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Fees to be Charged YES NO '� � ,
<br /> �Per.mit �
<br /> _ ,
<br /> ; , .. ;
<br /> Plan Review �`
<br /> 'State�Surcharge ti ,� ,�°A,� ��
<br /> , , .
<br /> Investigation Fee
<br /> '�AC ;�Nurriber.ro#SAC�U.�a:its� �,����,���„��, �'� �;�, �
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<br /> Sewer Connection
<br /> ��1t��i`ATIi�Il@C�l1�.11"� �w�' �gw, �{ ..A �� �,�;: �,., .., �,_, .,,.:�s�,;'
<br /> �w,�..U.,. ..r�...,. . . .�,. .:+�.,.. ._..�:.�z�`r�.+CSy''��µ� �_ ",,r,�`�.� .- '"��^..���.� ..... . �. . .�.-.h
<br /> Park Fee
<br /> - � ._„
<br /> ��te�I�s,�ez�E�pn�� ���A�-"���. ,�,�yr �. ��r-
<br /> _ _ _ _ = F?4, Px"«�1�Y'�i s�^c'�w�s�. z ��d.��`hd4%kFs'a."F�'�4�., .���., rh. �
<br /> Other(specify)
<br /> �Nfsc�rl�au�e��s�F�ee��� `� `���'���'�'�-� ��-�������, *�� _ �
<br /> s�iv�:s:.�«r, s�,.�.,,. -1r�f�.��i'i�, .� ,1. _ -�s*� �.,� -t1:��_��"d'�.+n �'"�'fi�.., .w.., _.,�,'"�+,_5'.`
<br /> Calculated By: ,..�
<br /> Square Foota e $ per Square Foota e
<br /> Basement X = �
<br /> 15' Floor X = �
<br /> 2nd Floo� X - $
<br /> Garage X = �
<br /> Estimated Construction Value: $ � �� (�00 °,
<br /> Orono fnspections Required Work Requiring Separate Permits Required State Permits
<br /> � Site 0 Plumbing ❑ Grading / Filling 0 Well
<br /> 0 hiardcover Removal ❑ Mechanical � Fire � Electrical
<br /> �Footing ❑ Septic ❑ Water Connection
<br /> � Poured Wall � ❑ Fireplace � Sewer Connection
<br /> ❑ Foundation Survey ❑ Masonry ❑ Lawn Irrigation
<br /> ❑ Radon Rock Bed ❑ Mfg.
<br /> �Framing ❑ Other(specify)
<br /> 0 Insulation
<br /> ❑ As-Built Survey
<br /> ,�Final
<br /> ❑ Other(specify)
<br /> REMARKS (in-house):
<br /> Other Review: Reviewed by: Date Approved:
<br /> Access:Existing: 0 YES ❑ NO New: ❑ YES � NO
<br /> REMARKS (TO BE NOTED ON PERMIT AND INITIALLED BY PERSON PULLING PERMtT)
<br /> U pdated: 09/11/2009
<br /> z:\formslplan review checklist.docx
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