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S'�RUCTI�RE INFORMATION: 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction a. Length(ft.)= 92� Number of bedrooms= 4 �Wood!Frame b.Width(ft.)= 99� Number of garage stalis: 2 ❑Masonry Areas in sauare feet Attached= 2 StBIIS ❑Metal ❑ Pole Bldg. c. Basement= N�p` Detached= � ❑ ICF d. 15t Story = 3,856 SF Total Area includes 902 ❑On-site Prefab e.2^d Story= 1,439 SF SF attached garage NON-HAB ❑Off-site Prefab f. '/z Story = 700 SF MEzz ❑Other(piease specify): g.Total Area= 5,995 SF REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: Not Enclosed A licable O O Buildin Permit Escrow A reement and Fees ❑ ❑ Plan Review Fee ❑ ❑ Com leted A lication Form ❑ ❑ Pro osed Buildin Plans—2 full size sets,to scale and 1 reduced 11 x 17 or 8'h x 11 set ❑ 0 Minnesota State Ener Code Calculations and Mechanical Code Re uirements ❑ ❑ Surve —2 full size,to scale meetin ALL surve re uirements ❑ � Hardcover Calculations ❑ ❑ Se tic S stem Certification ❑ ❑ Minnehaha Creek Watershed District(MCWD)Permit or Documentation from MCWD statin no ermit is re uired ❑ ❑ Landsca Walls and/or Retainin Wall Plans ❑ ❑ Stormwater Pollution Prevention Plan SWPPP ❑ ❑ Access Permit ❑ ❑ Data Privac Adviso Form APPLICANTIOWNER ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Building Department; • Agrees to pay the City of Orono for engineering consultant review costs in excess of$500; • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are solely responsible for submitting a complete application being aware that upon failure to do so,the staff has no alternative 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 Gassified by State law as either private or confidential. Private data is information 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 intended use of this information is to annually update our records and records of other governmental agencies required by law. If you refuse to supply the information,the application may not be issued. • Agrees that in the>event that weather or o�er c�nditions prevent the completic�n of an as-bullt survey at the tlme th� Cert�cate of�ccupancy is requested,a;temporary Certi�cate of Occupancy may be,issued upan rece�p#af a$10,000 escrow#o ensure completian of the as-built survey and all site improvements. Applicant's Signature: Date: Owner's Signature: ��,� � Date: Mav 19, 2017 Packet Last Updated: August 2015 Page 22