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■ . . i <br /> ' STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> , C� u <br /> a.Length(ft.)= �O��Z Numberof bedrooms=� <br /> �Wood/Frame <br /> 1 k <br /> b.Width(ft.)= 3� '2 Number of garage stalls: ❑Masonry <br /> Areas in spuare feet Attached= � ❑Metal <br /> c.Basemenh 2� �Z Detached=� ❑Pole Bidg. <br /> 2 S2S ❑icF <br /> d. 15�Story = , <br /> ❑On-site Prefab <br /> e.2"d Story= 1 '� 1 <br /> ❑Off-site Prefab <br /> f. '/z Story = �4k <br /> ❑Other(please specify): <br /> g.Total Area= �_cg <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 /> ❑ Buildin Permit Escrow A reement and Fees <br /> ❑ Plan Review Fee <br /> ❑ Com leted lication Form <br /> ❑ Pro osed Buildin Plans—2 full size sets,to scale and 1 reduced 11 x 17 or 8'/z x 11 set <br /> � Minnesota State Ener Code Calculations and Mechanical Code Re uirements <br /> 0 Surve —2 full size,to scale(meetin ALL surve requirements <br /> ❑ Hardcover Calculations <br /> ❑ Se tic S stem Certification <br /> ❑ Minnehaha Creek Watershed District(MCWD)Permit or <br /> Documentation form MCWD statin no ermit is r uired <br /> ❑ Landsca e Walls andlor Retainin Wall Plans <br /> ❑ Stormwater Pollution Prevention Plan(SWPPP <br /> ❑ Access Permit • <br /> ❑ Data Privac Adviso Form <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$500; <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 alternative <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 Gassifled 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 /> • q�rees that in ths event that weather or ather condttiarts pcevent#Itie compN�tian o#�m�-twitt survey at the time the <br /> Certiflcaf�of O�ctt�ncy is neqties#ed,a tentPorarY Ce�tiflcate vf t�cupancy m�y be issuetl upon��pt o���#(i,000 <br /> escrow to en��letion of the as�bulft survey:and a1i site hnprove►ncnts: <br /> ApplicanYs Signature: Date: �!��/�S <br /> Owner's Signature: Date: 1 � <br /> Packet Last Updated: January 2015 <br /> Page 21 <br />