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STRUCTURE INFORMATION: <br /> 1. Structure Dimensions 1. Structure Dimensions (continued) 2. Type of Construction i <br /> a. Length (ft.)= l{ �' o � 7� Number of bedrooms= � C{ iQ�QQ� Wood/Frame � <br /> b. Width (ft.)= Z� Number of gar�e stalls: ❑ Metalnry <br /> ��rfp� Attached = ❑ Pole Bidg. <br /> Areas in square feet t_� ^ Detached = ❑ ICF <br /> ,! ❑ On-site Prefab <br /> c. Basement= 4�7 ��2t �B = )`}�{ 0 ❑ Off-site Prefab <br /> d. 1 St Story = 2 ;` �p s� ❑ Other(please specify): <br /> e. Z�d StOf)/= 7 T% Z. 'f� e � � � � �� <br /> f. '/ Story = --- ' . <br /> g. Total Area= ��(o � � � = 5�"(G� <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> N ot <br /> Enclos d A plicable <br /> ❑ Permit A fication <br /> ❑ Pro osed Buildin Plans <br /> � ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> 3 ❑ Sunre meetin all re uirements <br /> � ❑ Stormwater Pollution Prevention Plan <br /> ❑ Hardcover Calculafion s <br /> � Se tic S stem Site Evaluation Re ort <br /> � ❑ Access Permit <br /> � �' Wetland Buffer Im rovement Plan <br /> � ❑ En ineered Plans for Retainin Walls 4 feet or above <br /> � ❑ Plan Review Fee � � <br /> � ❑ Other � �---- <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agrees to provide all informafion required or requested by the Building Department; � <br /> • Agrees to pay the City of Orono for engineering consultant review costs in excess of$500; I <br /> i <br /> • Certifies that the information suppfied is true and correct to the best of his/her knowledge. The applicant recognizes that they � <br /> are solely responsible for submitfing a complete appfication 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 pubfic 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 appfication may_not be issued. <br /> ApplicanYs Signature: � Date: �� �o� <br /> -21 - <br />