2015-01447 - addition to home - Laserfiche WebLink

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, .'� STRl1CTURE INFORMATICIN: 1.Structure Dimensions 1.Structure Dimenslons(continued) 2.Type of Construction a. Length(ft.)= �� Number of bedrooms=� �,�yood/Frame b.Width(ft.)= 5�— Number of garage stalls: ❑Masanry Areas in spuare feet Attached=� ��e�� c. Basement= �3�-� Detached= � Pole Bldg. ❑ ICF d. 1$`Story = �a�3� � ❑On-site Prefab e.2"d Story= ❑Off-site Prefab f. '/:Story = ❑Other(please specify): g.Total Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for our application to be rocessed: Not Enclosed licabls. � ❑ Permit lication '6� ❑ Pro sed Buildin Plans '� ❑ MN State Ener Code Calculations and Meahanical Code Re uirements Form ❑ ❑ Surve meetin all uirements ❑ ❑ Stormwater Pollution Prevention Plan ❑ ❑ Hardcover Calculation s ❑ ❑ Se tic S tem Site Evaluation Re rt O ❑ Access Permit ❑ ❑ Wetland Buffer Im rovement Plan ❑ O En ineered Plans for Retainin Walls 4 feet or above ❑ ❑ Minnehaha Creek Watershed District Permit s ❑ ❑ Plan Review Fee ❑ ❑ Application Escrow&Agreement ❑ ❑ Other: APPLICANT/OWNER ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Buifding Department; • Agrees to pay the City of Orono for engineering�onsultant review costs in exceas of s500; • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative but to reject it nntil it is complete; • Acknowledg�s the Escrow Agreement is completed and signed; • Understands some or all of the information that you are asked to provide on this application is classified by State law as either private or confidential. Private data is informa6on which generally cannot be given to the public but can be given to the subject of the data. Confidential data is informa6on which generally cannot be given to either the public or the subject of the data. Our purpose and intended use of this information is to annually update our records and records of other govemmental agencies required by law. If you refuse to supply the information,the application rYray not be issued. • Agrees that in the evelrj�that weather or other conditions prevent tl��ornpletiw'�of an as-built survey at tfie time the Certiftcats af Occupan is requarsted,a t�emporary Certific�te of Occupancy may be issued upon receipt of a S90,OQ0 escrow to ensure comp�tion of the as-built suwey and all site improvemerrts. ' l / Applicant s Signature: v Date: I �C. Owner's Signature: � Date: �_.__,..:..: