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STRUCTURE INFORMATlON: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a. Length(ft.j= "L� Number of bedrooms= ❑Wood/Frame <br /> ❑Masonry <br /> b.Width(ft.)= t.�,__�__ Number of garage stalis: ❑Metal <br /> Attached= ❑Pole Bidg. <br /> Areas in sQuare feet Detached= ❑ ICF <br /> ❑On-site Prefab <br /> c. Basement= ❑Off-site Prefab <br /> d. 1°�Story = ❑Other{please specify): <br /> e.2ntl Story= <br /> f. Y:Story = <br /> g.Total Area= <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be rocessed: <br /> Not <br /> Enclosed A ticable <br /> m ❑ PermitA fication <br /> D Pra osed Buildin Plans <br /> ❑ ❑ MN State Ener Code Galculations and Mechanical Code R 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 /> ❑ 0 En ineered Plans for Retainin Walls 4 feet or above <br /> ❑ Plan Review Fee <br /> ❑ O 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;500; <br /> • Certifies that the inforrnation 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 altemative <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 govemmental agencies required by law. <br /> If you refuse to supply the information,the application may not be issued. <br /> ApplicanYs Signature: "' �_---- Date: �"`(,C J"`� � <br /> Last Updated: 6/2 212 0 0 9 <br /> -20- <br />