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STRUCTURE INFORMATION: <br /> 1. Structure Dimensions 1.Structure Dimensions(continued) <br /> ,-"Xj <br /> a. Length(ft.)= <br /> Number of bedrooms= , _ L <br /> 2. Occupancy: �,,. l./" / r <br /> "'idth(ft.)= Number of garage stalls: <br /> 3. Occupant Load: <br /> as in square feet Attached= f/ <br /> c. Basement= 1 336 Detached= 4. Type of Construcion: -i--- r C/ <br /> d. 151 Story = /, 4 c1 <br /> e.2nd Story= /61 D 5. Code Edition: i'/q— /iige,. <br /> f. '/2 Story = 7/0 ;.er+ f G t r%-iik ' <br /> g.Total Area= .C3 <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 /> ❑ 0 Building Permit Escrow Agreement and Fees <br /> ❑ 0 Plan Review Fee <br /> ❑ 0 Completed Application Form <br /> lEr 0 Proposed Building Plans—2 full size sets,to scale and 1 reduced 11 x 17 or 8% x 11 set <br /> ISK 0 Minnesota State Enemy Code Calculations and Mechanical Code Requirements <br /> pK- 0 Survey—2 full size,to scale(meeting ALL survey requirements) <br /> 0 Hardcover Calculations <br /> ❑ 0 Septic System Certification <br /> ❑ 0 Minnehaha Creek Watershed District(MCWD)Permit or <br /> Documentation from MCWD stating no permit is required <br /> ❑ 0 Landscape Walls and/or Retaining Wall Plans <br /> ❑ 0 Landscape Plan <br /> ❑ 0 Stomiwater Pollution Prevention Plan(SWPPP) <br /> 0 0 _Access Permit <br /> L0 0 Data Privacy Advisory Form <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 are <br /> solely responsible for submitting a complete application being aware that upon failure to do so,the staff has no alternative but to <br /> 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 of <br /> 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 /> '.7------- - <br /> 'cant's Signature: _ Date: l Viz'/ / <br /> Owe ier'S Signature: Date: <br /> Packet Last Updated: January 2016 <br /> Page 22 <br />