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:. �.—v.,� �.,—,�.,�— . ... <br /> � . � : ,a <br /> , " — � <br /> �`� <br /> '<:t: <br /> STRUCTURE INFORMATION: '� <br /> 1. Structure Dimensions 1. Structure Dimensions(continued) 2.Type of Construction ^�� <br /> a. Length(ft.)= �/�� JrC Number of bedrooms=� �Wood/Frame {'� <br /> � ` ❑ Masonry <br /> b.Width(ft.)= ��� Number of garage stails: ❑ Metal <br /> Attached =� ❑ Pole Bldg. <br /> Areas in s4uare feet Detached= ❑ ICF <br /> ,� ❑ On-site Prefab ��,��4,Q ����E� a� <br /> c. Basement= � �i� ❑,�,�ff-site Prefab \ � `� <br /> d. 1 St Sto ��� L�Uther(please specify):��,��Q,� �C-�K ,;, <br /> rY = ':� <br /> e.2"d Story= �_ <br /> f. '/z Story = <br /> g.Total Area= c�� <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 Application <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 /> ' ` ❑ ❑ Septic S stem Site Evaluation Re ort '� <br /> M�: 9 <br />� ❑ ❑ Access Permit � <br />,b ; ,z� <br /> r ❑ ❑ Wetland Buffer Im rovement Plan .��� <br />�,: <br /> ❑ ❑ En ineered Plans for Retainin Walls 4 feet or above <br /> � <br /> ❑ ❑ Plan Review Fee <br />���� ❑ ❑ Other <br />�::, <br />� <br />>. <br /> �` APPLICANT ACKNOWLEDGEMENT: <br />�� <br /> k�; <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 altemative <br /> but to reject it until it is complete; <br /> �� <br /> • Acknowledges the Escrow Agreement is completed and signed; �`° <br /> �ti:':7 <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 tne data. Our <br />�"'s� 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 informafion,the application may not be issued. <br /> c:' <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 Occupancy is requested, a temporary Certificate of Occupancy may be issued upon receipt of a $10,000 <br /> escrow agreement to ensure completion of the as-built survey and all site improvements. <br /> E;, <br /> � � �`- — � <br /> ApplicanYs Signature: 1 i(, Date: '7 � � � <br /> � <br /> �..s <br /> , � <br />