2015-00413 - new structure - Laserfiche WebLink

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STRt�CTURE INFORMATION: 1. Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction a. Length(ft.)= 1� �� Number of bedrooms= J� �Wood/Frame � .'' ,-. . b.Width (ft.)= / 1 ��• Number of garage stalis: ❑ Masonry Areas in square feet Attached = � ❑ Metal � 3 ❑ Pole Bldg. c. Basement= � `�' `"' � Detached=� ❑ ICF d. 151 Story = �y�� � ❑ On-site Prefab e. 2itl Story= ��'� � ❑ Off-site Prefab f. '/2 Story = , ❑ Other(please specify): g. Total Area= /� REQUIRED SUBMITTALS: Aii of the information must be submitted in arder for your appiication to be processed: N ot Enclosed Ap 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 1 reduced 11 x 17 or 8 '/2 x 11 set � ❑ Minnesota State Ener Code Caiculations and Mechanicai Code Re uirements �7 ❑ Survey—2 full size,to scale(meeting ALL survey requirements) !it ❑ Hardcover Calculations ❑ �l Se tic S stem Certification � ❑ Minnehaha Creek Watershed District(MCWD)Permit or Documentation from MCWD statin no ermit is re uired O �i Landscape Walis and/or Retaining Waii Pians ❑ �J Stormwater Pollution Prevention Plan SWPPP ❑ �i Access Permit C�l ❑ Data Privac Adviso Form APPLICANT/OWNER ACKNOWLEDGEMENT: . Agrees to provide all information required or requested by the Building Department; . Agrees to pay the City of Orono for engineering consultant review costs in excess of$500; . 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 complete application being aware that upon failure to do so, the staff has no alternative but to reject it until it is complete; . Acknowledges the Escrow Agreement is completed and signed; • 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 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 subject of the data. Our purpose and intended use of this information is to annually update our records and records of other governmental agencies required by law. If you refuse to supply the information, the application may not be issued. . Agrees that in the event that weather or other conditions prevent the completion of an as-built survey at the time the Certificate of Occupancy is requested, a temporary Certificate of Oc�upancy may be issued upon receipt of a $10,000 escrow to ensure completion of the as-built survey and all site impravements. r �;!� , '� ?� Y, r, , ��-/ C,i.�,� � �� i 1'i��: �J � ApplicanYs Signature: ��'��'�-� Date: /��//i .�fOwner's Signature: ,�� Date: �� -.% ��%�-,�� l� � �� Packet last Updated: January 2015 Page 21