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Rpr 22 14 ,07: 41p Dupont Construction 763-413-2614 p. 2 <br /> STRUCTURE INFORMATION: <br /> 1_Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a Length{ft.)= Number of bedrooms= �1Nood/Frame <br /> b. Width(ft.)= Number of garage stalls: ❑Masonry <br /> Areas in square feet Attached= ❑Metal <br /> ❑ Pole Bldg. <br /> c. Basement= Detached - ❑ ICF <br /> d. 151 Story = <br /> ❑On-site Prefab <br /> e. 2"°Story = <br /> ❑Off-site Prefab <br /> f. %Story = <br /> ❑ Other(please specify): <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 Ap licable <br /> C] Permii A lication <br /> ❑ Pro osed Buildin Plans <br /> MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> ❑ Sunre meetin all re uirements <br /> ❑ Stormwater Pollution Prevention Plan � <br /> ❑ Hardcover Calculation(s} <br /> ❑ Se tic S stem Site Evaluation Re ort <br /> ❑ Access Permit <br /> ❑ Wetland Buffer Im rovement Plan <br /> ❑ En ineered Plans for Retainin Walls 4 feet or above <br /> d Minnehaha Creek Watershed District Permit s <br /> ❑ � Plan Review Fee � <br /> ❑ ❑ Application Escrow 8,Agreement <br /> O 0 Other: <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 <br /> are solely responsible for submitting a complete application being aware that upon failure to do so, Yhe siaff has no alternative <br /> but to reject it untif 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 generafly cannot be given to ihe public but can be given to The subject <br /> of the data. Confidential data is information which generally cannoY 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 510,OOD <br /> escrow to ensure completion of the as-built survey and alf site improvements. <br /> Applicant's Signature: Date: I�7 <br /> Owner's Signature: Date; <br />