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STkZUCTURE 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 stalis: ❑ Masonry <br /> Areas in square feet Attached= ❑ Metal <br /> ❑Pole Bidg. <br /> c. Basement= Detached= ❑ ICF <br /> d. 1 S'Story = <br /> ❑On-site Prefab <br /> e.2"d Story= <br /> ❑Off-site Prefab <br /> f. '/z Story = �Other(please specify): �� ��P./� <br /> g.Total Area= �^� �� ��� ��; �� <br /> � <br /> REQUIRED SUBMITTALS: ���� ��O'��" �`�,� ��``5��� '���5 � S`�`'"'��'�S <br /> All of the information must be submitted in order for your application to be processed: <br /> Not <br /> Enclosed licable <br /> ❑ 0 Buildin Permit Escrow A reement and Fees <br /> ❑ ❑ Plan Review Fee <br /> ❑ Com leted A lication Form <br /> ❑ Pro osed Buildin Plans—2 full size sets,to scale and 1 reduced 11 x 17 or 8%2 x 11 set <br /> ❑ Minnesota State Ener Code Calculations and Mechanical Code Re uirements <br /> ❑ Surve —2 full size,to scale meetin ALL surve re uirements <br /> ❑ ;�f Hardcover Catculations <br /> ❑ Se tic S stem Certification <br /> ❑ O Minnehaha Creek Watershed District(MCWD)Permit or <br /> Documentation from MCWD statin no ermit is re uired <br /> ❑ Landsca e Walls andlor Retainin Wall Plans <br /> ❑ Stormwater Pollution Prevention Plan SWPPP <br /> ❑ Access PeRnit <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�500; <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 govemmental 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 condit�ons prevent the completion of an as-built survey at the time the <br /> Certificate of Occupancy is requested, a temporary Certificate of Occupanry may be issued upon receipt of a 570,000 <br /> escrow to ensure oompletion of the as-built survey and atl site improvements. <br /> �-!_ "� <br /> J <br /> Applicant's Signature: ��t'T'11rJ- �-w�a �+'�`� Date: � I Zt�1 G� <br /> Owne�'s Signature: -''� Date: �� /� Z�1 lv <br /> , , _ � � �� ��� <br /> �� � <br /> Packet Last Updated: August 2015 <br /> Page 22 <br />