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Shoreland District NBCWD Permit Average Lakeshore Setback g�uff <br /> Met? <br /> ' �Yes 0 No Permit Number: _ 0 Yes � No �N/A � Ye�o ,.�� <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 /> ;-; �;_.�r. -.; ; �, �- ,� 0 Yes � No 0 Yes ,C] No <br /> 1 2 3� 4 5 , ,, - Type(s): Type(s): <br /> % > r, <br /> L � � " ._, , <br /> 4� . <br /> Fees to be Char ed YES NO <br /> Permit <br /> Plan Review � <br /> State Surcharge (/" <br /> Investigation Fee <br /> SAC—Number of SAC EJnits <br /> Other(specify) L�� <br /> S uare Foota e $ per Square Foota e <br /> Basement X = $ <br /> 1 S'Floor X = $ <br /> ` 2nd FIOOr X = $ <br /> Garage X = $ <br /> �-�' ,, } �� <br /> Estimated Construction Value: $ .��J ���(5�-'���` � <br /> Orono Inspections Required Work Requiring Separate Permits <br /> �Footing � Site �. Plumbing 0 Grading/Filling <br /> ❑ Poured Wall ,�Silt Fence/Erosion Control � Mechanical 0 Fire <br /> 0 Foundation Survey a Hardcover Removal Fireplace 0 Water Connection <br /> � Framing 0 Other(specify) 0 Masonry 0 Sewer Connection <br /> ❑ Waterproofing/Drain tile �Mfg. 0 Lawn Irrigation <br /> Foundation Waterproofing � Other(specify) 0 Landscaping <br /> ;` Framing <br /> � Insulation <br /> � As-Built Survey <br /> Final <br /> � Lathe Required State Permits <br /> ❑ Other(specify) <br /> � Well Electrical <br /> ; REMARKS (in-house): <br /> ; <br /> a <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> � See Builder Acknowledgement Form <br /> ❑ Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. <br /> Updated: May 2016 <br /> z:\forms\plan review checklist 5-2016.docx <br />