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STRUCTURE INFORMATION: <br /> 1.Structure Dimensions t.Structure Dimensions(continued) 2.Type of Construction <br /> a.Length(B.)= 56 Number of bedrooms= Wood/Frame <br /> b.Width(fl)_ _ Number of garage slags: ❑Masonry <br /> Areas in snuare feet Attached= O Metal <br /> C.Basement= IZ90 UNCI N ❑Pole Bldg. <br /> • Detached=� [:3 ICF <br /> d.id Story = 15-41 <br /> ❑On-site Prefab <br /> e.2"0 Story= ❑Off-site Prefab <br /> f. %Story = ❑Other(please specify): <br /> g.Total Area= <br /> REQUIRED SUBMITTALS: <br /> All of the Information must be submitted In order foryour application to beprocessed: <br /> Not <br /> Enclosed Applicable <br /> O Permit Application <br /> ❑ Propused Building Plans <br /> ❑ MN State Energy Code Calculations and Mechanical Code Requirements Form <br /> ❑ ❑ Survey(meeting all iternents <br /> ❑ O Stormwater Pollution Prevention Plan <br /> ❑ ❑ Hardcover Calculation(s) <br /> O X Septic System Site Evaluation Report <br /> ❑ iff, Access Permit <br /> ❑ Weiland Buffer Improvement Plan <br /> ❑ o En veered Plans for Retainina Welts 4 feet or above <br /> ❑ Minnehahe Creek Watershed District Permit(t) <br /> ❑ Plan Review Fee <br /> ❑ ❑ Other. <br /> APPLICANVOWNER 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$S00; <br /> • Certifies that the Information supplied Is true and correct to the best of hieArer knowledge. The applicant recognizes that they <br /> are solely responsible for suhmitifng 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 date. 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 S1o,000 <br /> escrow to ensure completion of the as-built survey and ail site improvements. <br /> Applicant's Signature: Date: <br /> :M Owner's Signature: Date: <br /> L <br /> Packet Last Updated.- 0411WO13 <br /> Page 23 of 23 <br />