2011-00829 - bathroom remodel - Laserfiche WebLink

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� 1 STRUCTURE INFORMATION: 1.Structure Dimensions 1.Structure Dimenslons(continued) 2.Type of Construction a.Length(ft.}= Number of bedrooms= ❑Wood/Frame ❑Masonry b.Width(ft.� Number of garage stalls: ❑Metal Attached= ❑Pole Bldg. Areas in sauare feet Detached= ❑ICF ❑On-site Prefab c.Basement= ❑Off-site Prefab d.1�Story = ❑Other(piease speciiY): e.2"°Story= f. '/�Story = g.Total Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: Not Enclosed icabls 0 Permit lication � ❑ Pro Buildin Plans ❑ MN State Ene Code Calculations and Mechanical Code R uirements Form ❑ Surve meetin all uirements 0 Stormwater Pollution Prevention Pian O S Hardoover Calculation s ' O Se tic S tem Sfte Evaluation R ❑ Access Permit ❑ Wetland Buffer Im rovement Pian ❑ En ineered Plans for Retainin Walls 4 feet or abave ❑ � Plan Review Fee O Other • APPLICANT ACKNOWLEDGEMENT: • Agrees to provide ali infortnation required or requested by the Building Departrnent; • Agrees to pay the City of Orono for engfneering consulta�rt review costs in excess of i500; • Certifies that the informati�supplied is true and correct to the best of his/her knowledge. The applicarrt rrecognizes that they are solely responsible for submitdng a compiete application being awaroe that upcxi failure to do so,the staff has no altemative but to reject it until it is complete; . Adcnowledges the Escrow Agreement is completed and signed; • Understands sane or all of the information that you are asked to provide on this application is dassified by State law as either private or c�nfidential. Private data is information which generally cannot be given to the public but can be given to the subject of the data. Confidential data is information which generally cannot be given to either the public or tfie subject of the data. Our purpose and intended use of this infortnation is to annually update our records and records of other govemmental agencies required by law. If you refuse to supply the information,the appiication may not be issued. • Agrees that in tl�e everrt that weather or other conditions prevent the completion of an as�uiK sunrey at the time the Certificate of Occupancy is requested, temporary Certificate of Occupancy may be issued upon receipt of a 510,0� escrow to ensure compledon of the as iR survey and all site improvements. ApplicanYs Signature: Date: 0'I d�(I Last Updated: 4l26/2011 -20-