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STRUCTURE INFORMATION: <br /> 1.Strvctur+e Dimensions 1.Strvcture Dimensions(continued) 2.Type of Construction <br /> a. Length(ft.)= x Number of bedrooms= y �Wood/Frame <br /> ❑Masonry <br /> b.Width(ft.)= X Number of garage stalls: ❑Metal <br /> Attached=�_ ❑Pole Bldg. <br /> Areas in sauare feet Detached= ❑ICF <br /> ❑On-site Prefab <br /> c. Basement= l�n od ' ❑Off-site Prefab <br /> d. 1�Story = «00(0 ❑Other(please specify): <br /> e.2n°Story= o�a-I(e <br /> f. �Story = <br /> g.Total Area= Jraea <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for our a plication to be rocessed: <br /> Not � <br /> Enclosed A licable <br /> ❑ ❑ Permit A lication <br /> ❑ ❑ Pro osed Buildin Plans <br /> ❑ � MN State Ene Code Calculations and Mechanical Code R uirements Form <br /> ❑ ❑ Surve meetin all re uirements <br /> ❑ ❑ Hardcover Calculation s <br /> ❑ Se tic S stem Site Evaluation Re ort <br /> ❑ .0' 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 ao�ultant review costs in excess of t500; <br /> • Certifies that the infortnation supplied is true and c�rrect to the best of his/her knowledge. The applicant recognizes that they <br /> are solely responsible for submitting a completie application being aware that upon failure to do so,the staff has no altemative <br /> but to reject it until it is complete; <br /> • Adcnowledges the Escrow Agreement is completed and signed; <br /> • Some or all of the informa6on that you are asked to provide on this application is Gassified by State law as either private or <br /> confidential. Private data is information which generally pnnot be given to the public but can be given to the subject of the data. <br /> Confide�Ual data is information which generally pnnot be given to either the public or the subject of the data. Our purpose and <br /> intended use of this infortnation is to annually update our records and recorcJs of other govemmental agencies required by law. <br /> If you refuse to supply the information,the application may not t�issued. <br /> ApplicanYs Signature: � a��� Date: �^ '� �'� <br /> - 19- <br />