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ti <br /> � . <br /> � • <br /> STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a. Length(ft.)= l04' Number of bedrooms= �J �Wood/Frame <br /> Masonry <br /> b.Width(ft.)= � Number of garage stalls: ❑Metal <br /> Attached= Z— ❑Pole Bldg. <br /> Areas in sauare feet Detached= ❑ICF <br /> � ❑On-site Prefab <br /> c. Basement= 1 �(oS ❑Off-site Prefab <br /> d. 1'`Story = 1 O'1 Z� ❑Other(please specify): <br /> e.2nd Story= � i 3� � <br /> f. %Story = <br /> g.Total Area= �ZQ-4-� <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for our application to be processed: <br /> Not <br /> Enclosed A Iicable <br /> ❑ Permit A lication <br /> ❑ Pro osed Buildin Plans <br /> 1� ❑ MN State Ene Code Calculations and Mechanical Code Re uirements Form <br /> �i� ❑ 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 /> ❑ ❑ En ineered Plans for Retainin Walls 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 /> �re 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 /> � <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-buitt 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 to ensure completion of the as-built survey and all site improvements. <br /> ApplicanYs Signature: s) �— Date: (v Z' � � <br />