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r � . <br /> STRUCTURE INFORMATION: � <br /> 1. Structure Dimensions 1. Structure Dimensions (continued) 2.Type of Construction <br /> a. Length (ft.)= �v Number of bedrooms= y <br /> �Wood/Frame <br /> b•. Width (ft.)= a� Number of garage stalls: ❑ Masonry <br /> Areas in spuare feet Attached= � y ❑ Metal <br /> ❑ Pole Bldg. <br /> c. Basement= 0 Detached = ❑ ICF <br /> d. 15`Story = �� <br /> b ❑ On-site Prefab <br /> e. 2"d Story= � <br /> ❑ Off-site Prefab <br /> f. 'h Story = <br /> l� � ❑ Other(please specify): <br /> g. Totai Area= <br /> 1 ` <br /> REQUIRED SUBMITTALS: , � . � � � � � <br /> All of the information must be submitted in order for your application to be processed: <br /> N ot <br /> Enclosed Ap licable <br /> ❑ Permit A lication' ' <br /> ❑ Pro osed Buildin :Plans ' � � ' <br /> ❑ MN State Ene� ' G�ode�alculatioris �hd Mec anical Code Re uire ents Form <br /> • • � • ., rve rneetin all re uirements • • `� <br /> ❑ . � ' S�orrrdniater Pollution Prevention Plan •' •, - ' � . <br /> � ': �'. 1� •Hardcover Calculation s -. �' �� � ' ' ' • <br /> ❑ �- Se tic S stem Site Evaluation Re ort - , •'• � <br /> ❑ Access R rrnit ' •, ' � - � •t � <br /> ❑ Wetlancl Buffer Im rovemenf Plan ' ' <br /> ❑ En ineered Plans for Retainin Walls 4 feet or above <br /> ❑ Minnehaha Creek Watershed District Permit s ' ' ��. • • <br /> � ❑ Plan Review Fee • <br /> . � ` - ' ' ❑ Other: ` � . . . <br /> . . . �. . <br /> APPLICANT/OWNER ACKNOWLEDGEMENT: �'` "'� "� •�� �' `� �, �� � � ' <br /> • , , <br /> • Agrees to provide all information required or requested by the Building�Department; , <br /> � .�� <br /> A rees to a the Cit�of Orono for en ineerin consultant reviev�costs�i� s of$SOb; ' ; <br /> " 9 P Y 1 9� 9 . <br /> • Certifies that the information supplied is true and correct to the best of his/her knowl�dge. :Th� applicant recognizes that they <br /> are solely responsible for submitting a complet��pplicatiqn bei►i8 aware�hat upo�i failu�e.to do sb, 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 a plication is classified by State law as either <br /> private or confidential. Private data is information which generally cannot be give}��o 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 femporary 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 /> Ap li ' � e: .�.. - ----- -__ _ _ Date: (U �1�'? <br /> �� /� <br /> Owner's Signatur � � � ' ` � Date: ���' Z� - � � <br /> . � <br /> Packet Last Updated: 04/19/2013 � <br /> Page 23 of 23 <br />