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STRUCTURE INFORMATION: <br /> 1.Structure pimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a.Length(ft.)= Number of bedrooms= [�,.�Wood/Frame <br /> b.Width(ft.)= Number of garage stalls: �Masonry <br /> Areas in sauare feet Attached= ❑Metal <br /> c.Basement= Detached= ❑ Pole Bidg. <br /> d. 1''Story = � lQ S ❑ ICF <br /> S•S '� 'Ss' � ❑On-site Prefab <br /> e.2"d Story= S � 3a' 3 - �i'1 <br /> ❑Off-site Prefab <br /> f. '/,Story = ��� t � �� ' i Y'� ❑p�er(please specify): <br /> g.Total Area= C�t �7 T.L � 3 �� <br /> r�.. t � .f - <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for our ap lication to be rocessed: <br /> 'i', Hflt. <br /> Enclos�d �li�able �� , . � � <br /> 0 � Buildin Permit Escrow A reement and Fees <br /> � ❑ Plan Review Fee <br /> � Gom leted lication Form <br /> 0" ❑ Pro osed Buildin Ptans-2 fuil size sets,to scale and 1 reduced 11 x 1T or 8"/,x 11 set <br /> � ❑ Minnesota State Ener Code Calculations and Mechanicai Code Re uirements <br /> � ❑ Surve -2 full size,to sca{e meetin ALL surve re uirements <br /> � ❑ Hardcover Calculations <br /> � � Se tic S stem Certification <br /> � ❑ Minnehaha Creok Watershed District(MCWD)Perrnit or ,�.��7„ ��4 ;„��,� <br /> Documentatian from MCWD statin no ermit is re uired <br /> C1 �' Landsca e Wails and/ar Retainin Wall Plans <br /> � o- Stormwater PolluBon Prevention Ptan SWPPP <br /> ❑ G� Access Permit <br /> ❑ Oata Privac Adviso Form <br /> APPLICANT/OWNER ACKNOWLEDGEMENT: <br /> • Agrees to provide alt information required or reQuested by the Building Department; <br /> • Agrees to pay the Clty of Orono for engineering consultant review costs in excess of;500; <br /> • Ce�tifies that the information supplied is true and correct to the best af hislher knowledge_ The applicant recognizes that they are <br /> solely rospansible for submitting a complete application being aware that upon failure to do so,the staff has no altemative but to <br /> reject it until it is comp4ete; <br /> • Acknowledges the Escrow Agreement is completed and signed; <br /> + Understands some or all of the infoRnation that you are asked to provide on this application is classified by State law as either <br /> private or confidentiaL Private data is informetion which generally cannot be given to the public but can be given to U�e subject of <br /> the data. Confidential data is informaGon 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 rewrds of other govemmental agencies <br /> required by law. If you refuse to supply the information,the application may nat be issued. <br /> � • eA�s'ees;4f�f ir►tta� a�►.3rt�t�k��+sr a'r ott�r ct��fiicrttr`Pr�vn�sY tfte cc�ar� ���ir�ft acirv�y t�E�e;iiu��� <br /> � �estffrr.�a of Us,^rw�ancy is�reqtrr�sted,n iGem ' �°�. <br /> ' �rar�Cett�t3c3Ye trf�fl�a�c�,r rrya��. .. �pon.r6cd�pt a€&5�44,'�� � <br /> e�crar�r�o�tss�ar�,eo�xzpKeflo�;uf tYEs as�>u'��s�rrrr��r�ii all s2��fripruyarzscerrl�, <br /> � ; <br /> ..v; . . �, <br /> ApplicanYs Signature: Date: '�"�`�"�'� . ����„�;,��� <br /> Owner'sSignature: Date: 9 'a�- /-5' � �" � <br /> Packet Last Updated: August 2015 <br /> Page 22 <br />