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� r <br /> Fees to be Charged YES NO � <br /> Permit , � <br /> Plan Review <br /> State Surcharge <br /> Investigation Fee <br /> SAC— Number of SAC Units <br /> Sewer Connection <br /> Water Connection <br /> Park Fee <br /> Site Jnspection - <br /> Other(specify) <br /> Miscellaneous Fees <br /> Calculated By: <br /> Square Foota e $ per Square Foota e <br /> Basement X = $ <br /> 1s1 Floor X = $ <br /> 2nd Floo� X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ .�UC'�. Oc�G �+� <br /> Orono Inspections Required Work Requiring Separate Permits Required State Permits <br /> � Site Plumbing � Grading / Filling 0 Well <br /> � Hardcover Removal �Mechanical 0 Fire �lectrical <br /> �ooting � Septic 0 Water Connection <br /> Poured Wall Fireplace 0 Sewer Connection <br /> �Foundation Survey � Masonry ❑ Lawn Irrigation <br /> 0 Radon Rock Bed ,�Mfg. <br /> Framing � Other(specify) <br /> �nsulation <br /> �►s-Built Survey <br /> �nal <br /> � Other (specify) <br /> REMARKS (in-house): <br /> Other Review: Reviewed by: Date Approved: <br /> Access:Existing: 0 YES ❑ NO New: 0 YES � NO <br /> t�r11 t=01�iYV Cl'� <br /> REMARKS (TO BE NOTED ON PERMIT AND INITIALLED BY�����,w��;',��� "�) <br /> �_� ���� Li�� ���V����V1� �� (� ��.1�111� � 1 �-k-1 �4�1���� ��� `�" ��� �!� a <br /> LI CQY�I�QYlQ� ���L 4�l (Y1� -t' (?C,r�'7Y(����.� I"� �.'lI �� <br /> + � � t' ,. � , <br /> -DE- -F' �ti,1 � � , �, ,, �I�; ,� 1� �� i �- � ��2 �-e�/ <br /> e��-�e'r �I � i� j � z. <br /> Updated: 09/11/2009 <br /> z:\forms\plan review checklist.docx <br /> � <br />