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STRUCTURE INFORMATION: <br /> 1. Structure Dimensions 1. Structure Dimensions (continued) 4 <br /> � '� -�_ - � ��"/ <br /> a. Length (ft.)= � 1 Number of bedrooms = 2. Occupancy: _ <br /> � <br /> b. Width (ft.)= �� Number of garage stalls: <br /> 3 3. Occupant Load: <br /> Areas in square feet Attached = <br /> c. Basement= f J (�� Detached = 4. Type of Construction: ��� <br /> d. 151 Story = I 9 7 0_ <br /> e. 2�d Story= 5. Code Edition: O I /'! V <br /> f. '/z Story = <br /> g. Total Area= <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> Not <br /> Enclosed Applicable <br /> ❑ ❑ Buildin Permit Escrow A reement and Fees <br /> ❑ ❑ Plan Review Fee <br /> ❑ ❑ Completed Application Form <br /> ❑ ❑ Proposed 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 Requirements <br /> ❑ ❑ Survey-2 full size, to scale (meeting ALL survey requirements) <br /> ❑ ❑ Hardcover Calculations <br /> ❑ ❑ Septic S stem Certification <br /> ❑ ❑ Minnehaha Creek Watershed District(MCWD) Permit or <br /> Documentation from MCWD statin no ermit is re uired <br /> ❑ ❑ Landsca e Walls and/or Retainin Wall Plans <br /> ❑ ❑ Stormwater Pollution Prevention Plan SWPPP <br /> ❑ ❑ Access Permit <br /> ❑ ❑ Data Privacy Advisory 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 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 /> _ <br /> ApplicanYs Signatu� '� Date: �iy <br /> `e..-' <br /> Owner's Signatur'�- � - <br /> - -- <br /> : ___-�-----�-- ___ _ � Date: � <br /> Last Updated: January 2016 <br />