2014-01447 - new structure - Laserfiche WebLink

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1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction . C,I � �� = a. Length(ft.)= D G � Number of bedrooms=� ��F�me b.Width(ft.� �� Number of garage stalls: ❑ Masonry Areas in sauare feet q��- 7 ❑Metal ❑ Pols Bldg. c. Basement= �� Detached= � ❑�CF d. 1"`Story = 17 0� � i,7 9 S ❑On-site Prefab e.2 Story= ❑Off-site Prefab f. h Story = 06 �aner(p�ease specify): g.Total Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for our a lication to be rocessed: Not Enclosed A Iicable ❑ ❑ Permit A lication D Pro osed Buildin Plans 0 o MN State Ener Code Calculations and Mechanical Code R uirements Form O Surve meetin a(I re uirements O ❑ Stormwater Pollutian Prevention Plan ❑ Hardcover Calculation s ❑ Se tic S tem Site Evaluation Re �t ❑ Access Pennit � WeUand Butf�er Im rovement Plan ❑ En ineered Plans for Retainin Walls 4 feet or above 0 o Minnehaha Creek Watershed District Permit s O O Plan Review Fee ❑ ❑ Application Escrow 8 Agreement ❑ O Other. APPLICANTIOWNER ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Building Department; • Agrees to pay the City cf Orono for enpinee�ing consultant review costs in excess of 5600; • Certifies that!he informa6on supplied is true end correc:t to the best of his/her knowledge. The applicent recognlzes that they are solely responsible for submit6ng a complete appfication being aware that upon failure to do so, the staff has no altemebve but to�jed ft until ft is complete; • Adcnowledges the Escrow Agreement is completed and signed; • Understands some or all of the information that you are asked to provide on this application is classifiad by Stabe law as either private or co�fidential. Private date is information which generally cannot be given to the public but can be given to the subject of the data. Confidential data is information which generally cannot be given to either the public or the subjed of the data. Our purpose and intended use of this informaUon is to annually update our records end records of other gavernmental agenaes requir�ed by law. If you retuse to supply the information,the applic�tion may not be Issued. • Agrees that in the event that weather or other conditlons prevent the completion of an as-built survey at the time the CertlScate of Occupancy Is requestsd,a tempoiary Certificate of Occupancy may be issued upon receipt of a 510,000 escrow to ensure completlon of the as-built aurvey and all site improvemer�ts. Applicant's Signature: /y�v � " Date: !z l� l� Owner's Signature: 1 1� �._��/L� Date: