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. • . <br /> � , , <br /> StRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a. Length(ft.)= 7�' Number of bedrooms= � �1Nood/Frame <br /> ❑ Masonry <br /> b.Width(ft.)= �� Number of garage stalls: ❑ Metal <br /> Attached= ❑ Pole Bldg. <br /> Areas in sauare feet Detached� ❑ ICF <br /> ❑On-site Prefab <br /> c. Basement= — ❑Off-site Prefab <br /> d. 1$'Story = ❑Other(please specify): <br /> e.2nd Story= —' <br /> f. %z Story = -- <br /> g.Total Area= Z 3��t" <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for our application to be processed: <br /> Not <br /> Enclosed A licable <br /> ❑ ❑ Permit A lication <br /> ❑ ❑ Pro osed Buildin Plans <br /> 0 MN State Ener Code Calculations and Mechanical Code R uirements Form <br /> � ❑ Surve meetin all re 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 /> 0 � En ineered Plans for Retainin Walls 4 feet or above <br /> O ❑ 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 consulfant review costs in excess of 5500; <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 govemmental 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 510,000 <br /> escrow to ensure completion of the as-built survey and all site improvements. <br /> ApplicanYs Signature: lX��� Date: � Z � � <br /> f... <br /> Last Updated: M26/2011 <br /> 0 <br />