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- - ii <br /> STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a.Length(ft.)= 4o: L. Number of bedrooms= ! <br /> IiNood/Frame <br /> b.Width(ft.)-- jp'' -(o Number of garage stalls: 0 Masonry <br /> Areas in square feet Attached= g ❑Metal <br /> 0 Pole Bldg. <br /> c.Basement= Pi°11, Detached= D ICF <br /> d. 1e Story = /S)S ❑On-site Prefab <br /> e.2r4 Story= J ; ❑Off-site Prefab <br /> f. t4 Story = ❑Other(please specify): <br /> g.Total Area= 41 <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> Not <br /> EnclosQd Applicable .. <br /> 0 Building Permit Escrow Agreement and Fees <br /> LZ✓ 0 Plan Review Fee <br /> Er 0 Completed Application Form <br /> 10' 0 Proposed Building Plans-2 full size sets,to scale and 1 reduced 11 x 17 or 8%x 11 set <br /> ®' ❑ Minnesota State Energy Code Calculations and Mechanical Code Requirements <br /> id" 0 Survey-2 full size,to scale(meeting ALL survey requirements) <br /> 0 Hardcover Calculations <br /> ❑ Ira' ----1 Septic System Certification <br /> Er- 0 Minnehaha Creek Watershed District(MCWD)Permit or <br /> Documentation from MCWD stating no permit is required <br /> O IB✓ Landscape Walls and/or Retaining Wall Plans <br /> ❑ lV Stormwater Pollution Prevention Plan(SWPPP) <br /> ❑ Access Permit <br /> ❑ gr.' Data Privacy Advisory 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 are <br /> solely responsible for submitting a complete application being aware that upon failure to do so,the staff has no alternative but to <br /> 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 classified 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 of <br /> 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 /> • Agrees that in the event that weather or other conditions prevent the completion of an as-built survey at the time the <br /> Certificate of Occupancy is requested, a temporary Certificate of Occupancy may be issued upon receipt of a$10,000 <br /> escrow to ensure completion of the as-built survey and all site improvements. <br /> r. <br /> t--- I� <br /> 11" <br /> Applicant's Sign A, .i __�_. _ _rte _ Date: /://(rey%7 <br /> Owner's Signature: �►,i. - Date: /e1/&.s/ .7 <br /> I <br /> Packet Last Updated:August 2015 <br /> Page 22 <br />