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Average Lakeshore Setback <br /> Shoreland District MCWD Permit Met? Bluff <br /> � Yes � No Permit Number: I � —� 0 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 °/o and sf <br /> � Yes No � Yes No <br /> 1 2 3 4 5 � Type(s): Type(s): <br /> U -,��� '. ��� <br /> Fees to be Char ed YES NO <br /> Permit <br /> Plan Review � <br /> State Surcharge � <br /> Investigation Fee <br /> SAC—Number of SAC Units <br /> Other(specify) <br /> Square Foota e $ per Square Foota e <br /> Basement X - _ $ <br /> 15t Floor X = $ <br /> 2"d FI00� X = $ <br /> Garage X = $ <br /> � <br /> Estimated Construction Value: $ ��, ' ' (� <br /> Orono Inspections Required Work Requiring Separate Permits <br /> �Footing 0 Site �Plumbing � Grading/Filling <br /> Poured Wall �Silt Fence/Erosion Control Mechanical 0 Fire <br /> Foundation Survey � Hardcover Removal Fireplace 0 Water Connection <br /> � Framing � Other(specify) ❑ Masonry 0 Sewer Connection <br /> Waterproofing/Drain tile � Mfg. � Lawn Irrigation <br /> Foundation Waterproofing 0 Other(specify) ❑ Landscaping <br /> Framing <br /> Insulation <br /> As-Built Survey <br /> Final <br /> 0 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 /> � 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 />