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STRUCTURE INFORM�►TION: 1.Structure Dimensions 1. Structure Dimensions(continued) ' ' ' a. Length(ft.)= Number of bedrooms= 2. Occupancy: ��`r� b.Width(ft.)= Number of garage stalls: 3. Occupant Load: `'"'"1� Areas in sauare feet Attached= w c. Basement= Detached= 4. Type of Construcion: ✓� d. 15S Story = �� O V e.2"d Story= 5. Code Edition: f. '/2 Story = g.Total Area= REQUIRED SUBMITTALS: . • • � A11 of the information must be submitted in;ocder far yoU�application to be proces�s�d: Not Enclosed A licable ❑ O Buildin Permit Escrow A reement and Fees ❑ ❑ Plan Review Fee ❑ ❑ , Com I ted lication Form • ❑ ❑ • � Pro Sed Buildin P1ans-2fu113Sze sAts to scale and 1 reduced 1�1 x 17 or 8%s x 11 set ❑ ❑ Minnesota State Ener Code Calculations and Mechanical Code Re uirements ❑ � ; r: ❑ ' ' • Sur'v,e -2 full size,to scale meetin A�.L Surv� re uiremBnts •p•. • ;: ��,• ; Hardcover Calculations ' " ' a � `� �� ❑ Se tic S stem Certification " ❑ ❑ ' MmnehahaCfeek�l/Vatershge�tris�(�A6�W )Pejmi�or +, ; • •' Documentation from MCV'VD s�tirt `ho ermit i§te"uired �-• • • ❑ ❑ Landsca e Walls and/or Retainin Wall Plans ❑ ❑ Landsca e Plan � . . ❑ ❑ Stormwater Pollution Preven�ion Plen PPP � ' ❑ Access Permit ' ' '' � • , .p.�. ❑' ; ; . Data Privac Adviso Form • ''" • �. '- ;s � . •1'`' \,.. . ,��'.i• .#`� , � Y��-��a�` , APPLICANT/OWNER 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 classified 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 �nformaticy� is,to annually update our records and records of other governmental agencies required by law. If you refuse to sapply the Jnf�Sr[nat�Qn,the.�Spplication may not be issued. . Agrees that in the event that weather or other conditions prevent the completion of an as-built survey at the time the Certificate of Occupancy is requested, a temporary Certificate of Occupancy may be fssued upon recelpt of a 510,000 escrow to ensure completfon of the as-bullt survey and all site improvements. ApplicanYs Signature: Date: `�C "+l �` "-'�7 Owner's Signature: Date: Packet Last Updated: January 2016 '. . � � ' �� � ' �. `` ' Page 22