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STRUCTURE INFORMATION: <br /> 1. Structure Dimensions 1. Structure Dimensions(continued)r <br /> a. Length(ft.)= i_l 7 Number of bedrooms= "t 2. Occupancy: <br /> b.Width(ft.)= 5 Number of garage stalls: <br /> 3. Occupant Load: <br /> Areas in square feet j Attached = <br /> ` <br /> c. Basement= 'f U ) Detached= 4. Type of Construction: <br /> d. 1St Story = Li 2 <br /> e.2nd Story= j U 7 C 5. Code Edition: <br /> f. ''A Story = <br /> g.Total Area= `j'-21 <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> Not <br /> Encloped Applicable <br /> d ❑ Building Permit Escrow Agreement and Fees <br /> 0 Plan Review Fee <br /> 0 Completed Application Form <br /> 1E1/- <br /> 0 Proposed Building Plans—2 full size sets,to scale and 1 reduced 11 x 17 or 8'/2 x 11 set <br /> 0 Minnesota State Energy Code Calculations and Mechanical Code Requirements <br /> 0 Survey—2 full size,to scale(meeting ALL survey requirements) <br /> Er 0 Hardcover Calculations <br /> O C3" Septic System Certification <br /> ❑' <br /> 0 Minnehaha Creek Watershed District(MCWD) Permit or <br /> Documentation from MCWD stating no permit is required <br /> ❑ l2- Landscape Walls and/or Retaining Wall Plans <br /> 0 Stormwater Pollution Prevention Plan(SWPPP) <br /> ❑ Access Permit <br /> O 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 /> Applicant's Signature: rf ?, Date: <br /> -7/( <br /> Owner's Signature: Date: <br /> Last Updated: January 2016 <br />