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STRUCTURE INFORNiATION: <br /> 1. Structure Dimensions 1.Structure Dimensions{continued) , <br /> a. Length(ft.)= �� Number of bedrooms= � 2. Occupancy: �� � 1 <br /> b.Width(ft.)= �Z � Number of garage stalls: <br /> 3. Occupant Load: <br /> Areas in sQuare feet Attached= � ��7 <br /> c. Basement= Detached=Z 4. Type of Construcion: <br /> d. 15'Story = ,n - <br /> e.2"d Story= l� � 5. Code Edition��l� /�� � � <br /> f. '/z Story = <br /> g.Totai Area= <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> Not <br /> Enclosed A licable <br /> ❑ � Buildin Permit Escrow A reement and Fees <br /> ❑ ❑ Plan Review Fee <br /> ❑ � Com leted A lication Form <br /> ❑ O Pro osed Buildin Plans–2 full size sets,to scale and 1 reduced 11 x 17 or 8%z x 11 set <br /> ❑ ❑ Minnesota State Ene Code Calculations and Mechanical Code Re uirements <br /> ❑ ❑ Surve –2 full size,to scale meetin ALL surve re uirements <br /> ❑ ❑ Hardcover Calculations <br /> ❑ ❑ Se tic S stem Certfication <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 /> ❑ ❑ Landsca e Plan <br /> ❑ ❑ Stormwater Pollution Prevention Plan SWPPP <br /> ❑ ❑ Access Permit <br /> ❑ ❑ Data Privac Adviso Form <br /> APPLICANT/OWNER �►CKNOWLEDGEMENT: <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 /> solefy responsible for submitting a complete application being aware that upon failure to do so,the staff has no altemative 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 govemmental agencies <br /> required by law. If you refuse to supply the information,the application may not be issued. <br /> . Agrees that in the even4 that weather or other conditions prevent the completlon of an as-buflt survey at the ttme 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-butlt survey and all site improvements. <br /> � �- —� Date: ' / <br /> Applicant's Signature: � Z ~ r G��t' <br /> Owner'S Signature: Date: � Z ' ; �—�� <br /> Packet Last Updated.� January 2016 <br /> Page 22 <br />