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STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a.Length(ft.)= Zif Number of bedrooms= <br /> A Wood/Frame <br /> b.Width(ft.)= 20 Number of garage stalls: ❑ Masonry <br /> Areas in sauare feet Attached= 2- 11 Metal <br /> ❑ Pole Bldg. <br /> c.Basement= Detached= -- ❑ ICF <br /> d.1St Story = 142 0 <br /> ❑On-site Prefab <br /> e.2nd Story= Jc^ 6 <br /> ❑Off-site Prefab <br /> f. %Story = 0 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 /> En losed Applicable <br /> O Permit Application <br /> O Proposed Building Plans <br /> ASI 0 MN State Energy Code Calculations and Mechanical Code Requirements Form <br /> A 0 Survey(meeting all requirements) <br /> o a Stormwater Pollution Prevention Plan <br /> 0 Hardcover Calculation(s) <br /> ❑ )9 Septic System Site Evaluation Report <br /> ❑ 0 Access Permit (fr a.1 i-u' ne 2nG(,dbtd) <br /> o g1 Wetland Buffer Improvement Plan <br /> ❑ - Engineered Plans for Retaining Walls 4 feet or above <br /> ❑ 0 Minnehaha Creek Watershed District Permit(s) (AJa4 vc r mirk_ e4nr.tAlse.09 <br /> ❑ 0 Plan Review Fee 4) <br /> ❑ 0 Application Escrow&Agreement <br /> ❑ 0 Other: <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 <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 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 si .' .w•rovements. <br /> Applicant's Signature: c _t / <br /> AppliC g Date: 5-/&//y <br /> ar/ Aar. <br /> Owner's Signature: / ' C� , Date: 51414 <br />