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�� � <br /> STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1. Structure Dimensions (continued) 2.Type of Construction <br /> ► �; J <br /> a. Length(ft.}= �_ Number of bedrooms= �� ❑Wood/Frame <br /> 1�..5«'`� <br /> Masonry "�f��� <br /> b.Width(ft.}= Number of garage stalls: ❑ Metal <br /> Attached= ❑ Pole Bldg. <br /> Areas in sauare feet �_ / Detached = ❑ ICF <br /> c. Basement- `v fr ❑ On-site Prefab <br /> - ❑ Off-site Prefab <br /> d. 1 Sl Story - ❑ Other(please specify): <br /> e.2"d Story= ' <br /> � <br /> f. 'h 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 /> Enclos Applicable <br /> ❑ Permit Application <br /> ❑ Pro osed Buildin Plans <br /> ❑ C-f' 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 /> ❑ Septic S stem Site Evaluation Re ort <br /> ❑ Access Permit <br /> ❑ Wetiand Buffer Im rovement Plan <br /> ❑ En ineered Plans for Retainin Walis 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 /> • 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 agreement to ensure completion of the as-built survey and all site improvements. <br /> � <br /> ApplicanYs Signature: Date: .� �� 'Z� �--� <br />