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r‘ <br /> STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a. Length(ft.)= 3 6 Number of bedrooms= — j$Wood/Frame <br /> 0 Masonry <br /> b.Width(ft.)= 02 y Number of garage stalls: 0 Metal <br /> Attached= 0 Pole Bldg. <br /> Areas in square feet Detached= oZ 0 ICF <br /> 1 ❑On-site Prefab <br /> c.Basement= 0 Off-site Prefab <br /> d. 1 st Story = 8(j,y <br /> 0 Other(please specify): <br /> e.2n°Story= <br /> f. %Story = <br /> g.Total Area= g 69 <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 /> i13---- 0 Permit Application <br /> II,' 0 Proposed Building Plans <br /> ❑ lir- MN State Energy Code Calculations and Mechanical Code Requirements Form <br /> V2-"" 0 Survey(meeting all requirements) <br /> ❑ (EY' Stormwater Pollution Prevention Plan <br /> ❑ IZV Hardcover Calculation(s) <br /> ❑ El^ Septic System Site Evaluation Report <br /> ❑ lid A ss Permit <br /> ❑ Cg-- Wetl nd Buffer Improvement Plan <br /> ❑ IA" Engineered Plans for Retaining Walls 4 feet or above <br /> ❑^ 0 Plan'Review Fee <br /> ❑ 0 Other <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agrees to provide all information regiired or requested by the Building Department; <br /> • Agrees to pay the City of Oronofqr engineering consultant review costs in excess of$500; <br /> • Certifies that the information suppli 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 Agreemerht 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 s 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 irformation is to annually update our records and records of other governmental agencies <br /> required by law. If you refuse to sup ly 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: 204,Mt.--z-p-7-2.21-z., Date: /4/c, //2O ii <br />