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STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a. Length(ft.)= )�� ` -� Number of bedrooms= <br /> �Wood/Frame <br /> b.Width (ft.)= �E r� Number of garage stalls: � ❑ Masonry <br /> Areas in sauare feet r/�� Attached = J�� ❑ Metal <br /> ._1/�Q ❑ Pole Bldg. <br /> c. Basement= Detached= � � <br /> ❑ ICF <br /> d. 15�Story = ❑ On-site Prefab <br /> e. 2"d Story= ❑ 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 plicabie <br /> l�' ❑ Permit A lication <br /> C� ❑ Pro osed Buildin Plans <br /> ❑ � MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> ❑ 8 Surve meetin all re uirements <br /> ❑ � Stormwater Pollution Prevention Plan <br /> ❑ p Hardcover Calculation s <br /> ❑ Se tic S stem Site Evaluation Re ort <br /> ❑ Access Permit <br /> ❑ � Wetland Buffer Im rovement Plan <br /> ❑ En ineered Plans for Retainin Walls 4 feet or above <br /> ❑ 0 Minnehaha Creek Watershed District Permit s <br /> B ❑ Plan Review Fee <br /> B ❑ 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 suppiied 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 confidentiai. 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 /> ,='_� _. <br /> / � �,/ 26 <br /> ApplicanYs Signature� . Date: / /�� <br /> Owner's Signature: � Date: �' �� — �� <br /> Packet Last Updated: 04/19/ 13 <br /> Page 23 of 23 <br />