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STRUCTURE INFORMATION: 1.Structure Dimensions 1.Structure Dimensions(continued) r �r a.Length(ft.)= S G O Number of bedrooms= 4 2. Occupancy: r b.Width(ft.)= �"1 10 Number of garage stalls: 3. Occupant Load: ------- Areas in square feet Attached= 3 c.Basement= 3 Oc Detached= 4. Type of Construction: {g d. 1st Story = o--43 e.2nd Story= ' O S 5. Code Edition: _zal4 ,fg c... f. %:Story = g.Total Area= '-k? S-5 REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: Not Enclosed Applicable ❑ ❑ Building Permit Escrow Agreement and Fees ❑ 0 Plan Review Fee ❑ 0 Completed Application Form ❑ 0 Proposed Building Plans—2 full size sets,to scale and 1 reduced 11 x 17 or 81/2 x 11 set ❑ ❑ Minnesota State Energy Code Calculations and Mechanical Code Requirements ❑ 0 Survey—2 full size,to scale(meeting ALL survey requirements) ❑ 0 Hardcover Calculations ❑ 0 Septic System Certification ❑ 0 Minnehaha Creek Watershed District(MCWD)Permit or Documentation from MCWD stating no permit is required ❑ ❑ Landscape Walls and/or Retaining Wall Plans ❑ 0 Stormwater Pollution Prevention Plan(SWPPP) ❑ ❑ Access Permit ❑ ❑ Data Privacy Advisory Form 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 information is to annually update our records and records of other governmental agencies required by law. If you refuse to supply the information,the application 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 issued upon receipt of a$10,000 escrow to ensure completion of the as-built survey and all site Improvements. Applicant's Signature: Date: t i b ' 1-3- Owner's Signature: ,_� Date: Last Updated: January 2016