2017-00961 - new house - Laserfiche WebLink

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, . STRUCTURE INFORMATION: 1.Structure Dlmensions 1.Structure Dimensions(continued) c�7� 1 �► /� a. Length(ft.)= J`7 �V Number of bedrooms= 2. Occupancy: ��C. ` � b.Width(ft.)= �U Number of garage stalls: � 3. Occupant Load: Areas in sauare feet Attached= r c. Basement= �CD Detached= 4. Type of Construction: ��-� d. 1�Story = ZO,3� e.2"�Story= "" 5. Code Edition: ��7 / /��` f. '/Story = g.Total Area= � � REQUIRED SUBMITTALS: All of the information must be submitted in order for our application to be processed: Not Enclosed licable ❑ Buildin Pe�mit Escrow A reement and Fees O Plan Review Fee ❑ Com leted A lication Form ❑ Pro sed 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 Re uirements ❑ Surve —2 full size,to scale meetin ALL surve r uirements ❑ Hardcover Calculations ❑ � Se tic S stem Certification O Minnehaha Creek Watershed District(MCWD)Permit or c ea- nti c Documentation from MCWD statin no rmit is r uired Pr-{- ' cc � Landsca e Walls and/or Retainin Wall Plans O CY Storrnwater Pollution Prevention Plan SWPPP ❑ Access Pertnit � Q' Data Privacy Advisory FoRn APPLICANT/OWNER ACKNOWLEDGEMENT: • Agrees to provide all infortnation required or requested by the Building Department; • Agrees to pay the City of Orono for engineering consultant review costs in excess of�500; • Certifies that the information supplied is true and correct to the best of his/her 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 alternative but to reject it until it is complete; • Acknowledges the Escrow Agreement is completed and signed; • Understands some or all of the information that you are asked to provide on this application 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. Confldential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and irrtended 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 condltfons prevent the completion of an aa-built survey at the time�e Certlflcabe of Occupancy is requested, a temporery Certiflcate of Occupancy may be issued upon receipt of a$10,000 escrow to ensure completlon of the as-built survey and all site improvements. ApplicanYs Signature: Date: ��6/�� Owner's Signature: Date: Lasf Updated: January 2016