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�ul 13 14 02: 47a Nate Harke 507-345-5817 p, 3 <br /> . <br /> � STRUC7URE INFORMATION: <br /> ' 1.Structure Dimensions 1,Structure Dimenslons(continued) 2.Type of Construction <br /> a.Length(ft.)= Number of bedrooms= <br /> ❑Wood!Frame <br /> b.Width(ft.)= Number of garage stalis: ❑Masonry <br /> Areas in sauare feet Attached= ❑Metal <br /> ❑Pole Bldg. <br /> c.Basement= Detached= <br /> d. 1 S`Story = <br /> ❑ICF <br /> e.2"�Story= ❑On-site Prefab <br /> f. %:Story = �.Off-site Prefab <br /> ❑Other(pfease speciiy): <br /> g.Total Area= <br /> REQUIRED SUBMITTALS: <br /> Alf of the information must be submitted in order for our a lication to be processed: <br /> Not <br /> Encfosed A Iicable <br /> C7 C7 Permit A llcation <br /> 0 ❑ Pro sed Buildin Plans <br /> � ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> � ❑ Surve meeGn alf re ulrements <br /> 0 O Stormwater Polluiion Preventian Plan <br /> � O Hardcove�Calculation s) <br /> � � Se tic S tem Site Evaluatian Re ar! <br /> d 0 Access Permit <br /> � D Wetland Suffer Irn rovement Plan <br /> � ❑ En ineered Plans for Retainin Walls 4 feet or above <br /> � �7 Minnehaha Creek Watershed District Permit(s <br /> � � Plan Re�iew Fee <br /> � ❑ Application Escrow 8�Agreement <br /> � 0 Qther: <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 irue and correct to the besl of hislher knowledge. The applicant recognizes ihat they <br /> are solely responsible for submitting a complete appllcation 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 same or al!of the information thai you are asked to provide on this application is classified by State law as efther <br /> private or confidential. Private daia is i►rformafion which generally cannot be given to the public but can be given to ihe 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 infended use of lhis 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 /> • Agrees that In the ev�nt that weather or other conditions prevent the completlon of an as-bullt survey at tha ttme the <br /> C�rtiflcate of Qccupancy is requested, a temporary Certificate of Qccupancy may be issued upon receipt of a$10,000 <br /> escrow to ensure completion of the as-built survey and all slte improvements. <br /> t <br /> ApplicanYs Signafure: �l!'G Date: 5��1�5 <br /> Owner's Signature: Date: <br />