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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.)= _�y'C__ Number of garage stalls: ❑ Metal <br /> Attached=_ 3 _ ❑ Pole Bldg. <br /> Areas in sQuare feet Detached=___ ❑ ICF <br /> �l��; <br /> ❑ On-site Prefab <br /> c. Basement= �" ❑ Off-site Prefab <br /> d. 15'Story = _��I S_ ❑ Other(please specify): _ ___ <br /> @. 2�d.StOry= ✓1 �� <br /> f. Yz Story = _ _ <br /> g.Total Area= �7����_ <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> Not <br /> Enclosed A plicable <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 Plan <br /> ❑ Hardcover Calculation s <br /> ❑ Se tic S stem Site 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 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 /> Understands some or all of the information that you are asked to provide on this application is classified by State law as either <br /> private or confidential. Private data is information which generally cannot be given to the public but can be given to the subject <br /> of the data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our <br /> purpose and intended use of this information is to annually update our records and records of other governmental agencies <br /> required by law. If you refuse to supply the information,the application may not be issued. <br /> Agrees that in the event that weather or other conditions prevent the completion of an as-built survey at the time the <br /> Certificate of Occupancy is requested, a temporary Certificate of Occupancy may be issued upon receipt of a $10,000 <br /> escrow to ensure completion of the as-built survey and all site improvements. <br /> � T 'j� <br /> / .-�' <br /> ,--'" <br /> ApplicanYs Signature: `��� � Date: I�i/�}C���l <br />