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STRUCTURE INFORMATION: t <br /> , 1. Structure Dimensions i 1. Structure Dimensions (continued) ! 2. Type of Construction ; <br /> I a. Length (ft.)= >L ! Number of bedrooms= I�' ❑Wood/Frame I <br /> ; � �,Masonry i <br /> b.Width (ft.}= � � ; Number of garage stalls: ❑ Metal <br /> j Attached = ❑ Pole Bldg. � <br /> Areas in square feet ' Detached = I ❑ ICF <br /> j ❑ On-site Prefab <br /> c. Basement= � I� ❑ Off-site Prefab <br /> d. 151 Story = I , ❑ Other(please specify): <br /> G'. Z�d.StO � � <br /> rY= I � <br /> f. Yz Story = � <br /> g.Total Area= <br /> I <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> Not I <br /> Enclosed Ap licable <br /> � I ❑ I Permit A lication <br /> ❑ ❑ � Pro osed Buildin Plans <br /> � � I MN State Ener Code Calculations and Mechanical Code Re uirements Form � <br /> ❑ I ❑ : Surve meetin all re uirements <br /> ❑ ❑ ' Stormwater Pollution Prevention Plan I <br /> I � ❑ , Hardcover Calculation(s ; <br /> ❑ � ❑ { Se tic S stem Site Evaluation Re ort ; <br /> ❑ � I Access Permit <br /> ❑ ❑ i Wetland Buffer Im rovement Plan <br /> ❑ ❑ En ineered Plans for Retainin Walls 4 feet or above <br /> ❑ ❑ ; Plan Review Fee I <br /> � _ ❑ i � j 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 ezcess of$500; <br /> • Certifies that the information supplied is true and correct to the best of his/her knowledge. The appficant 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. I <br /> If you refuse to supply the information, the application may not be issued. , <br /> Applicant's Signature: Date: �� �� �� <br /> i <br /> Last Updated: 6/22/2009 � <br /> - 20 - <br />