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STRUCTURE INFORMATION: <br /> 1.Structur+e Dlmensions 1.Structure Dimensions(contlnued) 2.Type of Construction <br /> , �i <br /> a. Length(ft.)= ��� Number of bedrooms= � �'[Wood/Frame <br /> ❑ Masonry <br /> b.Width(ft.)= 31 -� Number of gara e stalis: ❑Metal <br /> Attached= � ❑ Pole Bldg. <br /> Areas in sauar�e feet Detached=—T ❑ ICF <br /> ❑On-site Prefab <br /> c. Basement= � ❑Off-site Prefab <br /> d. 1 s'Story = ❑Other(please specify): <br /> e.2"d StOry= <br /> f. %Story = <br /> g.Total Area= �3��'��, <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 /> �d' ❑ Permit A lication <br /> ❑ Pro osed Buildin Plans <br /> ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> ❑ Surve meetin all 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 /> ❑ En ineered Plans for Retainin Walls 4 feet or above <br /> '� ❑ Plan Review Fee <br /> 0 � 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 a500; <br /> • Certifies that the infvrmation supplied is true and coReot 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 afternative <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 apptication 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 510,000 <br /> escrow to ensure completlon of the as-built survey and all site improvements. <br /> a <br /> ApplicanYs Signature: / _ Date: � p`v��� <br /> Last Updffied: 4/26/2011 <br /> -20- <br />