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i <br /> STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a. Length(ft.)= i v C� Number of bedrooms= Li �Wood/Frame <br /> ❑Masonry <br /> b.Width(ft.)= _�'� Number of gara e stalls: ❑Metal <br /> Attached=� ❑Pole Bldg. <br /> Areas in sauare feet Detached- ❑ICF <br /> ❑On-site Prefab <br /> c. Basement= U ❑Off-site Prefab <br /> d. 151 Story = �� '�L� ❑Other(please specify): <br /> e.2"d Story= r, <br /> f. '/�Story = —C� � <br /> g.Total Area= "2�7�� <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for our application to be processed: <br /> Not <br /> Enclosed licable <br /> � Permit A lication <br /> �tY ❑ Pro osed Buildin Plans <br /> ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> ❑ Surve meetin all r uirements <br /> q Stormwater Pollution Prevention Plan <br /> ❑ Hardcover Calculation s <br /> ❑ Se tic S stem Site Evaluation Re ort <br /> ❑ Access Permit <br /> ❑ WeUand Buffer Im rovement Plan <br /> ❑ En ineered Ptans 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 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 classfied 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 govemmental agencies required by law. <br /> If you refuse to supply the information,the application may not be issued. <br /> � <br /> ApplicanYs Signature: iG'�% Date: 2� Jn <br /> Last Updated: 9/29/2009 <br /> - 18- <br />