2017-00482 - new structure - Laserfiche WebLink

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� � STRUCTURE INFORMATION: 1.Structure Dimensions 1.Structure Dimenslons(continued) i a� a. Length(ft.)= _� ��- � Number of bedrooms= � 2. Occupancy: _ i �— b.Width(ft.)= �'� I � y Number of garage stalls: Areas in sauare feet 3 3. Occupant Load: �'L 13 Attached= c. Basement= 5Q•t"��=� �',3 Z Detached= �� 4. Type of Construction: d. 1s1Story = „qL�-03 �r11�}- a�ay� e.2"d Story= 3 4 q`� J 5. Code Edition: f. %:Story = g.Total Area= �� REGIUIRED SUBMITTALS: All of the infoRnation must be submitted in order for your application to be processed: Not Enclosed A licable ❑ ❑ Buildin Permit Escrow A reement and Fees ❑ Plan Review Fee ❑ Com leted A lication Form ❑ Pro osed Buildin Plans-2 full size sets,to scale and 1 reduced 11 x 17 or 8%x 11 set ❑ Minnesota State Ener Code Calculations and Mechanical Code R uirements m ❑ Surve -2 full size,to scale meetin ALL surve r uirements ❑ Hardcover Calculations O � Se tic S stem Certification O Minnehaha Creek Watershed District(MCWD)Permit or Documentation from MCWD statin no ermit is uired ❑ ❑ Landsca Walls and/or Retainin Wall Plans � ❑ Stormwater Pollution Prevention Plan SWPPP ❑ O Access Permit ❑ ❑ Data Privacy Advisory Form APPLICANT/OWNER ACKNOWLEDGEMENT: • Agrees to provide all informatlon required or requested by the Building Departrnent; • Agrees to pay the City of Orono for engineering consultant revlew costs in excess of$500; • Certifies that the informa6on supplied is true and correct to the best of hislher knowledge. The applicant recognizes that they are solely responsible for submitting a complete application being aware that upon failure to do so,the staff has no altemative but to reject it until it is complete; • Acknowledges the Escrow Agreement is completed and signed; • Understands some or al►of the information that you are asked to provide on this applip6on is classified by State law as either private or confidential. 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 the subject of the data. Our purpose and intended use of this information is to annually update our records and records of other governmental agencies required by law. If you refuse to supply the information,the application may not be issued. • Agrees that in the event that weather or other conditlons prevent the completion of an as-built survey at the time the Certfficate of Occupancy is requested, a temporary Certificate of Occupancy may be issued upon receipt of a$10,000 escrow to ensure completion of the as-built survey and all site Improvements. ApplicanYs Signature: Date: '�''i� / Owner's Signature: � �---� ; Date: � • 12• 1 �" Last Updated: January 2016 \