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Fees to be Charged YES NO • � • • � <br /> Permit �/ <br /> Plan Review ,_, � <br /> °'State Surcharge �� <br /> Investigation Fee ! <br /> SAC-�Number ofSAC Units <br /> Sewer Connection ; <br /> `�Water Connection : ���,; <br /> Park Fee <br /> �Site�lnspection <br /> Other(specify) <br /> Misceilaneous>Fees <br /> Calculated By: <br /> S uare Foota e $ er S uare Foota e <br /> Basement X = $ <br /> 1 S' Floor X = $ <br /> 2nd FIOOf X = � <br /> Garage X = � <br /> Estimated Construction Value: $ Z`�, � � � �y <br /> Orono Inspections Required Work Requiring Separate Permits Required State Permits <br /> ❑ Site P mbing � Grading / Filling 0 II <br /> 0 Hardcover Removal Mechanical ❑ Fire Electrical <br /> 0 Footing 0 Septic � Water Connection <br /> � Poured Wall � Fireplace ❑ Sewer Connection <br /> 0 Foundation Survey � Masonry � Lawn Irrigation <br /> � adon Rock Bed � Mfg. <br /> F aming � Other(specify) <br /> Insulation <br /> 0 9s-Built Survey <br /> ��Final <br /> � Other(specify) <br /> REMARKS (in-house): <br /> Other Review: Reviewed by: Date Approved: <br /> Access:Existing: � YES 0 NO New: ❑ YES 0 NO <br /> REMARKS (TO BE NOTED ON PERMIT AND INITIALLED BY PERSON PULLING PERMIT) <br /> Updated: 09/11/2009 <br /> z:\forms�plan review checklist.docx <br />