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STRUCTURE INFORMATION: � 'I.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Constructbn� / a.Length(ft.)= �_ Number pf bedrooms= � ` �� I � � Wood/ ram I b.Width(ft.)= _� Number of garage stalis l.-� Maso ��Gvpay� ��1 I Areas in sauare feet ❑ et I � Attached=� �j�, ,//J ,I[/' J I c.Basement= � f��`'� Detached= N�a' ❑ e Bldg. �L/l� /"��!/(� ! d. 15'•Story = � 3� ❑ IF ( e.2n0 Story= �QD� ❑ -site Prefab � f. %Siory = �/J-� site Prefab ( g.Total Area= ��`-i � r(please specify): REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed:_ r--- Not � Enciosed Applicable � Buiidin Permit EscrowA reement and Fees ❑ Plan Review Fee � Com leted A lication Form - � Pro osed Buildi Plans-2 ful�size sets,to scale and 1 reduced 11 x 17 or 8%z x 11 set � � Minnesota State Ener Code Calculations and Mechanical Code R uirements � Surve -2 full size,to scale meeti A�L surve re uirements D Hardcover Calculations � � Se tic S tem Certification � , � � Minnehaha Creek Watershed District(MCWD)Permit or � ��'{z� �' Documentation from MCV�lD statin no ermit is re uired ❑ Landsca e Walls andlor Retaini Wafl Plans � -- Stormwater Pollution Prevention Plan(SWPPP) -- � �' � Access Permit - ---�_ _- — � DataPnvacyAdvisoryForm - I APPLICANT/OWNER ACKNOWLEDGEMENT: • Agrees to provide a11 information required or requested by the Building Department; • Agrees to pay the City of Orono for engineering consuitant review costs in excess of 5500; i • Certifies that the information supplied is true and correct to the best of his/her knowiedge. The applicant recognizes that they are i I 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; � I i • Uncerstands some or all of the information that you are asked to provide on this applicatior, is classified by Siate 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 I the data. Confidential data is informat±on 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 annuafly update our records and records of other governmental agencies � required by law. (f you refuse to supply the information,the application may not be issued. I • Agrees that in the event that weather or other tonditions prevent the completion of an as-built survey at the time the I � Certficate of Occupancy ' quested, a temporary Certificate of Occupancy may be issued upon receipt of a :10,Q00 i ; escrow to ensure co tio of -built survey and all site Improvements. I Applicant's Signature� � 1�-�� Date: _._ � �/b Owner's Signature� -��` f Date: %f Z 1 ,�-�. Packet Lest Updated: August 2015 Page 22