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STRUCTURE INFORMATION: <br /> , 1. Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction ,yf, y� <br /> .��G'� f� <br /> a. Length (ft.)= �� Number of bedrooms=�� oo /Frame <br /> b.Width (ft.)= �l0 Number of garage stalls: Mas'nry ��'G U,QQ'd C ��G� / <br /> !/ � 6 <br /> Areas in square feet � Attached=� Me � C�,(� r f� t( <br /> � ,} (!� �(�-!'f"�(� <br /> �'^Lm . � P e Bldg. <br /> c. Basement= �,�c��c��f���` Detached=,� ��� /�- `�j� /� r <br /> d. 15�Story = � 1 l� t I F `� v � ' / �`� <br /> � (�� n-site Prefab <br /> e.2nd Story= �_� Off-site Prefab <br /> f. '/z Story = ther(please specify): <br /> g.Total Area= � S <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> Not ' <br /> Enclosed A licable . <br /> ❑ Buildin Permit Escrow A reement and Fees <br /> ❑ ❑ Plan Review Fee <br /> ❑ Com leted A lication Form <br /> ❑ Pro osed Buildin Plans—2 full size sets,to scale and 1 reduced 11 x 17 or 8'/z x 11 set <br /> ❑ Minnesota State Ener Code Calculations and Mechanical Code Re uirements <br /> (� ❑ Surve —2 full size,to scale meetin ALL surve re uirements <br /> � ❑ Hardcover Calculations <br /> ❑ Se tic S stem Certification <br /> � ❑ Minnehaha Creek Watershed District(MCWD)Permit or <br /> Documentation from MCWD statin no ermit is re uired <br /> ❑ Landsca e Walls and/or Retainin Wall Plans <br /> ❑ Stormwater Pollution Prevention Plan SWPPP <br /> ❑ Access Permit <br /> ❑ Data Privac Adviso Form <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 are <br /> solely responsible for submitting a complete application being aware that upon failure to do so,the staff has no alternative but to <br /> 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 pubiic but can be given to the subject of <br /> the data. Confideniiai 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 o�other conditions prevent the completion of an as-built survey at the time fihe I <br /> Gertfficate of Accupancy is requested, a ferrrpvrary Certificate of Occupancy may be issued upon receipt of a $1D,000 � <br /> escrow ta ensure completion of the as-buil4 survey and aFl site improvements. � <br /> i <br /> � <br /> ����,c,U �� � �c � � 1r3,1� <br /> ApplicanYs Signature: �� � ��\ Date: <br /> � - <br /> Owner's Signature: Date: <br /> ����� <br /> ��N T � �a�� <br /> Packet Last Updated: August 2015 <br /> Page 22 �7•Y,����ND <br />