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STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a.Length(ft.)= 20 Number of bedrooms= ❑Wood/Frame <br /> ❑ Masonry <br /> b.Width(ft.)= 1z 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. 1S'Story - ❑ Other(please specify): <br /> e.2nd Story= <br /> f. Y�Story = <br /> g.Total Area= 240' <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> Not <br /> Enclosed A licable <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 Pian <br /> ❑ ❑ Hardcover Calculation s <br /> � ❑ Se tic S stem Sile 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 consuitant 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 ro 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 appiication 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 /> i� <br /> ApplicanYs Signature: - Date: Qy-�„y� /� <br /> Last Updated: 9/29/2009 <br /> - 18- <br />