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f . . � <br /> STRUCTURE INFORMATION: <br /> 1.Structure 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 sauare feet Attached=_� ❑Metal <br /> ❑Pole Bldg. <br /> c.Basement= ____ Detached=_____ ❑ICF <br /> d. 1S`Story = ------- <br /> ❑On-site Prefab <br /> e.2"d Story= _______ ❑Off-site Prefab <br /> f. '/2 Story = ______ <br /> ❑Other(please specify): <br /> g.Total Area= �QBO_ <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> Not <br /> Enclosed ]icable <br /> (ST ❑ Permit A lication <br /> ❑ Pro osed Buildin Plans <br /> ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> ❑ Surve meetin all re uirements <br /> ❑ Stormwater Pollution Prevention Plan <br /> ❑ Hardcover Calcula6on s <br /> ❑ Se tic S stem Site Evaluation Re ort <br /> ❑ Access Permit <br /> ❑ Wetland Buffer Im rovement Plan <br /> ❑ En ineered Plans for Retainin Walls 4 feet or above <br /> ❑ Minnehaha Creek Watershed District Permit s <br /> ❑ Plan Review Fee <br /> ❑ ❑ Other: <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 a500; <br /> • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they <br /> are solely responsible for submitting a complete application being aware that upon failure to do so,the staff has no alternative <br /> but to 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 <br /> of 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 /> ;;� <br /> • A�r�� ,����s�t�at westhe��, � �p�r� " �tt�s:thr�e� <br /> C�ic�;� �� is u � � �� � . �� �� � � '1� <br /> -, y�. � �1 ea�'t�� :. ,,,�� . .,. � � , .. . �� � ,� <br /> �rov�r�-�,+�p���.�a�b�ll����„��� "" .,� <br /> Applicant's Signature: Date: ��'� Z�� —�3 <br /> Owner's Signature: Date: <br /> Packet Last Updated: OM19/2013 <br /> Page 23 of 23 <br />