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STRtJCTURE INFORMATION: <br /> 1.Sfructure Dimensions 1.Structure Dimensions(contlnued} 2.Type of Construction <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 sauare feet Detached=sL ❑ICF <br /> ❑On-site Prefab <br /> c. Basement= 1 3 ��! ❑Off-site Prefab <br /> '��� ❑Other(please speafy): <br /> d. 1�Story = <br /> e.2nd Story= 2C Y� <br /> f. %2 Story = <br /> g.Total Area= �% <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for our a lication to be processed: <br /> Not <br /> Enclosed A licable <br /> �p}. ❑ Permit A lication <br /> ❑ Pro osed Buildin Plans <br /> ❑ ❑ MN State Ener Code Ca�culations and Mechanical Code Re uirements Form <br /> ❑ ❑ Surve meetin all re uirements <br /> ❑ ❑ Stormwater Pollution Prevention Plan <br /> ❑ ❑ Hardcover Calcu�ation 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 Departmerrt; <br /> • Agrees b�pay the City of Orono for englnee�ing consultant review cwsts in excess of�500; <br /> . Certifies that the information supplied is true and correct to the best of his/her Imowledge. The applicant recognizes that they <br /> are solely responsible for submitting a complete applicafion being aware that upon failure to do so, the staff has no alternative <br /> but to reject it until it is complete; <br /> • Aclaiowledges 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 tt�e 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 /> _._�---.� � �3 a <br /> ApplicanYs Signature: �1..�-t,_i Date: � _ <br /> Last Updated: 9/29/2009 <br /> - 18- <br />