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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 /> b.Width (ft.)= Number of garage stalls: ❑ Metal <br /> Attached= � ❑ Pole Bldg. <br /> Areas in spuare feet Detached =� ❑ ICF <br /> ❑ On-site Prefab <br /> c. Basement= ❑ Off-site Prefab <br /> d. 151 Story - ❑Other(please specify): <br /> e. 2"d Story= <br /> f. '/z Story = <br /> g. Total Area= <br /> ��L= a�'�i..t 1•v�('d`y <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 lication <br /> ■ ❑ Pro osed Buildin Plans <br /> ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> � ❑ Surve meetin all re uirements <br /> �J ❑ Stormwater Pollution Prevention Plan <br /> f� ❑ Hardcover Calculation s <br /> ❑ � Se tic S stem Site Evaluation Re ort <br /> ❑ 41 Access Permit <br /> ❑ Gl 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 /> • 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 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 �aw. <br /> If you refuse to supply the information, the application may not be issued. <br /> ApplicanYs Signature: � � �,�% Date: I �L� ZC�/G <br /> � <br /> Last Updated: 12/21/2010 <br /> -20- <br />