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i r . <br /> STRUCTURE INFORMATION: <br /> �. Structure Dimensions//�- �/" 1. Structure Dimensions(continued) 2. Type of Construction <br /> a. Length (ft.)= ��t—� Number of bedrooms= � Wood/Frame <br /> � �Masonry <br /> b.Width (ft.)= .Zf�' � Number of garage stalls: ❑ Metal <br /> s���� Attached= C� ❑ Pole Bldg. <br /> Areas in s4uare feet Detached= C� ❑ ICF <br /> �s� ❑ On-site Prefab <br /> c. Basement= ❑ Off-site Prefab <br /> d. 151 Story = �J`D ❑ Other(please specify): <br /> e.2"d StOry= <br /> f. '/2 Story = <br /> g.Total Area= <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> Not <br /> Enclosed Applicable <br /> ❑ Permit A plication <br /> � ❑ Pro osed Buildin Plans <br /> ❑ ❑ MN State Ener Code Calculations and Mechanical Code Re 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 /> ❑ ❑ 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 /> 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 suliject <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 /> :: <br />� • Agrees that in the event that weather or other conditions prevent the completion of an as-built survey at the time the <br /> ��; <br /> �`-`�" Certificate of Occu anc is re uested, a tem ora Certificate of Occu anc ma be issued u on recei t of a $10,000 <br /> w P Y 4 P rY P Y Y P P <br /> �; escrow agreement to ensure completion of the as-built survey and all site improvements. <br /> �:; <br /> gy: <br /> � � �/f <br /> ApplicanYs Signature: �� Date: — <br />