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STRUCTURE INFORMATION: <br /> 1. Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a. Length (ft.)= <br /> 4;." Number of bedrooms= Z <br /> ❑Wood/Frame <br /> b.Width (ft.)= / 21‘ Number of garage stalls: ❑ Masonry <br /> Areas in square feet Attached = $.Metal <br /> El Pole Bldg. <br /> c. Basement= 17�' Detached = NCF <br /> d. 1St Story = 17 <br /> ❑ On-site Prefab <br /> e. 2nd Story= Z� <br /> ❑ Off-site Prefab <br /> f. 'A Story = ® Other(please specify): 4 14 A (-RET F <br /> g.Total Area= j 1 o <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 Permit Application <br /> 0 Proposed Building Plans <br /> Pt <br /> 0 MN State Energy Code Calculations and Mechanical Code Requirements Form <br /> ❑ Survey(meeting all requirements) <br /> ❑ ® Stormwater Pollution Prevention Plan <br /> 0 Hardcover Calculation(s) <br /> ❑ Septic System Site Evaluation Report <br /> ❑ Access Permit <br /> ❑ 61 Wetland Buffer Improvement Plan <br /> ❑ ®, Engineered Plans for Retaining Walls 4 feet or above <br /> ❑ 0 Minnehaha Creek Watershed District Permit(s) /n proczss <br /> ® 0 Plan Review Fee <br /> 0 Other: Roo r 44,17 F woe re✓ $i J SPEC 5HEr• r <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 clas ified by State law as either <br /> private or confidential. Private data is information which generally cannot be given to the public butcan 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 Signature: Date: if/ZZ//II <br /> Owner's Signature: it Date: _1/L/It y <br /> Packet Last Updated: 04/19/2 13 <br /> Page 23 of 23 <br />