2015-00155/00631-VOIDED - Laserfiche WebLink

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,. 4 . � STRUCTURE INFORMATION: 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Constructlon � a.Length(ft.)= Number of bedrooms= ❑Wood/Frame b.Width(ft.)= Number of garage stalls: ❑Masonry Areas in sauare feet Attached= ❑Metal ❑Pole Bldg. c.Basement= Detached= ❑ICF d. 18�Story = ❑On-site Prefab e.2"°Story= ❑Off-site Prefab f. '/z Story = ❑Other(please specify): g.Total Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for your a lication to be rocessed: Not Enclosed A licable ❑ Permit A lication ❑ Pro osed Buildin Plans ❑ ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form �" ❑ Surve meetin all re uirements ❑ ❑ Stormwater Pollution Prevention Plan ❑ ❑ Hardcover Calculation s ❑ ❑ Se tic S stem Site Evaluation Re ort ❑ ❑ Access Permit ❑ ❑ Wetland Buffer Im rovement Plan ❑ ❑ En ineered Plans for Retainin Wails 4 feet or above ❑ ❑ Minnehaha Creek Watershed District Permit s ❑ ❑ Plan Review Fee ❑ ❑ Application Escrow&Agreement ❑ ❑ Other: APPLICANT/OWNER ACKNOWLEDGEMENT: . Agrees to provide all information 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 lnformation 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 befng aware that upon failure to do so,the staff has no altemative but to reject It until it is complete; • Acknowledges the Escrow Agreement is completed and signed; • Understands some or all of the inforrnation that you are asked to provide on this application is classffled 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. ConfidenUal data is information which generally cannot be given to either the pubiic or the subject of the data. Our purpose and Intended use of this Information is to annually update our records and records of other governmental agencles required by law. If you refuse to supply the informat(on,the application may not be issued. • Agrees that in the event that weat r er conditions prevent the completion of an as-built survey at the time the Certificate of Occupancy is requ , �temporary Certiflcate of Occupancy may be issued upon recetpt of a$10,000 escrow to ensure�o letion as��iuilt survey and all site improvements. / ApplicanYs Signature: � Date: � Owner's Signature: � Date:� �/2 2/�5 � i