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STRUCTURE INFORMATION: <br /> 1•Struclure D)manslons f.Structure Dlmensions(continued) <br /> a.Length(ft.)= Z�� Number ot bedrooms= �� <br /> 2. OccupancY: ,� /" <br /> ---�---- <br /> b'W���ft-1- IVumber of garage staAs: <br /> t <br /> Areas in sauare feet 3• �cCupant Load: <br /> Attached= <br /> c.Basement= Detached= 4. Type of Constniction:�i /� <br /> � <br /> d. 1 s'Siory = • <br /> e.2��Story 5. Cocfe Edition: _��� ��_ <br /> f. Y:Story = <br /> g.Total Area= � f <br /> REQUIRED SUBMITTALS: <br /> AU of the informa�on must be submitted in order for our application ta be processed: <br /> ' � ^Not` ' • • , <br /> Enclosed.� _Icable . . <br /> , ,•. <br /> � 0 Buildin Permit Escrow A �eement and Fees <br /> � � Plan Review Fee <br /> � 0 Com leted licstion Fortn <br /> � � Pro sed Buildin Plans-2 full size sets to scale and 1 reduced 11 x 17 or 8'�x 11 set <br /> � � Minnesota State Ene Code Calwlations and Mechanical Code Re uirements <br /> 0 � Surve -2 fuif size,to scale mee0n ALL surve ►e uirements <br /> � ❑ Hardcover Cs�ulatfons <br /> � � Se dc S stem Cert�cation <br /> � � Minnehaha Creek Watershed Disfrict(MCWD)Permit or <br /> Documentati�from MCWQ sfatin no emiit is re crired <br /> � 0 Landsca e Wafls and/or Retainia Wall Plans <br /> � � Stormwater Pollution Preventlon Plan SWPPP <br /> � � Aocess Permit <br /> � ❑ Data Privacy qdvisory Form <br /> APPLICANT/OWNER ACKNOWLEDGEMENT: <br /> � Agnees to provide all informaHon required or requested by the Building Department; <br /> • Agreas to pay tha City of Orono for englneering consultant review costs in excess o!5500; <br /> • Certifies that the infortnation supplied is true and correct to the best of hisR�er knowledge. The applicant recognizes that they are <br /> solely responsible for submitting a camplete application being aware that upon failure to do so,the statf has no aRemaGve 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 infortnation that you are asked to provide on this applica6on is classified by State Isw as either <br /> private or confldential. Prfvate data is infom�atlon which generally cannot be glven to the public but can be gNen to the subject of <br /> the data. Co�fidential data is information which generally qnnot be given to either the public or the subject af the data. Our <br /> purpose and intended use of fhis infoRnation is to annually update our records and r�ds of other govemmental agencies <br /> required by law. It you refuse to supply the information,the application may not be issued. <br /> , , . , <br /> �.::�Agxrees'tthatsln,;tha event�that�westher or othar conditlons pre�$M;tFie conq�ledon"�ofran�ias.jwlk,sunrey"jat,,the.time;Uie <br /> C�tffcste�of Occu'�n, Is rsauested;�alterripoiary Ce�dficate ofyOccupancy may,'be,,issueil�pon:roeetp!'of,a�S10;000 <br /> Ai �,.r� af r.E'���L.»b.iF "'TxL� �y Cry',• k� ..i�.. Y.\.;r� <br /> eacrow to ensuro oompletlon of the as-buiR�survey`and all'sl�;lmprovements: <br /> ApplicanYs Signature: pa�: ,� � l <br /> Owner's Signature: Date: � � <br /> Lasf Updated: January 2016 <br />