2015-00819 (Re-model) - Laserfiche WebLink

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To: permit desk Page 3 of 7 2015-06-23 18:48:19(GM� 15072999410 From:,4MANDA BINSTOCK � , STRUCTURE INF4RMATION: �' 9.Structure Dime�ivn� 1.Strucivre Dimenstons(continued) 2.Type of Cun�trucUon � a a.Length(ft.)= Number af bed�ooms= ��p�f FrBme b.Wldth(ft.)= Number af garage sialls: ❑Masonry fAreas in sauare feet pnaCp,ed= ❑Metal i ❑Pole Bldg. ; � c.Bas�rr�nt= D�lached= �ICF d. 1815toty � ❑�n-site Prefab e.2`�Story= ❑Oif-site Prefab f. Y:Story = ❑Other(piease specify}; g.Tatal�4rea� � � REQUIRED SU�MPTTI�LS: All of the informatian must be submitted in order for our a lication to be rocessed: Not _Enclosad licab�e D ❑ � Rermit lieation O � Proposed Building Plans _ _ 0 0 MN State Ener Cad�Calculatinns and Mechanica!Code Re uirernents Form ❑ Sunre meeti alf re uirements � � ' n ❑ Stormwat�Polfutian Preventio�Plan !� � ❑ -� ❑ Hardcover Calcu►atia s • O ❑ Se tic S stem Site Eualue�tlan R� ort � ❑ O Access Rermit ^ � 4 ❑ O WeUarid BufFer Irn rovem��rt Plan � k _ ❑ ❑ En ineered Plans for Retaini� Walls 4 fee!or abo�e _ O O Minnehaha Creek UVatershed District Permit s � O O Plan Review Fee ; 0 ❑ AppHcation Escraw&Agreement r---� ----- -.- [] ❑ Othe�; APPLICANT/�WNER ACKtVUWLEDGEMENT: • Agrees#�pravide all infwmation required or requested by the Building Department; • Agreas to pay the City of Orono for angin�rNng consuttartt review costs in excess of�00; • C�r�ifies that the information supplied is true and correct to the best of hislher knowte�ige. The appiicant recagnizes that they are solely responsible for submitting a complete appllcatian t�ing�w�re that upon failure to da so,the staff has no alternative but to reJect it uniil it is complete; • Ackn4wledges the EscrowAgreement is completed and signed; � • Understartd�some or all of the information th�t you are asked to pravide on this application is c►assified by State law a�eithar i privete ar confideniial. Private data is information which generally cannot be given ta the pubUc but�an k�given to the subject ' of the data. Ca�'idential d2ta is infarmabon which generally cannot be given to either the publiC or the SubjeCi of the dat8. Our purpose and intended use oF this iniormation is to annually update our records and records of other governmerrtai agenaes required by law. If you refusa to supply the informa�on,the application may not be issued. I » Agreres U�at in the ever�t that weather or ather canditiams prevsrit ths complattan o'F an as-�Ik surrrey at tha time t�e t;ertrficate of Occupancy is requestacl, a ternporery Certificats of Occupancy may be�i�sued vpon receipt of�$10,Ii00 � esc�ow to ensure compietIon of tha�-buitt sunrey and ai!slte lmprovements. A�Plicant's Signature: �'�L�l.��" Date: ��3��j Qwner's Signatu�e: Date: