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DocuSign Envelope ID:D095C6FC-BC6B-4772-8A5D-E021 DAF4D0C8 <br /> , STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction lc„� <br /> a. Length(ft.)= 49 Number of bedrooms= 3 <br /> E Wood/f`rameCC16l/17- <br /> b. Width (ft.)= 38 Number of garage stalls: ❑ aso y /�/I <br /> Areas in square feet Attached = 2 ❑ -t" 2DS- r C AfIC <br /> ❑ Po - Bldg. <br /> c. Basement= 820 Detached = it- <br /> d. 1st Story = 1116 ❑ •n-.ite Prefab <br /> e. 2nd Story = 1160 <br /> • Off-•ite Prefab <br /> f. 1/2 Story = v Othejplease specify): <br /> g. Total Area= 3096 <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 /> 0 Proposed Building Plans—2 full size sets,to scale and 1 reduced 11 x 17 or 8 1/2 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 /> 0 Hardcover Calculations <br /> ❑ Septic System Certification <br /> gr 0 Minnehaha Creek Watershed District(MCWD) Permit or App t„„ 4.1/0 it <br /> Documentation from MCWD stating no permit is required <br /> O Landscape Walls and/or Retaining Wall Plans <br /> ❑ 0 Stormwater Pollution Prevention Plan(SWPPP) <br /> ❑ ❑ Access Permit <br /> Rei ❑ _ 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 /> ,-DocuSigned by:eat Q <br /> Applicant's Signature. �t�0�°� Ce' <br /> Date: "(11>-)t, <br /> i 873596AB77A8433... 1VA4t.144X i "roe-- <br /> Owner's Signature: Date: <br /> PATRICIA REDMOND WEBBER 4/10/2018 <br /> Packet Last Updated: August 2015 <br /> Page 22 <br />