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• <br /> STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a.Length(ft.)= I0(o4"dN Number of bedrooms= '5� •Wood/Frame <br /> r�•�� ►t ❑Masonry <br /> b.Width(ft.)= i T'40 Number of g age stalls: ❑Metal <br /> Attached= 0 Pole Bldg. <br /> Areas in square feet Detached= 0 ICF <br /> 0 On-site Prefab <br /> c.Basement= le,450 ❑Off-site Prefab <br /> d.1st Story = zez. 0 Other(please specify): <br /> e.2nd Story= Z41'1 <br /> f. %z Story = <br /> g.Total Area= (13$ <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 /> A 0 Permit Application <br /> • 0 Proposed Building Plans <br /> • 0 MN State Energy Code Calculations and Mechanical Code Requirements Form <br /> ■ <br /> 0 Survey(meeting all requirements) <br /> ❑ ❑ Stormwater Pollution Prevention Plan <br /> ❑ ❑ Hardcover Calculation(s) <br /> ■ 0 Septic System Site Evaluation Report <br /> ❑ ■ Access Permit <br /> ❑ ❑ Wetland Buffer Improvement Plan <br /> ❑ ■ Engineered Plans for Retaining Walls 4 feet or above • <br /> ❑ <br /> 0 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 /> I • 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 Issued upon receipt of a$10,000 <br /> escrow to ensure completion of the as-built survey and all site improvements. <br /> Applicant's Signature: (otel4W Date: 9/ Q <br />