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, , � ;,, r, <br /> ._ ,. , , . . , v.:_�. <br /> REMARKS (in-house): <br /> Fees to be Ghar ed YES N� <br /> �@t'iY11$ ' .n <br /> = Plan Revie�v a/ <br /> State Surcharge <br /> Investigation Fee , <br /> SAC—Number of SAC Units <br /> Other(specify) <br /> S uare Foota e $ er S uare Foota e <br /> Basement X - $ <br /> 15t Floor X - � <br /> 2nd Floor X - � <br /> Garage X ' $ <br /> ��'� <br /> Estimateci Construction Value: $ �f ��� <br /> Orono fnspections Required Work Requiring Separate F'ermits Required State Permits <br /> � Site 0 Plumbing 0 Grading / Filling � Well <br /> Q Hardcover Removal � Mechanical 0 Fire � Electrical <br /> , 0 Footing � Septic � Water Connection <br /> � Poured Wall 0 Fireplace � Sewer Connection <br /> 0 Foundation Survey 0 Masonry 0 Lawn Irrigation <br /> 0 Radon Rock Bed 0 �f9� <br /> � Framing 0 Other(specify) <br /> x: � Insulation <br /> 6 0 As-Built Survey <br /> ;' �Final <br /> ,: � Wetland Buffer <br /> 0 Other(specify) <br /> REMARKS (in-hause): <br /> Other Review: Reviewed by: Date Approved: <br /> ' Rccess: Existing: � YES � NO New: 0 YES � NO <br /> OFFICiAL REMARMC� -TO BE NOTED ON PERMIT/A(�D INITIALl�ED <br /> � Updated: January 2013 <br /> v:\forms�plan review checklist 2013.docx <br />