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STRUCTURE INFORMATION: <br /> 1.Stri;cture�Dimensions� 1.Structure Dimensions(continued) 2.Type of Construction <br /> a.Length(ft.)= �7� Number of bedrooms=___ <br /> �Wood/Frame <br /> b.Width(ft.)= �L � Number of garage stalls: ❑Masonry <br /> Areas in square feet Attached= ❑Metal <br /> � ❑Pole Bldg. <br /> c.Basement= Detached= � ❑ICF <br /> d. t s'Story = <br /> ❑On-site Prefab <br /> e.2ntl Story= <br /> ❑Off-site Prefab <br /> f. Yz Story = <br /> 7 O ❑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 rocessed: <br /> Not <br /> Enclosed A licable <br /> ❑ Buildin Permit Escrow A reement and Fees <br /> ❑ Plan Review Fee <br /> ❑ Com leted A lication Form <br /> ❑ Pro osed Buildin Plans—2 full size sets,to scale and 1 reduced 11 x 17 or 8 Yz x 11 set <br /> ❑ Minnesota State Ener Code Calculations and Mechanical Code Re uirements <br /> � ❑ Surve —2 full size,to scale meetin ALL surve re uirements <br /> ❑ Hardcover Calculations <br /> ❑ � Se tic S stem Certification <br /> ❑ � Minnehaha Creek Watershed District(MCWD)Permit or <br /> Documentation from MCWD statin no ermit is re uired <br /> ❑ Landsca e Walls and/or Retainin Wall Plans <br /> ❑ � Stormwater Pollution Prevention Plan SWPPP <br /> ❑ �1 Access Permit <br /> ❑ � Data Privac Advisor 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 confidentfal. 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 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 /> ApplicanYs Signature: f�d� .�"'"`'"L^ Date: a `1• � So <br /> c <br /> Owner's Signature: _ _ ��. Date: � �• �� <br /> PacketLast Updated: August2015 <br /> Page 22 <br />