2013-00738 - new structure - Laserfiche WebLink

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STRUCTURE tNFORMATION: � 1.Structure Dimerisions • 1.Structure Dimensions(coMinued) 2.Type ot Construction i a. Length(ft.)= .�_ Number of bedrooms=� Wood/Frame � q l b.Width(ft.)= �,� (� Number of garage stalls: ❑Masonry Areas in spuare feet Attached= � �� ❑Pole Bldg. c. Basement= �3g Detached=� ❑ICF d. 1�`Story = ��7 � ❑On-site Prefab e.2nd Story= 9��_ ❑Off-site Prefab. f. %z Story = ❑Other(please specify): g.Totat Area= � REGIUIRED SUBMITTALS: All of the information must be submitted in order for our a lication to be rocessed: Not Enclosed ' A licable ❑ ❑ Permit lication ❑ ❑ Pro osed Buildin Plans ❑ ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form ❑ ❑ Surve meetin all r uirements ❑ ❑ Stormwater Pollution Prevention Plan ❑ ❑ Hardcover Calculation s D ❑ Se tic S stem Site Evaluation Re ort 0 ❑ Aocess Permit � ❑ ❑ Wetland Buffer Im rovement Plan ❑ ❑ En ineered Plans for Retainin Walls 4 feet or above ❑ ❑ Minnehaha Creek Watershed District Permit s ❑ ❑ Plan Review Fee ❑ ❑ Other: APPLICANT/OWNER ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Building Department; • Agrees to pay the Clty 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 altemative but to reject it until it is complete; • Adcnowledges 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 information is to annually update our records and records of other govemmental agencies required by law. If you nefuse to supply the information,the application may not be issued. • Agrees that in tt�event that w�ther or other conditlons pre�rrt the completfon of an as-buift survey at the time the Certiftcate of Occupancy Is requested,a damporary Certiflcate of Occupancy maq be Issued upon recefpt of a$10,000 escrow to ensure completlon af the as-bullt survey and all site improvemepts. Applicant's Signature: Date: Owner's Signature: Date: ��-�-��?`J Packet Last Updat • 19/2013 Page 23 0/23