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STRUCTURE INFORMATION: <br /> � 1.StrucHSre Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> , a.Length(ft.)= � Number of bedrooms= �'�" �ood/Frame <br /> b.Width(ft.)= �� Number of garage stalls: ❑Masonry <br /> Areas in sc�uare feet I Attached=� ❑Metal <br /> � ❑Pole Bldg. <br /> c.Basement= �� �, Detached=_ ❑ICF <br /> d.15t Story = �� <br /> � ❑On-site Prefab <br /> e.2ntl Story= ❑Off-site Prefab <br /> f. '/Story = <br /> 3�� ❑Other(please specify) <br /> g.Total Area= i <br /> ------- -- --___—' <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> E Not <br /> Enclosed licable <br /> ❑ ❑ Buildin Permit Escrow Agreement and Fees <br /> ❑ ❑ Plan Revrew 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 /> ❑ ❑ Survey–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 /> ❑ ❑ Landscape 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 public but can be given to the subject of <br /> the data. Confdential data is information which generally cannot be given to either the pubiic 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. I <br /> • Agrees tfiat in the event that weather or oU�er conditiorts prevent ifie completion of an as-buift survey af the time the I <br /> Ceriificate of Occupancy is reyuesled,a temporary Certificate of Occupancy may be issued upon receipt of a j10,000 I <br /> escrow to ensure completion of ffie as-buift survey and ail site improvemerM,s. I <br /> � <br /> ApplicanYs Signature: Date: � �/" � <br />/�Owner's Signature: Date: <br /> Packef Lasf Updaled� Augusf 2015 <br /> Page 22 <br />