2009-00047 - new structure - Laserfiche WebLink

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STRUCTURE INFORMATION: 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction � n a. Length (ft.)= 9�'�' �1 Number of bedrooms= s �Wood/Frame < <� ❑ Masonry b. Width (ft.)= 7�0 (a Number of garage stalls: ❑ Metal Attached =� ❑ Pole Bldg. Areas in square feet Detached= ❑ ICF ❑ On-site Prefab c. Basement= Z 377 ❑ Off-site Prefab d. 1St Story = Z�lq ❑ Other(please specify): e. 2�d Story= �� `..a..�, f. 'h Story = g. Total Area= 7331 REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: Not Enclosed Applicable R ❑ Permit Application I� ❑ Pro osed Buildin Plans � ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form [�p C ❑ Surve meetin all re uirements ❑ � Hardcover Calculation s) Q� ❑ Septic S stem Site Evaluation Report ❑ � Access Permit ❑ �I Wetland Buffer Im rovement Plan ❑ L� En ineered Plans for Retainin Walls 4 feet or above � ❑ Plan Review Fee =�e��.�f 1�,rj��; � � '�s �� 'r;;;� ❑ Other ' APPLICANT & OWNER ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Building Department, • Agrees to pay the City of Orono for engineering consultant review costs in excess of$500, and • Certify that the information supplied is true and correct to the best of his/her knowledge. The applicant and owner recognize that they are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative but to reject it until it is complete. • Acknowledge the Escrow Agreement is completed and signed. • The Owner hereby acknowledges and agrees to this application and further authorizes reasonable entry onto the property by City Staff, consultants or agents, for purposes of investigation of this request. • Some or all of the information that you are asked to provide on this application is classified by State law as either private or confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and intended use of this information is to annually update our records and records of other governmental agencies required by law. If ou refuse to su I the information, the a lication ma not be issued. r �, _ , �'� � � 4� ? Applicant's Signature: ��f°�-E,�l':;� ,.,=v�, �---- u�{ c�,�.�,a;>("� Date: Z !�n l49 . / Applicant's Signature: f Date: Owner's Signature: Date: Owner's Signature: Date: - 19 -