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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= ✓ <br /> �ood/Frame <br /> b.Width (ft.}= �L Number of garage stalls: � ❑ Masonry <br /> Areas in square feet Attached= � ❑ Metal <br /> � ❑ Pole Bldg. <br /> c. Basement= Detached= ❑ ICF <br /> d. 1bt Story = f�0 ❑ On-site Prefab <br /> e.2"d Story= � b D ❑ Off-site Prefab <br /> f. '/z Story = ��� ❑Other(please specify): <br /> g.Total Area= ���' <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your appfication to be processed: <br /> Not <br /> Enclos A licabfe <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 /> ❑ Stormwater Pollution Prevention Plan <br /> ❑ �' Hardcover Cafculation s <br /> ❑ Se tic S stem Site Evaluation Re ort <br /> ❑ GY Access Permit <br /> ❑ [�` Wetland Buffer Im rovement Plan <br /> ❑ En ineered Pians for Retainin Walls 4 feet or above <br /> ❑ Plan Review Fee <br /> ❑ Application Escrow&Agreement <br /> ❑ C� Other. <br /> APPLICANT/OWNER 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 faifure to do so, the staff has no alternative <br /> but to reject it until it is compfete; <br /> • Acknowledges the Escrow Agreement is compfeted and signed; <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 the data. Our <br /> purpose and intended use of this information is to annualfy update our records and records of other governmental agencies <br /> required by law. If you refuse to supply the information,the application may not be issued. <br /> . Agrees that in the event that weather or other conditions prevent the completion of an as-built survey at the time the <br /> Certificate of Occupancy is requested, a temporery Certificate of Occupancy may be issued upon receipt of a $10,000 <br /> escrow to ensure completion of the as-built survey and all site improvements. <br /> �--- <br /> Appficant's Signature: <br /> j -� Date: l�'�� 2,�`1 lf <br /> �� � �l�-'���--��� <br /> Owner's Signature: Date: <br />