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Average Lakeshore Setback <br /> Shoreland District MCWD Permit Met? Bluff <br /> Yes No Permit Number: « ..5�q 0 Yes 0 No I/A 0 Yes No b( <br /> 0 N/A—see attached 1 Setback: <br /> Stormwater Quality Existing Proposed <br /> Overlay District Tier Hardcover Hardcover Variance Required CUP Required <br /> (circle one) (% and sf) (% and sf) <br /> 0 Yes l0 0 Yes (KNo <br /> 1 2 3 4 5 Eyeeple4._ ' Type(s): Type(s): <br /> Fees to be Charged YES NO <br /> Permit <br /> Plan Review <br /> State Surcharge <br /> Investigation Fee <br /> SAC—Number of SAC Units <br /> Other(specify) <br /> Square Footage $ per Square Footage �,^p <br /> Basement 0 !�- X 8S 7�0 = _$ 7 / C. 60 <br /> 1st FloorciltdOOk4 //B'*'t X /Oa ZC = $ / lel) -39-. ZO <br /> 2nd Floor 14,-33 X /00,Z(2 = $ / 4.511077,- 76 <br /> Garage 833 X 38-570 = $ 3Z1 /Z0-48. -, . <br /> / <br /> !� <br /> Estimated Construction Value: $ 1/1/4, 788 cc <br /> Orono Inspections Required Work Requiring Separate Permits <br /> Footing 0 Site 'Plumbing 0 Grading/Filling <br /> Poured WallSilt Fence/Erosion Control Mechanical 0 Fire <br /> Foundation Survey 2:If...Hardcover Removal X Fireplace 0 Water Connection <br /> 0 Framing 0 Other(specify) 0 Masonry 0 Sewer Connection <br /> Waterproofing/Drain tile $ Mfg. 0 Lawn Irrigation <br /> O Foundation Waterproofing 0 Other(specify) 0 Landscaping <br /> Framing <br /> Insulation <br /> As-Built Survey <br /> Final <br /> 2( Lathe Required State Permits <br /> O Other(specify) <br /> Well / f Electrical <br /> REMARKS (in-house): <br /> OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: <br /> riSee Builder Acknowledgement Form <br /> 0 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 />