2015-01382 (new structure) - Laserfiche WebLink

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STRUCTURE INFORMATION: 1.Structure Dimansfons 1.Struc�ure Dimensions(continued) 2.Type of Constructlon a.Length(ft.)= .3 / I g �� Number of bedrooms= � � �Wood!Frame b.Width(ft.)= �2 Number of garage stalls: ❑Masonry �reas in sauare feet Attached= � ��e�� ❑Pole Bldg. c.Basement= �.3 Detached= a (��(Is�n d. 1'�Story = g3�f ❑ ICF � C�-� L, ❑On-site Prefab 8.�Sto,,,- �oo S 5 ❑OfE-site Prefab f. �Story = � a�7a ❑Other(piease specify): g.Totel Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for our a lication to be rocessed: Not Enclosed Ilcable O O Buildin Permit Esc.�ow A reemerrt and Fees 0 ❑ Plan Review Fee ❑ ❑ Com leted lication Form ❑ ❑ Pr ed Buildin Plans—2 full size sets,to scale and 4 reduced 11 x 17 or 8�x 11 set 0 ❑ Minnesota State Ene Code Calculations and Mechanical Code Re uirements O ❑ Surve —2 full size,to scale meeti ALL surve r uirements O ❑ Hardcover Calculations O � Se tic S tem Ce�ca�on ❑ ❑ Minnehaha Creek Watershed District(MCWD)Permit or Documentation from MCWD stati� no m�it is re uired ❑ � Landsca Walls andlor Retainin Wall Plans ❑ � Stwmwater Pollution Prevention Plan SWPPP ❑ Acoess Permit ❑ ❑ Data Privac Adviso Form APPLICANT/OWNER ACKNOWLEDGEMENT: . Agrees to provide all information required or requested by the Building Department; • Agrees to pay the City of Orono for enginearing consuitant review costs In excess of 5500; • Certfies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are solely responsibie for submitting a complete application being aware that upon failure to do so,the staff has no afternative but to reject it untii it is complete; • Acknowledges the Escrow Agreement is completed and signed; • Understands some or all of the information that you are asked to provide on this application is classified by Stats law as either private or oonfidential. Private data is information which generally cannot be given to the public but can be given to the subject of the data. Confiden6al data is information which generally cannot be given to either Uie public or the subjed of the data. Our purpose and intended use of this infomiation is to annualiy update our records and records of other govemmental agencies required by law. ff you refuse to supply the infortnation,the application may not be issued. • A�rees that in the event that weather or othor conditlons prevent tho completion of an as-buli!survey at the dme the Certtftcate of Occupancy Is requested,a temporary Certiticate of Occupancy may be Issued upon recsipt of a s10,000 escrow to ensure compietlon of the as-bullt survey and all site Improvemenb. Applicant's Signature: Date: ��`Z�—�� Owner's Signature: Date: �b — 26 '�� Packet Last Updated: August 2015 Pege 22