2015-00044 (new structure) - Laserfiche WebLink

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_ ,� STRUCTURE INFORMATION: 1.Structure Dimensions 1.Structure Dimensions(corrtinued) 2.Type of Construction a.Length{ft.)= Number of bedrooms= S (�yy�d/Frame b.Width(ft.)= Number of garage stalis: ❑Masonry Areas in sauare feet Attached= �✓ ❑Metai _ 3 ❑Pole Bidg. c. Basement= Detached- ❑ ICF d. 1s1 Story = ❑On-site Prefab e.2nd Story= ❑Off-site Prefab f. %z Story = ❑Other(please specify): g.Total Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for your ap lication to be processed: Not . , .. . . _.. ." ..^� ..�. Enclosed A licable � �x,, ,�. ,, ❑ Permit A lication �. � Pro sed Buildin Plans ' Q4 ❑ MN State Ener Code Calculations and Mechanical Code'R uirements Form ❑ Surve ' meetin all re uiremerrts ' � • ❑ ❑ � � StoFmwater Pollution Prevention Ptan � �- O Hardcover CBtculation s • ❑ ,� Se tic S stem Site Evaluation R ort ❑ �! Access Permit O � Wetland Buffer Im rovement Plan ❑ En ineered Plans for.Retainin Walls 4 feet or above O Minnehaha Creek Watershed Distrid Permit s O Plan Review Fee ❑ Application Escrow&Agreemerrt . O ❑ Other. ; � APPLICANT/OWNER ACKNOWLEDGEMENT: . . . � . Agrees to provide all information required or requested by the Building Depa�neM; i • Agrees to pay the City of Orono for engineering consultant review costs in excess of 5500; ' j • CerGfies that the ir�formation supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they I are solety r�esponsible for submitting a complete application being aware that upon failure to do so, the staif has no altemathre but to rejed it urrtil it is complete; • Acknowledges the Escrow Agreemerrt is completed and signed; • Understands some or all of the i►�formabon that you are asked to provide on this application is dassified by Sfate law as edher private or confidential. Private data is information which generally cannot be given to the public but can be given to the subjed of the data. Confidential data is infortnation which generally cannot be given to either the public or the subjed of the data. Our purpose and intended use of this information (s to ennually update our records and records of other govemmental agenaes required by law. If you reiuse to supply the information,the applipBon may not be issued. • Agrees that in the event that weather or other condi6ons prevent the completion of an as-built survey at the time the 'Certificate of Occupan is requested, a temporary Certificate of Occupancy may be issued upon receipt of a �10,000 escrow to ensure c eHon of the as-built survey and all site improvements. ApplicanYs Signature: Date: � � I'L ��j b � i Ov►mer's Signature: Date: �