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� �� � StRTJ�TURE INFORMATION: ,1.Structure Dimensions 1.Structure Dimensions(coMinued) 2.Type of Construction 1 a. Length(R)= �� Number of bedrooms=�y � �Wood/Frame b.Width(ft.)= � 2 Number of garage stalls: ❑Masonry Areas in sauare feet Attached= �- ❑Metal c. Basement= ��('� � ❑Pole Bidg. —"`�" Detached=� ❑ICF d. 1�Story = � ❑On-site Prefab e.2nd Story= ��J ❑Off site Prefab f. %z Story = � ❑Other(please speafy): g.Total Area= �rOOS REQUIRED SUBMITTALS: All of the information must be submitted in orde�for our a lication to be rocessed: Not Enclosed A licable ❑ Buildin Permit Escxow A reement and Fees ❑ Plan Review Fee ❑ Com leted lication Form ❑ Pro sed Buildin Pians—2 full size sets,to scale and 1 reduced 11 x 17 or 8'�x 11 set ❑ Minnesota State Ener Code Calculations and Mechanical Code R 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 rmit is re uired Landsca Walls and/or Retainin Wall Plans ❑ Stormwater Pollution Prevention Plan SWPPP ❑ Access Permit ❑ Data Priva Adviso Form APPLICANT/OWNER ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Building Department; • Agre�to pay the City of Orono for engineering consultar�t review costs in excess of 5500; • 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 dassified by State law as either private or confiden6al. 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 subjed of the data. Our purpose and intended use of this information is to annually update our records and records of other govemmental agenaes required by law. If you refuse to supply the information,the apptication may not be issued. • Agrees that in the eveM that weather or other conditions prevent the completion of an as-built survey at the ttme the Certificate of Occupancy is requested,a temporary Certiflcate of Occupancy may be issued upon recelpt of a s10,000 escrow to ensure completion of the as-b survey and all site improvements. ApplicanYs Signatu . Date: �� —�=�/� Owners Signature: , Date: � � � � ��` Pecket LBst Updated: Augast 2015 Page 22