ot <br /> Enclosed Applicable <br /> ❑ Permit Ap 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 /> ❑ ❑ 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 /> confidenfial. Private data is information which generally cannot be given to the pubfic 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 /> / —��='`'� i� <br /> '� '� -��� J/q � <br /> r / � r '� / ,` !/ / <br /> Appficant's Signature: , �-��.. <�-'�� , Date: � �� <br /> Last Updated: 9/29/2009 <br /> - 18 - <br />