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STRUCTURE INFORMATION: <br /> 1. Structure Dimensions � 1. Structure Dimensions (continued) 2. Type of Construction --� t <br /> a. Length (ft.)= Number of bedrooms= � � � <br /> ❑Wood/Frame � <br /> b.Width (ft.)= Number of garage stalls: ❑ Masonry <br /> Areas in sauare feet Attached= �(Metai �CG(��Gt�T L � � <br /> ❑ Pole Bldg. , �U�� �O <br /> c. Basement= Detached = ❑ ICF t% e����� <br /> d. 15'Story = <br /> nd ❑ On-site Prefab n s1� �� m� <br /> e.2 Story= ��'�� <br /> `''�'T ❑ Off-site Prefab �f1�y., �,�C <br /> f. '/�Story = �Other(please specify): sh�#<ock- <br /> g.Total Area= o��q� <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 /> O Plan Review Fee - �..ar�.� ", <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 /> ❑ k7 Minnesota State Ener Code Calculations and Mechanical Code Re uirements <br /> �7 � Surve -2 full size,to scale meetin ALL surve re uirements -� S m,�� <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 -u-�� s��-�� <br /> ❑ �I Landsca e Walls and/or Retainin Wall Plans <br /> ❑ Stormwater Pollution Prevention Plan SWPPP <br /> ❑ k7 Access Permit <br /> k� ❑ 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 pubtic 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 /> � <br /> ApplicanYs Signature: � Date: �d ��/�/� <br /> , <br /> Owner's Signature: � Date: � � �� <br /> Packet Lasf Updated: August 2015 <br /> Page 22 <br />