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i � <br /> STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a. Length(ft.)= �_ Number of bedrooms= �Wood/Frame <br /> ❑ Masonry <br /> ( j Number of garage stalls: ❑ Metal <br /> b.Width ft.)= J�� <br /> Attached= ❑ Pole Bldg. <br /> Areas in sauare feet Detached= ❑ ICF <br /> ❑On-site Prefab <br /> c. Basement= ❑Off-site Prefab <br /> d. 15�Story — ❑Other(please specify): <br /> P. Z��d S10fy= <br /> f. '/s StOfy = <br /> g.Total Area= Z� <br /> REQUIRED SUBMITTALS: <br /> Ali of the information must be submitted in order for your application to be processed: <br /> Not <br /> Enclosed A licable <br /> ❑ Permit A lication <br /> �. ❑ Pro osed Buildin Plans <br /> ❑ � MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> ❑ Surve meetin all re uirements -Ultl <br /> ❑ $] Stormwater Pollution Prevention Plan <br /> ❑ Hardcover Calculation s <br /> ❑ �1 Se tic S stem Site Evaluation Re ort <br /> ❑ Access Permit <br /> ❑ Wetland Buffer Im rovement Plan <br /> ❑ �7 En ineered Plans for Retainin Walls 4 feet or above <br /> ¢Z1 ❑ 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 /> • Some or all of the information that you are asked to provide on this appiication 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 /> Applicant's Signature: � Date: <br /> Last Updated: 9/29/2009 <br /> - 18- <br />