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i <br /> STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a. Length(ft.)= ZD Number of bedrooms= <br /> ' 9Wood/Frame <br /> b.Width(ft.)= Q_ Number of garage stalls: ❑ Masonry <br /> Areas in souare feet Attached= ❑ Metal <br /> ` El Pole Bldg. <br /> c. Basement= Detached= ❑ ICF <br /> d. 16'Story = <br /> ❑On-site Prefab <br /> e.2"°Story= <br /> ❑Off-site Prefab <br /> f. 1/2 Story = JO` ' <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 beprocessed: <br /> Not <br /> Enclosed Applicable <br /> ❑ Permit Application <br /> ❑ Proposed Building Plans <br /> ❑ ❑ MN State Energy Code Calculations and Mechanical Code Requirements Form <br /> ❑ Surve (meeting all requirements) <br /> ❑ 0 Stormwater Pollution Prevention Plan <br /> ❑ Hardcover Calculation(s) <br /> ❑ 0 Septic System Site Evaluation Report <br /> ❑ ❑ Access Permit <br /> 0 ❑ Wetland Buffer Improvement Plan <br /> 0 ❑ Engineered Plans for Retaining Walls 4 feet or above <br /> ❑ ❑ Minnehaha Creek Watershed District Permit(s) <br /> ❑ 0 Plan Review Fee <br /> 0 ❑ Application Escrow&Agreement <br /> ❑ ❑ Other: <br /> APPLICANT/OWNER ACKNOWLEDGEMENT: <br /> 0 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 /> U 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 /> U 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 <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 /> Applicant's Signature: Date: <br /> Owner's Signature: Date: <br />