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STRUCTURE INFORMATtON: <br /> -- <br /> -_ __. ----- - - - ------- <br /> ; 1.Structure Dimensions I 1.Structure Dimensions(continued) i 2. Type of Construction �1 <br /> i <br /> ', a. Length(ft.)= ? Number oi bedrooms= j <br /> j , ❑Wood I Frame <br /> i b.Width(ft.)= � Number of garage stalls: � ❑ Masonry <br /> 1 i <br /> � Areas in square feet � Attached= <br /> j ❑ Metai <br /> ; t <br /> ' ❑ Pole Bldg. f <br /> ! c. Basement= ; Detached= �I ❑ ICF � <br /> ! d. 1st Story = �; ❑On-site Prefab � <br /> j e. 2°d StOfSI= � � <br /> ; ❑ Off-site Prefab <br /> ', f. Yz Story = ; <br /> ❑Other(please specify): � <br /> �f g.Total Area= ; <br /> � � <br /> � <br /> _ _ ___ _ _--_� _--__..- - --- ---- --i- i <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 /> ❑ ❑ Permit A�Iication <br /> ----- ----__ __-----�------ ------- -- ------------------ <br /> ❑ ❑ ' Pro osed Buildin Plans <br /> ❑ ❑ , MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> ❑ ❑ Surve �meeting all requirements) <br /> ❑ ❑ Stormwater Pollution Prevention Plan <br /> --- ------ _ - ---- --__ __-------- ---. _— _ <br /> ❑ O i Hardcover Calculation s) <br /> ❑ � ❑ � Se tic S stem Site Evaluation Re ort <br /> ❑ i ❑ ' Access Permit <br /> ----_ __ _ ___ ___ T ___ <br /> ❑ ❑ Wetland Buffer Im rovement Plan <br /> ❑ ❑ En ineered Plans for Retainin Walls 4 feet or above <br /> ❑ ❑ Minnehaha Creek Watershed District Permit s�_ <br /> _ _ . _ __------- <br /> ❑ O ! Plan Review Fee <br /> -- --� --�--------------- <br /> ❑ ❑ Application Escrow&Agreement <br /> ,_...__.___.. .Q_._.__ .____ <br /> . _ ____ ___._._ .. _ . __ _.__. _ _.._ __..._ _._ _._. ____.___.._---.___ ______.._.___.___.._-----.__ - __---, <br /> ❑ Other: <br /> APPLICANT/OWNER ACKNOWLEDGEMENT: <br /> ' • Agrees to provide all information required or requested by the Building Department; � <br /> i <br /> • Agrees to pay the City of Orono for engineering consultant review costs in excess of$500; I <br /> : ; <br /> • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they � <br /> are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative � <br /> E but to reject it until it is complete; j <br /> • Acknowledges the Escrow Agreement is completed and signed; � <br /> f <br /> • Understands some or all of the information that you are asked to provide on this appfication is classified by State law as either ! <br /> private or confidential. Private data is iniormation which generally cannot be given to the public but can be glven 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 temporary 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 /> � ---- '--- --- ----- -_ - - — __ _ __ __.__._ _. ---- ____ - ----- ---- -- —� <br /> l � <br /> Applicants Signature: �� � Date: �X ��� —1 � <br /> / �- <br /> Owner's Signature: Date: <br />