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STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1. Structure Dimensions(continued) 2.Type of Construction <br /> a. Length(ft.)= l;�� � S�j Number of bedrooms= �� , <br /> ;�.Wood/Frame <br /> b.Width(ft.)= �'/ G <Z`�� Number of garage stalls: [�,Masonry <br /> Areas in square feet Attached= � �Metal <br /> �� ❑ Pole Bidg. <br /> c. Basement= lu+� Detached= ❑ ICF <br /> d. 151 Story = �,�u ` �; ;►v� <br /> nd �'�"d�'. ❑ On-site Prefab <br /> e.2 Story= �F� !v e ��;��31. - <br /> ❑ Off-site Prefab <br /> f. '/�Story = �r} ���` � <br /> ❑ Other(please specify): <br /> g.Total Area= 'r "??r�� �j J V <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for our 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 <br /> ❑ Stormwater Pollution Prevention Plan <br /> ❑ -' Hardcover Calculation s — - ( � �- ��('c. <br /> ❑ Se tic S stem Site Evaluation Re ort <br /> ❑ ,C3� 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/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 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 /> • 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 annually 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 temporary Certificate of Occupancy may be issu�d upon receipt of a $10,000 <br /> escrow to ensure completion of the as-built survey and all site improvements. <br /> G' .7� <br /> ApplicanYs Signature: � Date: � � ��' <br /> Owner's Signature: Date: <br /> Packet last Updated: 03-06-2012 <br /> -22 - <br />