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1 <br /> . " :� <br /> STRUCTURE INFORMATION: <br /> 1. Structure Dimension� 1. Structure Dimensions (continued) 2.Type of Construction <br /> ���Kl <br /> a. Length (ft.)= � Number of bedrooms= <br /> �Wood/Frame <br /> b. Width (ft.)= _�� Number of garage stalls: �Masonry <br /> Areas in spuare feet Attached = ❑ Metal <br /> ❑ Pole Bldg. <br /> c. Basement= � Detached = ❑ ICF <br /> d. 1 S`Story = �W <br /> ❑ On-site Prefab <br /> @. Z�d StOf)�_ . , � <br /> ,� ❑ Off-site Prefab <br /> f. '/z Story = <br /> ❑ Other(please specify): <br /> g. Total Area= �3 2 <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> Not <br /> Enclosed Applicable <br /> ❑ Permit A lication <br /> ,8' � Pro osed Buildin Plans <br /> ,0" ❑ Mt�l State Ener Code Calculations and Mechanical Code Re uirements Form <br /> ❑ Surve meetin all re uirements <br /> ❑ 13 Stormwater Pollution Prevention Plan <br /> ❑ Hardcover Calculation s <br /> O .0 Se tic S stem Site Evaluation Re ort <br /> ❑ E 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 engineerirag consultant revievv costs in excess of$500; <br /> • Certifies that the information supplied is true and correct to the best of hislher 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 /> • 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 /> ApplicanYs Signature: Date: _3 <br /> Owner's Signature: <br /> � " �'` Date: � � <br /> Packet Last Updated: 04/19/2013 <br /> \ Page 23 of 23 <br />