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STRUCTURE INFORMATION: 1.Structure Dimenslons 1.Structure Dimensions(contlnued) a.Length(ft.)= b�j Number of bedrooms= 5 2. Occupancy: �� ! b.Width(ft.)= �_ Number of garage stalls: 3. Occupant Load: Areas in sauare feet Attached=�_ c.Basement= � Detached= 4. Type of Construction: ,,.L- d.1�'Story = � �D(� � �Q�C e.2nd Story= �7 l 5. Code Edition: � /1 f. '/z Story = g.Total Area= 5 q• REQUIRED SUBMITTALS: All of the information must be submitted in order for our application to be processed: Not Enclosed A licable ❑ Buiidin Permit Escrow A reement and Fees ❑ Plan Review Fee ___ � ❑ Com leted A lication Fortn p Pro osed Bufidin Plans—2 full size sets,to scale and 1 reduced 11 x 17 or 8'/a x 11 set ❑ Minnesota State Ener Code Caiculations and Mechanical Code fteauirements O Surve —2 full size,to scale meetin ALL surve re uirements O Hardcover Calculalions O Se tic S stem Certification � O Minnehaha Creek Watershed District(MCWD)Permit or �� Documentation from MCWD statin no ermit is re uired ❑ @!. Landsca e Walis andlor Retainin Wall Plans p StoRnwater Pollution Prevention Plan SWPPP ❑ Access Permit ❑ � Data Privacy Advisory Fortn APPLICANT/OWNER ACKNOWLEDGEMEN7: . Agrees to provide all information required or requested by the Building Department; • Agrees to pay the Cfty of Orono for englneering consultant review costs in excess of a500; . Certifies that the fnformation supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are solely responsibls for submitting a complete application being aware that upon failure to do so,the staff has no altemative but to reJect it until it is complete; . Acknowledges the Escrow Agreement is completed and signed; • Understands some or all of the information that you are asked to provide on this application is classified by State law as either private or confidential. Private data is intormation which generally cannot be given to the public but can be given to the subject of the data. Confidential data is information which generally cannot be given to either the public or the subJect of the data. Our purpose and iMended use of this info�mation is to annually update our records and records of other govemmental agencies required by�aw. If you rofuse to supply the information,the application may not be issued. . Agrees that in the event that weather o�other conditions prevent the completfon of an as-built survey at tfie time the Certiticate of Occupancy is requested,a lempo�ary Certificate of Occupancy may be fssued upon receipt of a S10,OOQ escrow to ensure completion of the as-buiit survey and ail aite improvements. ApplicanYs Signature: Date: �� f - � 7 Owner's Signature: � Date: /�/ -�� Last Updated: Jaht{ary 2016