2013-00471 - new structure - Laserfiche WebLink

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STRUCTURE INFORMATION: 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction �. /.. a.Length(fl.)= y�j%L Number of bedrooms= I �� Q Wood/Frame b.Width(ft.)= 0��_3 Number of garage stalis: ❑Masonry Areas in sauare feet Attached= 3 ❑Metal ❑Pole Bldg. c.Basement= �_ Detached=� 0 ICF d. 151 story = 20 3 ! ❑On-sile Prefab e.2'�Story= �_�� ❑Off-site Prefab f. '/�Story = `� ❑Other(piease specify): g.Total Area= ,� �1 REQUIRED SUBMITTALS: All of the information must be submitted in order for our application to be processed: Not Enclosed A licable 6� O Permit tication � ___ � _ Proposed Building Plans� 0 MN State Ener9 Code Calculations and Mechanical Code Re uirements Form 6 O Surve meetin all re uirements ❑ � Stormwater Pollution Prevention Plan I� ❑ Hardcover Calculalion s O .� � Se tic S stem Site Evaluation Re ort ❑ � Access Permit ❑ `d Wetland Buffer Im rovement Plan ❑ � En ineered Pians for Retainin Walls 4 feet or above 6i ❑ Minnehaha Creek Watershed District Permit s SI ❑ Plan Review Fee ❑ ❑ Other: APPLICANT/OWNER ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Building Department; • Agrees to pay the City of Orono for engineerfng consultant review costs in excess of$500; • Certifies that tl�e information supplied is irue and correct to the best of his/her knowledge. The appiicant 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; • Acknowiedges 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 informalion which generally cannot be given to the pubiic 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 hy ta�v. If you refuso to supply the information,the application may not be issued. • Agrees that in the ovent t17at weather or other conditions prevent the completion of an as-built survey at the time the Certificate of Occupancy is requested, a temporary Co�tificate of Occupancy may be issued upon receipt of a$10,000 escrow to ensure completion of th�as-bullt survcy and all sitQ improvements. � -- -. .. - __ __. _ R_ _ ._.�__---- ----------_ _ _._ _ _ ___----_--._.--------------- Applicant's Signature: ___ _ Date: �y,p [ �l� Owner'sSignature: __ Date: June 7, 2013 Packet Lasf Updated: 04J 013 Page 23 of 23