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STRUCtURE INFORMATION: <br /> 1.Stru+cture Dimensions 1. Structure Dimensions(continued) 2.Type of Construction <br /> a. Length (ft.)= ����m-. Number of bedrooms= <br /> ❑Wood/Frame <br /> b. Width(ft.)= �f�fp(,�i�-- Number of garage stalls: ❑ Masonry <br /> Areas in spuare feet Attached= <br /> 5� � �`� ❑ Metal <br /> c. Basement= Detached= N/� ❑ Pole Bldg. <br /> d. 151 Story = ❑ ICF <br /> e. 2"d Story= ❑On-site Prefab <br /> ❑ Off-site Prefab <br /> f. Yz Story = <br /> ❑ Other(please specify): <br /> g. Total Area= � <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> Not <br /> Enclosed A licable <br /> ❑ Permit A lication <br /> ❑ Pro osed Buildin Plans <br /> ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> -g ❑ Surve meetin all re uirements <br /> � � Stormwater Pollution Prevention Plan <br /> ❑ � Hardcover Calculation s <br /> � Se tic S stem Site Evaluation Re ort <br /> ❑ 0� Access Permit <br /> � 0' Wetland Buffer Im rovement Plan <br /> � 0" En ineered Plans for Retainin Walls 4 feet or above <br /> ❑ 0' Minnehaha Creek Watershed District Permit s <br /> ❑ 0 Plan Review Fee <br /> � ❑ Application Escrow&Agreement <br /> 1� ❑ Other. <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 <br /> are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative <br /> but to 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 <br /> of 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 /> ApplicanYs Signature: ' Date: ��- �� �`3 <br /> Owner's Signature: ._.i Date: � � �� ��� <br />