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Fees to be Charged YES NO •
<br /> P.er.mit �' ��,� �;
<br /> ,��,�� .,�: ��;.
<br /> Pfan Review ��
<br /> ,State.Surcharge ';� �.; s �
<br /> Investigation Fee
<br /> �SS�9cC Number,of.'SACdUrr`its.• ,�;��A, �,:
<br /> .,.-�
<br /> �,. .�,_ ,.. , _ .. ., ,
<br /> Sewer Connection
<br /> �.���CT���i7�eC`xlD.fl�����*.`�'��'.ul����`��s��=�,x,��az��....s.s`�'�j"xafit�:.�.., ".�''`�`�
<br /> Park Fee
<br /> �
<br /> ';`S�#e�l�,is ec'�ion�`��°� '� rk > � • �
<br /> �::. , _ .,_..� .... Pr��Ect� e�.•�����'�};;.a,������. ' �,.4��, a � ,�+:�
<br /> � - � ;._ . . .,„ ..,_.... �.. ._ � �..�,�.
<br /> Other(specify)
<br /> u�Miscellane.o,�us�F�e�es��T��1.q��;q�i��ti� ��'� �,{��q � �����° �W���� �� .. ,a- .
<br /> ..�n, -,rV`�i'GxlK:�WCM:',�i ��4,•r��R 1'L.,_�W,',�i, ..�F�#,`�M1�'{� � �4wb�,�
<br /> Calculated By:
<br /> Square Foota e $ per Square Foota e
<br /> Basement X _ $
<br /> 15' Floor X - $
<br /> 2nd FIoO� X - $
<br /> Garage X = g
<br /> Estimated Construction Value: $ Zib, odo =-°
<br /> Orono Inspections Required Work Requiring Separate Permits Required State Permifs
<br /> ❑ Site ,O�Plumbing � Grading / Filfing 0 Well
<br /> 0 Hardcover Removal ❑ Mechanical ❑ Fire Electrical
<br /> 0 Footing � Septic ❑ Water Connection
<br /> 0 Poured Wall ❑ Fireplace 0 Sewer Connection
<br /> 0 Foundation Survey ❑ Masonry ❑ Lawn Irrigation
<br /> � Radon Rock Bed � Mfg.
<br /> ,�Framing � Other(specify)
<br /> ,�Insulation
<br /> � As-Built Survey
<br /> ,O�Final
<br /> D Other(specify)
<br /> REMARKS (in-house):
<br /> Other Review: Reviewed by: Date Approved:
<br /> Access:Existing: 0 YES 0 NO New: ❑ YES ❑ NO
<br /> REMARKS (TO BE NOTED ON PERMIT AND INITIALLED BY PERSON PULLING PERMfT)
<br /> Updated: 09/11/2009
<br /> z:\formslplan review check(ist.docx
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