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STRUCTURE INFORMATION: <br /> 1. Structure Dimensions , 1. Structure Dimensions(continued) <br /> ; i� � <br /> _ ' ,,.�, <br /> a. Length (ft.)= i�' � ��, Number of bedrooms= � 2. Occupancy: ���" � <br /> � <br /> b.Width (ft.)= �� �I `%� Number of garage stalls: <br /> 3. Occupant Load: <br /> Areas in square feet Attached = � <br /> c. Basement= E' Detached = � 4. Type of Construction: ��(/` <br /> d. 1 S�Story = �-I `12 <br /> e. 2"d Story= ("� 5. Code Edition: Z Q���� '�j�� <br /> f. 'h Story = ("� � <br /> g. Total Area= �l y Z <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 /> � ❑ Buildin Permit Escrow A reement and Fees <br /> ❑ ❑ Plan Review Fee <br /> � ❑ Completed Application Form <br /> � ❑ Pro osed Buildin Plans—2 full size sets,to scale and 1 reduced 11 x 17 or 8'/�x 11 set <br /> ❑ � Minnesota State Ener Code Calculations and Mechanical Code Re uirements <br /> m ❑ Surve —2 full size,to scale meetin ALL surve re uirements <br /> � ❑ Hardcover Calculations <br /> ❑ � Septic S stem Certification <br /> ❑ ❑ Minnehaha Creek Watershed District(MCWD)Permit or <br /> Documentation from MCWD statin no ermit is re uired <br /> ❑ 0 Landsca e Walls and/or Retainin Wall Plans <br /> � ❑ Stormwater Pollution Prevention Plan SWPPP <br /> ❑ m Access Permit <br /> ❑ � 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 weather or other conditions prevent the completion of an as-built survey at the time the <br /> Certifcate of Occupancy is requested, a temporary Certificate of Occupancy may be issued upon receipt of a 310,000 <br /> escrow to ensure completion of the as-built survey and all site improvements. <br /> ApplicanYs Signature: �� �' �`� ��--�=-�J�.�`�9�,,if� Date: ���� ��L� �� <br /> Owner's Signature: Date: Z ^' � <br /> Last Updated: January 2016 C/�� � � �� <br />