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ST�:-ijCTURE INFORMATION: <br /> -- --------------, <br /> � 1. Structure Dimensions 1. Structure Dimensions(continued) 2.Type of Construction � <br /> �. Length (ft.)= 44 Number of bedrooms= 3 I <br /> ��- �oo�S/�l1y�s,a�� 01 <br /> b. Width(ft.)= 24 Number of garage stalls: ��C C�� <br /> Areas in square feet Attached = �� '�"' !�/� � <br /> � /� l, <br /> c. Basement= 320 Detached = i�_I(;F <br /> 5t 900 �te�r^Ik��vS �y`0,Q <br /> d. 1 Story = <br /> e. 2�d Story= 900 ��G <br /> f. 'h Story = <br /> ❑ Other(please specify): <br /> g.Total Area= <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 'h 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 /> X ❑ Minnehaha Creek Watershed District(MCWD) Permit or <br /> Documentation from MCWD statin no ermit is re uired <br /> � CI Landsca e Walls and/or Retainin Wall Plans <br /> 0 ❑ Stormwater Pollution Prevention Plan SWPPP <br /> ❑ ❑ Access Permit <br /> ❑ ❑ Data Privac Adviso Form <br /> APPLICANT/OWNER ACKNOWLEDGEMENT: <br /> • Agrees to provide all informatio� 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 public but can be given to the subject of <br /> the data. Confidential 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 or other conditions prevent the completion of an as-built survey at the time the <br /> � Certificate of Occupancy is requested, a temporary Certificate of Occupancy may be issued upon receipt of a $10,000 <br /> escrow to ensure completion of the as-built survey and all site improvements. <br /> �✓ <'�-:>G�� <br /> ^-_"�' ( �D fB Lr . 5�`.I-�r Cl C <br /> ApplicanYs Signature: � � Date: <br /> Owner's Signature: � Date: ,�U- � v'/.� <br /> � � ' 1 l <br /> �� � � <br /> �e <br /> Packet Last Updated. August 2015 <br /> Page 22 <br />