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Y <br /> � � <br /> � � <br /> STRUCTURE INFORMATION: <br /> 1. Structure Dimen ions 1. Structure Dimensions (continued) 2. Type of Construction <br /> �� �CJ ��� <br /> a. Length (ft.)= � �� Number of bedrooms= <br /> [�N d/Frame <br /> b. Width (ft.)= 7� �� Number of garage stalls: asonry <br /> Areas in square feet Attached = � ❑ Metal <br /> n ❑ Pole Bldg. <br /> c. Basement= ,(�� Detached = ��Z ❑ ICF <br /> d. 15`Story = (�-W—�, ❑ On-site Prefab <br /> e. 2"d Story= � <br /> ❑ Off-site Prefab <br /> f. 'h Story = ��Q ❑ 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 /> Enclos Applicable <br /> ❑ Permit A lication <br /> � Pro osed Buildin Plans <br /> ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> ❑ Surve 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 /> I � ❑ Minnehaha Creek Watershed District Permit s <br /> O Plan Review Fee ' <br /> ❑ O Other: <br /> APPLICANT/OWNER ACKNOWLEDGEMENT: � <br /> • Agre�s 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, the staff has no alternative <br /> but to 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 subjec4 <br /> of 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 �ccupancy 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 site i ovements. <br /> ApplicanYs Signature: Date: ? / <br /> r <br /> / <br /> Owner's Signature: i ' Date: <br /> Packet Last Updated: 04/19/2013 ✓ , <br /> Page 23 of 23 <br />