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Shoreland District MCWD Permit Average Lakeshore Setback Bluff <br /> Met? <br /> es 0 No Permit Number: Yes � No � N/A � Ye No � <br /> N/A—see attached Setback: <br /> Stormwater Quality Existing Proposed <br /> Overlay District Tier Hardcover Hardcover Variance Required CUP Required <br /> circle one % and sf % and sf <br /> , � Yes � No � Yes �- o <br /> � 2 3 4 5 Type(s): Type(s): <br /> �.� � <br /> Fees to be Char ed YES NO <br /> Permit � <br /> Plan Review �,r- <br /> State Surcharge i/' <br /> Investigation Fee �_;' <br /> SAC—Number of SAC Units ��' <br /> Other(specify) �-- <br /> Square Foota e $ per Square Foota e <br /> Basement X = $ <br /> 15f Floor X = $ <br /> 2nd FlOor X = $ <br /> Garage X = $ <br /> Estimated Construction Value: $ �; ��, �� � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> �,Footing � Site `�Plumbing ❑ Grading /Filling <br /> �Poured Wall Silt Fence/Erosion Control Mechanical 0 Fire <br /> ��,Foundation Survey ❑ Hardcover Removal ' � Fireplace � Water Connection <br /> ❑ Framing 0 Other(specify) 0 Masonry ��Sewer Connection <br /> �Waterproofing/Drain tile �Mfg. ❑ Lawn Irrigation <br /> � Foundation Waterproofing ❑ Other(specify) 0 Landscaping <br /> �Framing <br /> �9. Insulation <br /> As-Built Survey <br /> Final <br /> Lathe Required State Permits <br /> � Other(specify) <br /> Well Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> �See Builder Acknowledgement Form <br /> ior to e o es i t survey an er calculations ed an ed. <br /> Updated: May 2016 <br /> z:\forms\plan review checklist 5-2016.docx <br />