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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.)= Number of garage stalls: e'Masonry <br /> Areas in sQuare feet Attached= ❑ Metal <br /> ❑ Pole Bldg. <br /> c. Basement= Detached= ❑ ICF <br /> d. 1 Si Story = � ,, ,c 5 3, �. = 3.�i� <br /> ❑ On-site Prefab <br /> e.2"d StOry= � x 3:,'� "5 _ !�.� <br /> ❑ Off-site Prefab <br /> f. '/z Story = !�, 2 ri� �`� ' i�7 ❑ Other(please specify): <br /> g.Total Area= �� � �` �'�• "� � �,;�� <br /> r�, t .. �" - <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 /> ❑ 0' Buildin Permit Escrow A reement and Fees <br /> ❑ ❑ Plan Review Fee <br /> 0'' ❑ Com leted A lication Form <br /> �' ❑ Pro osed Buildin Plans—2 full size sets,to scale and 1 reduced 11 x 17 or 8'/z x 11 set <br /> ❑ ❑ Minnesota State Ener Code Calculations and Mechanical Code Re uirements <br /> �` ❑ Surve —2 full size,to scale meetin ALL surve requirements <br /> 0" ❑ Hardcover Calculations <br /> ❑ �' Se tic S stem Certification <br /> ❑ ❑ Minnehaha Creek Watershed Distnct(MCWD)Permit or .4,.�,� � �,.e� r �,_ ,,.�;,F,: I <br /> Documentation from MCWD statin no ermit is re uired <br /> ❑ 0' Landsca e Walls and/or Retainin Wall Plans <br /> ❑ f� Stormwater Pollution Prevention Plan SWPPP <br /> ❑ C�' Access Permit <br /> ❑ Data Privac Adviso Form <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 E500; <br /> • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are <br /> solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative but to <br /> 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 of <br /> 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�iuilt survey and all site improvements. <br /> ApplicanYs Signature: ��� ��'���� Date: ``` "'r��,-� :�'~ <br /> � <br /> Owner's Signature: Date: <br /> Packet Last Updated.• August 2015 <br /> Page 22 <br />