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STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a. Length (ft.)= �Z Number of bedrooms= kWood/Frame <br /> b.Width(ft.)= $ Number of garage stalls: Z Masonry <br /> Areas in souare feet Attached= ❑ Metal <br /> ❑ Pole Bldg. <br /> c. Basement= Detached= ❑ ICF <br /> d. 15'Story = ❑ On-site Prefab <br /> e. 2nd Story= ❑ Off-site Prefab <br /> f. '/2 Story = <br /> ❑ Other(please specify): <br /> g.Total Area= <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 Application <br /> ❑ Propose Building Plans <br /> ❑ JZ MN State Energy Code Calculations and Mechanical Code Requirements Form <br /> 21' ❑ Survey(meeting all requirements) <br /> ❑ 121' Stormwater Pollution Prevention Plan <br /> ❑ e Hardcover Calculation(s) <br /> ❑ Septic System Site Evaluation Report <br /> ❑ 0 Access Permit <br /> ❑ IZ1 Wetland Buffer Improvement Plan <br /> ❑ (Z Engineered Plans for Retaining Walls 4 feet or above <br /> ❑ 0 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$500; <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 /> • 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 /> Applicant's Signatur Date: A9_/11�1_AT <br /> _�Owner's Signature: Date: 47 3 <br /> Packet Last Updated: 64111912013 <br /> Page 23 of 23 <br />