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FOR O.FFIC~ USE ON~_ <br /> <br />Date <br /> <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br />1. JOb Description <br /> <br />RESIDEN'IIAL COMMERCIAL <br />NewSFDw/gamge [ ] Accessory [ ] New [ ] Sign <br />New $FD w/ogaragc [ ] Relocate [ ] Addition [ ] Demo <br />Aflditiotl I ] D~mo ~ Altet~ton ~ } ~cr <br />] Alteration [ ]~er '[~ ~ange/~cupan~ ~._. <br /> <br />C 3°cation of Installation <br /> <br />Contractor Infl )n <br /> <br /> Mailing ,Address & Phone No <br /> <br /> Ior Businc~ Name & Numar Ma/ling ,Add.ss & Phone No <br /> <br /> le Information (Chock wh~m aDp,ea~lo} <br /> <br />Precept Site Evataatt~ <br /> <br />Test Hol~q Ready <br /> <br /> have read this application in tt~ ontircty and certify that thc s~ted reformat/on <br /> is true and cut.ecl to thg best of xny knowledge <br /> am performing '~oek on a property I nwa or oecup~ <br />I am a registered builder OR [ ] the a~lthoriv~ed representative cfi a registered <br />budder <br /> <br />~._I agree to build according4o thc submitted plans and specifications, thc laws of <br /> <br />5. Fee Schedules <br /> <br />A New One-and-Two Famd~ Dwelhng Code Valuation: $ <br /> (includes El. M~, PI) <br /> <br />(l)Sq Ft____x 28 <br />(2) 5% Slate Surcharge 605 x A l) <br />(3) Base Fee for Plan Review <br />(4) Zoning Surcharge (If Applicable) <br /> <br />(1) Penni[ Fee <br />(2) 5% State Surcharge (05 x BI) <br />(3) Zoning Surcharge ( 05 x <br />(4) Plans Check ( 65 x BI) <br /> <br />C Septic Fees (hleludes DEQ Surcharge) <br /> (1) Site Bvaluatton <br /> (2) New Septic Insmllatton PmYrht <br /> (3) Authofi~tton N~ice <br /> ~ Exi~t~g Sys~ <br /> ajor Re.ir <br />~mor Re.ir (rank ~ly) <br /> <br />(1) Driveway w/curb @ $750 <br />(2) Driveway win curb @ $17,00 <br />(3) Site Plao Rewew (e~me~ial ~ly) <br />(4) In~estigati~ Fee <br />(5) Rems~ti~ Fee @ $25 ~ <br />(6) O~er insp~aions not listed a~ve <br /> <br /> = 1~5,0o <br /> <br />Subtotal;; $ <br /> <br />Subtotal:: $___ <br /> <br />x $40 = <br /> <br /> <br />