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� ' ' + <br /> 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.)= !3 Number of garage stalls: ❑ Metal <br /> Attached=�_ ❑ Pole Bidg. <br /> Areas in sauare feet Detached= ❑ICF <br /> ❑On-site Prefab <br /> c. Basement= 3�0$` ❑Off-site Prefab <br /> ❑Other(please specify): <br /> d. 1 St Story = y�� <br /> e.2"d StOry= �taS�D <br /> f. '/z Story = <br /> g.Total Area= � <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for our application to be processed: <br /> Not <br /> Enclosed Ap licable <br /> ❑ Permit lication <br /> ❑ Pro osed Buildin Plans <br /> ,� ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> ❑ Surve meetin all r uirements <br /> .� ❑ Stormwater Pollution Prevention Plan �F' iNYl�G 5 F�vc_E. <br /> � � Hardcover Calculation s � <br /> ❑ Se tic S stem Site Evaluation Re ort <br /> ❑ � Access Permit <br /> ❑ (8' Wetland Buffer Im rovement Plan <br /> ❑ .� En ineered Plans for Retainin Walls 4 feet or above <br /> 'k�', ❑ Plan Review Fee <br /> ❑ �il 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 5500; <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 /> 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 /> ApplicanYs Signature: Date: ��/�6� <br /> 5TGVE �L.�w`Coti — �JFa�v.t-`,'� <br /> Last Updated: 9/29/2009 <br /> - 18- <br />