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From:Michael Therp Fax:(783)333-2445 To:9522494616(a�rcfax.con Fax: +19522484616 Page 4 of 4 11lO6l2015 11:17 AM . [ � , STRUCTURE INFORMATION: 1.Stnicture Dimensions 1.Strueture Dfinensions(corrtinued) 2.Type of Construction a.Length(ft.r Number of bedrooms= �yy��Frame b.Width(ft.}= Number of gardge staqs: ❑Masonry Areas in sau�e feet Attached= ❑Metai ❑Pole Bldg. c.Basement= Detached= ❑ICF d. 1'�Story = ❑On-site Prefab e•��' ❑Off-site Prefab f. '/Story = ❑OcF�er(please s�cifjr): g.Total Area= REQUIRED SUBMITTALS: A!I of the information must be submitted in order for our a lication to be processed: Not Enclosed IicaWe � � Permit ication O O Pro d Bu�ldin Pians ❑ Ci MN State Ener Code Calcuiatians and Mechanical Code Re uirements Fam � O Surve meebn all uirements O ❑ Stormwater Poilution Prevention Pian 0 O Warda�ver Calculation s ❑ O Se tic S tem Site Evaluation Re rt ❑ 0 Access Pennit � O Wetiand Buffer im rovement Plan 0 O En ineered Plans for Retainin Walls 4 feet or above ❑ O Minnehaha Creeic Watershed District Pennf s ❑ O Plan Review Fee 0 O Applicatia�Escxow&Agreement O O Other: APPLtCANT/OWNER ACKNOWLEDGEMENT: . Agrees to provide all information required or requested by the Building Department; • Agrees to pay the City of Orono for engineering consultar�t review costs in excess of$500; • Certities that the information suppiied is true and correct to the best of his/her knowledge. The applicant recognizes that ihey are solely responaib!e for submitting a complete apptication being aware that upon fadure to do�,the staff has no altemative but to reject it until it is�mplete; • Adcnowledges the Escrow Agreement is completed and sigr�ed; • Understands some or ali of the infoRr�ation that you are asked to provide on ihis appiication is dassified by State{aw as either private or confidential. Private data is infonnabon which generally cannot be given to the public�t can be given to the subject of the data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and intended use of this iMormatian is W annually update our records and records of other govemmental agencies required by law. If you retu�to supply the informaaon,the application may not be issued. • Agrees that in the eveM that-weaft�sr or otFaer condlNons preveM ths cwnpletbn of an as-built�rvey at the tlme the Certlftcate of Occupancy is r�uested.a temporary Certiflcate of Occupancy may be iRsued.upon recelpt of a a10�000 escraw to ensure completfon of the as-buitt survey and sll site ImprovemeMs. � Appiicant's Signature: Date: '�1/6/201 S Owner's Signature: Date: