2016-01435 (new structure) - Laserfiche WebLink

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( � E � STRUCTURE INFORMATION: 1.Structure Dimensions 1.Strucfure Dimensions(continued) 2.Type of Construction a. Length(ft.)= � Number of bedrooms= � j�+�/�lood/Frame b.Width(ft.)= �Z Number of garage stalls: ❑Masonry Areas in sauare feei Attached=� ❑Metal ❑Pole Bldg. c.Basement= �� Detached= G �� d. 1S�Story = 2�5 ❑On-site Prefab e.2nd Story= �Z�o ❑Off-site Prefab f. '/�Story = � ❑Other(please specify): g.Total Area= 7 3� REQUIRED SUBMITTALS: AI! of the information must be submitted in order for your appiication to be processed: Not Enclosed A licabie ❑ Buildin Permit Escrow A reement and Fees ❑ Plan Review Fee � Com leted A lication Form ❑ ❑ Pro osed Buildin Plans-2 full size sets,to scale and t reduced 11 x 17 or 8 Y=x 11 set O ❑ Minnesota 5tate Ener Code Calculations and Mechanical Code Re uirements � ❑ Surve -2 fuB size,to scale meetin ALL surve re uirements ❑ ❑ Hardcover Caiculations ❑ ❑ Se tic S stem Certification p ❑ Minnehaha Creek Watershed District(MCWfl}Permit or Documentation from MCWD statin no ermit is re uired O ❑ Landsca e Walis and/or Retainin Wall Plans O ❑ Stormwater Pollution Prevention Plan SWPPP O ❑ Access Permit O � Data Privac Adviso Form APPLICANT/OWNER ACKNOWLEDGEMENT: • Agrees to provide ali information required or requested by the Buiiding Department; . Agrees to pay the City of Orono for engineering consultant review co�sts in excess of�500; , o Certifies that the information supplied is true and correct to the best of hislher knowledge. The applicant recognizes that they are solely responsible for submitting a compiete application being aware that upon failure ta do so,the staff has no altemative but to reject it until it is complete; • Acknowledges the Escrow Agreement is completed and signed; o Understands some or all of the information that you are asked to provide on this application is classified by State law as either private or confidential. Private data is information which generaliy 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 subject of the data. Our : purpose and intended use of this information is to annually update our records and records of other govemmental agencies : required by law. If you refuse to supply the information,the application may not be issued. • Agrees that in the even t weather or other conditions prever�t the compietion of an as-built survey at the time the Certificate of Occupa y s requested, a temporary Certificate of Occupancy may be issued upon receipt of a S1Q,OQ0 escrow to ensure c pl tion of the as-built survey and all site improvements. i ApplicanYs Signature: Date: 11-6- I� Owner'sSignature: � �"'-l�� J Date: ��1��/��`'�� (� , Packef Last Updated: August 2015 Page 22