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r <br /> / � � <br /> STRUCTURE INFORMATION: <br /> 1. Structure Dimensions 1. Structure Dimensions (continued) 2. Type of Construction <br /> a. Length (ft.)= �Z.—O �� Number of bedrooms= 5 �Wood/Frame <br /> �� ❑ Masonry <br /> b.Width (ft.)= �OO-O Number of garage stalls: ❑ Metal <br /> Attached =�_ ❑ Pole Bldg. <br /> Areas in square feet Detached =�_ ❑ ICF <br /> ❑ On-site Prefab <br /> c. Basement= Z�� ❑ Off-site Prefab <br /> d. 1S�Story - Z9 fo S ❑ Other(please specify): <br /> e.2"d Story= 313 4 <br /> f. �Yt�� = 1��to <br /> g.Total Area= �� <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> Not <br /> Enclosed A licable <br /> ❑ Permit A lication <br /> ❑ Pro osed Buildin Plans <br /> ❑ MN State Ener Code Calculations and Mechanical Code Requirements Form <br /> ❑ urve meetin` all re uiremen s <br /> ❑ Stormwater Pollution Prevention Plan_��� <br /> '� ❑ ard <br /> ❑ Se tic S stem Site Evaluation Re ort <br /> ❑ Access Permit <br /> ❑ � W rovement an <br /> ❑ ineered Plans for Retainin Walls 4 feet or above <br /> ❑ Plan Review Fee .___�.�..�•-�--------- <br /> ❑ ❑ er <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 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 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. <br /> If you refuse to supply the information,the application may not be issued. <br /> S-rEv� Lt c!-�T — C�/Zc.� Cud,t� CO • <br /> a� � ,�q_. p <br /> ApplicanYs Signature: � -- �G.�Cili� Date: 8 — Z I— (� 7 <br /> Last Updated: 6/22/2009 <br /> -20 - <br />