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10/28/2015 12 : 57 T0: 19522494616 FROM:6123544154 Page: 3 <br /> STRUCTURE iNFORMAl'ION: <br /> ! 1.Structure Dimensions 1.Structure Dimensions(continuedj 2.Type of Construction <br /> ' i <br /> a. Length(ft.}= Number of bedrooms= � � <br /> ! ❑Woad/Frame <br /> � <br /> ` b.Width{ft.)= Number of garage stails: � ❑ Masonry � <br /> , <br /> ' Areas in square feet ; Attached= ❑ Metal <br /> � <br /> ❑Paie B18g. � <br /> ' c. Basement= i Detached= ❑ ICF <br /> d. 1��Story = ❑On-site Prefab <br /> ' e, 2""�Story= ' <br /> , ❑Off-site Prefab i <br /> f. '/z Story = � <br /> ' ❑ Other(please specify): <br /> ' g.Total Area= I <br /> REQUIRED SUBMIT7ALS: <br /> All af the information must be submitted in order for your application to be processed: _ <br /> Not � <br /> ' _Enclosed Applicabie __ ; <br /> � Permit A lication <br /> Proposed Buildinq Plans � <br /> � � MN State Ener Gode Galculations and Mechanicai Code Requirements Forrn <br /> _..___a <br /> Surve meetin all re uirements <br /> Stormwater Pollution Prevention Plan � � <br /> T _..._�. ----_ <br /> ' ' Hardcover Calculation(s� <br /> , - -- -------.............._...----.........._......----........---.._...._------------__._............._...._.------------- --._..._� <br /> Se tic 5 stem Site Evaluatian Report___ <br /> � Access Permit i <br /> ; Wetland Buffer Improvement Plan j <br /> ':. i En ineered Plans for Retainin Walls 4 feet or above j <br /> ' ' ': Minnehaha Creek Watershed District Permit(s� : <br /> :......__ _...__- -------- _..__....---...----- -..__.�__ _..... ___.._ _.._......_..___----- -------..._._.; <br /> : Plan Review Fee i <br /> ' Application Escrow&Agreement <br /> .—._.__.__. ,-Ofher: ... <br /> APPLICANT/OWN�Ft ACKNOWLEDGEMENT: <br /> Agrees to pravid�;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 carrect to the best nf hislher knowiedge. 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 comple#e; <br /> Acknowledges the Escrow Agreement is completed and signed; <br /> � Understands some or a11 of the inforrnation that you are asked to provide on this application is classified by State law as either ! <br /> privaie 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 i <br /> � purpose and intended use of this informatian is to annually update our records and records of other gnvernmental agencies ` <br /> required by law. If you refuse to supply the information, the application may not be issued. <br /> [ Agrees that in the even##hat weather ar oxher canditions prevent the campletion of an as-built survey at the time the ; <br /> Certiiica#e of Occupancy is requested, a temporary Certificate of Occupancy may 6e issued upon receipt of a$10,000 <br /> � escrow to ensure completion of the as-built survey and all site impravements. <br /> i <br /> Applicant's Signature: ►� r � � 1� ;''��"E---�--�---''' Date: �}�2 c'�C.� '� <br /> _�._""_P_ <br /> Owner's Signature: �� .���'-''�-_.�-.�,:..---------�''��� Date: ��� �i� `c�-� I � <br />