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r;,-�. ,.� .. <br /> _ ;, ; _ _ _ , , __ <br /> -J . � <br /> � <br /> . <br /> STRUCTURE INFORMATION: <br />�:'" 1.Structure Dimensions 1. Structure Dimensions (continued) 2.Type of Construction <br />€:_'. <br /> a. Length (ft.)= Number of bedrooms=� ❑Wood/Frame <br /> ❑ Masonry <br /> b.Width (ft.)= Number of garage stalls: ❑ Metal <br /> Attached = ❑ Pole Bldg. <br /> Areas in square feet Detached = ❑ 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. '/2 Story = <br /> g. Total Area= <br />�;' <br /> 4.. <br />;�' REQUIRED SUBMITTALS: <br />`�' All of the information must be submitted in order for your application to be processed: <br /> F;<r <br />��w Not <br />� <br />�F Enclosed A plicable <br />� ❑ ❑ Permit A lication <br /> ❑ ❑ Pro osed Buildin Plans <br /> ❑ ❑ MN State Ener Code Cafculations and Mechanical Code Re uirements Form � <br /> ❑ ❑ Surve meetin all re uirements <br /> ❑ ❑ Stormwater Pollution Prevention Plan '�r' <br /> g�;:; ❑ ❑ Hardcover Calculation(s `�`;; <br />�:' ❑ Se tic S stem Site Evaluation Re ort <br />�''<�� ❑ ❑ Access Permit <br /> 5'� ❑ ❑ Wetland Buffer Im rovement Plan <br /> ❑ ❑ En ineered Plans for Retainin Walls 4 feet or above <br /> ❑ ❑ Plan Review Fee <br /> ❑ ❑ Other <br />;t,'. <br /> i:;f: <br />�'; <br />�� <br /> APPLICANT ACKNOWLEDGEMENT: <br />;,��: <br />�t • Agrees to provide all information required or requested by the Building Department; <br />�;;,;; <br />�"'� • Agrees to pay the City of Orono for engineering consultant review costs in excess of$500; <br />,;.�'' <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 /> • 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 /> t.. , � � <br /> \ <br /> '� <br /> ApplicanYs Signature: Date: <br /> � <br /> Last Updated: 9/29/2009 <br /> - 18 - <br />