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STRUCTURE INFORMATION: <br /> 1.Structur+e Dimensions 1.Structur+e Dimensions(continued) 2.Type of Constn�tian <br /> a.Length(ft.)= Number of bedrooms= ❑Wood/Frame <br /> ❑Masonry <br /> b.Width(R� Number of garage staiis: ❑Metal <br /> Attached= ❑Pole Bldg. <br /> Areas in sauare feet Detached= ❑ICF <br /> ❑On-site Prefab <br /> c.Basernern= ❑OfF site Prefab <br /> d. 1"Story = ❑Other(Please s�epfY): <br /> e.2nd Story= <br /> f. 'r4 Story = <br /> g.Total Ar+ea= <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for our ap lication to be rocessed: <br /> Not <br /> Enc iicable <br /> ❑ Permit lication <br /> O Pr osed Buildin Plans <br /> ❑ C�Y MN State Ene Code Calailations and Mechanical Code R uirements Form <br /> ❑ Surve meetin alt uirements <br /> O Stormwater Pollution Prevention Plan <br /> ❑ Hardcover Calculation s <br /> 0 Se tic S stem Site Evaluation Re ort <br /> ❑ [[Y Acoess Permit <br /> ❑ Wetland Buffer Im rovemeM Plan <br /> O En ineered Plans for etaini Walls 4 feet or above <br /> ❑ � Plan Review Fee �Ln,�,.� <br /> ❑ O Other <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agnees to provide all information required or requested by the Building Department; <br /> • Agreea to pay the City of Orono for engineering consultant review costs in excess of i500; <br /> • Certifies that the infortnation supptied is true and oomect to the best of hislher knowledge. The applicant recognizes that they <br /> are solely responsible for submitting a complete appliption being aware that upon failure to do so, the staff has no altemative <br /> but to rejed it urrtil it is c�mmplete; <br /> • Adcnowledges the Escrow Agreement is o�mpleted and signed; <br /> • Some or all of the information that you are asked to provide on this app{ication is dassified 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 subjed of the data. <br /> Confidential data is infortnation which generally pnnot be given to either the public or the subjed of tt�e data. Our purpose and <br /> intended use of this infortnation is to annually updabe our reoords and records of other govemrr�ntal agenc�s required by law. <br /> If you r�efuse to supply the information,the application may not be issued. <br /> ` � t / <br /> ApplicanYs Signature: Date: �'� 1 Z�l.'o <br /> Last updated: 9�2912009 <br /> - 18- <br />