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STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a.Length(ft.)= irN Number of bedrooms= S <br /> • Vood/Frame <br /> b.Width(ft.)= S c) Number of garage stalls: ❑Masonry <br /> Areas in square feet Attached= 3 ❑Metal <br /> c.Basement= l 8'16 ❑Pole Bldg. <br /> Detached= ❑ICF <br /> d. 1st Story = k O•SO 1.-2,31( <br /> S�,zen.j ri.1�- ❑On-site Prefab <br /> e.2nd Story= 4C v <br /> 0 Off-site Prefab <br /> f. %Story = <br /> g.Total Area= gS' ❑Other(please specify): <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 /> +4- 0 Permit Application <br /> C` 0 Proposed Building Plans <br /> 0 MN State Energy Code Calculations and Mechanical Code Requirements Form <br /> 0 Survey(meeting all requirements) <br /> ❑ .0'=- Stormwater Pollution Prevention Plan <br /> 0 Hardcover Calculation(s) <br /> ❑ Septic System Site Evaluation Report <br /> ❑ ..-- Access Permit <br /> ❑ di-- Wetland Buffer Improvement Plan <br /> ❑ Engineered Plans for Retaining Walls 4 feet or above <br /> S` 0 Minnehaha Creek Watershed District Permit(s) --Ni <br /> B- 0 Plan Review Fee 9� J <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 site improvements. <br /> . 4/ IC <br /> Applicant's Signature: / Date: "Lo <br /> Owner's Signature: 151 �U Date: /2I/I5 <br />