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STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a. Length(ft.)= '!'_ Number of bedrooms= b! <br /> (�Wood J Frame <br /> b.Width(ft.)= S Number of garage stalls: ❑Masonry <br /> Areas in square feet Attached= LJ ❑Metal <br /> c. Basement= 3563Detached Q ❑Pole Bldg. <br /> = <br /> d 1"Story = 257 1 ❑ ICF <br /> e.2'Story= 2�1� ❑On-site Prefab <br /> r. '12 Story = <br /> c EJ Off-site Prefab <br /> ❑Other(please specify):__ <br /> g. Total Area= . <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed- <br /> Not <br /> Enclosed Applicable <br /> ❑ Permit Application <br /> ❑ <br /> Proposed Building Plans <br /> ❑ MN State Energy Code Calculations and Mechanical Code Requirements Form <br /> 0 Survey(meeting all requirements) <br /> ❑ IKI Stonnwater Pollution Prevention Plan <br /> 19 1 ❑ Hardcover Calculation(s) <br /> ❑ on Septic System Site Evaluation Re ort <br /> 0 VQ Access Permit <br /> ❑ Wetland Buffer Improvement Plan <br /> 0 Ed Engineered Plans for Retainin Walls 4 feet or above <br /> SSI ❑ Minnehaha Creek Watershed District Permit(s) <br /> ❑ _ Plan Review Fee <br /> ❑ Application Escrow&Agreement <br /> ❑ Other: <br /> APPLICANVOWNER 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 <br /> are solely responsible for submitting a complete application 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 some or all of the information that you are asked tc 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 <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 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 /> i <br /> Applicant's Signature: Date: -A-1� II tot <br /> Owner's Signature: Date: /t 0 CU y <br />