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STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction eC <br /> a.Length(ft.)= Number of bedrooms= T3-Weeskitflraffie z©`� m/,Q,p�C <br /> 4kajo <br /> b.Width(ft.)- Number of garage stalls: --11 ` j <br /> Areas in square feet — Attached= letai OCcupa`CY t frC.sk1 <br /> =- <br /> c.Basement= Detached= 11 ICF cif-.,fvc 4 <br /> d. 1°R Story = ❑ • Prefab <br /> e.2nd Story= — 0 •lop:- <br /> Prefab <br /> f. 'A Story = rI • - •-=ase 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 /> Encidsed Applicable <br /> ❑ ❑ Building Permit Escrow Agreement and Fees <br /> ❑ ❑ Plan Review Fee <br /> ❑ 0 Completed Application Form <br /> ❑ 0 Proposed Building Plans-.2 full size sets,to scale and 1 reduced 11 x 17 or 8%x 11 set <br /> ❑ 0 Minnesota State Energy Code Calculations arid Mechanical Cdde Requirements <br /> ❑ 0 Survey-2 full size,to scale(meeting ALL survey,requirements) <br /> fl ' . ' ❑ Hardcover Calculations <br /> ❑ 0 • Septic System Certification <br /> ❑ 0 Minnehaha Creek Watershed District(MCWD)Permit or <br /> Documentation from MCWD stating no permit is required ' <br /> O 0 Landscape Walls and/or Retaining Wall Plans <br /> o 0 Stormwater Pollution Prevention Plan(SWPPP) <br /> ❑ ❑ Access Permit <br /> ❑ 0 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 ' they `'•'.er conditions prevent the completion of an as-built survey at the tine the <br /> Certificate of Occupancy Is - ,, .. a 111_,.1).). •ertlficate of Occupancy may be issued upon receipt of a$10,000 <br /> escrow toenswo ' , all site improvinlent <br /> I Pr <br /> Applicant's Signature. <br /> .--4p-17" / 1.4i"--'41111111° <br /> Date: C/ LC) `�G(`� <br /> /0 f6, <br /> Owner's Signature: r `10 Date: 6r <br /> Packet Last Updated: August 2015 <br /> Page 22 <br />