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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= F� �Wood/Frame <br /> ❑ Masonry <br /> b.Width (ft.)= �(1 _ Number of garage stalls: ❑ Metal <br /> Attached =� ❑ Pole Bldg. <br /> Areas in square feet Detached = ❑ ICF <br /> c. Basement= j'- �� ❑ On-site Prefab <br /> ❑ Off-site Prefab <br /> d. 15`Story - )SfL I ❑ Other(please specify): <br /> e. 2"d Story= 'u�,C; <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 processed: <br /> Not <br /> Enclosed Applicable <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 /> l� Se tic S stem Site Evaluation Re ort <br /> � Access Permit <br /> � � Wetland Buffer Im rovement Plan <br /> � �I 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$500; <br /> • Certifes 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 /> /�- "� <br /> ApplicanYs Signature: Date: � •-` -] -r(� <br /> i <br /> i� <br /> Last Updated: 12/21/2010 �-�� <br /> -20- <br />