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STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a. Length(ft.)= Number of bedrooms= <br /> ❑Wood/Frame <br /> b.Width(ft.)= Number of garage stalls: ❑ Masonry <br /> Areas in sauare feet Attached= ❑ Metal <br /> c. Basement= Detached= ❑ Pole Bldg. <br /> ❑ ICF <br /> d. 15S Story = <br /> e. 2nd Story= ❑ On-site Prefab <br /> ❑ Off-site Prefab <br /> f. %Story = ❑ 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 A licable ' <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 /> � ❑ Minnehaha Creek Watershed District Permit s <br /> � ❑ Plan Review Fee <br /> ❑ ❑ 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 5500; <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 altemative <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 subject <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 /> • : Agaees�t in�e sverrt that a�eai��r or+ather ccrnc�itiot� �event the completic�n of an as-built s�rvey a##���ne the <br /> Certi#icate cf C}ccupancy is�quest+ed�a tsr►�porar�r�ert�'t�ate�#C1cc�rpancy may be iss�ued u�on recei�t of'a�i�l,�t� <br /> escr�vv#�a�nsur�coimpletia�of 'a�-#u�t survey and all s�te imprcr�remerrfs, _ <br /> ApplicanYs Signature: �_/ Date: Z f� � <br /> Owner's Signature: Date: <br /> Packet Last Updated: 04/19/2013 <br /> Page 23 of 23 <br />