Spreadsheet: db7847ee-ee1c-4304-8908-683b842cf962
Sheet: S3 Civil Inspection

TOWN OF [NAME]
Development Services Department Fee Worksheet
Section 3:  Horizontal / Civil Inspection
(Incorrect payments will not be accepted)
 |  |  |  |  |  | = Fillable Cells
Submittal Date:
Project Name:
Applicant Contact:
Project Location:
Planning and [NAME] Number: |  |  |  |  | Internal Tracking Number:
 |  |  | Public ROW |  | Private Improvements
User Fee Description | Unit | Fee | Qty | Fee | Qty | Fee
GRADING CONSTRUCTION PERMITS
Base Fee, Plus (Includes Clear and [NAME]) |  | 50
: Less than 5 Acres | AC | 290
: Greater than 5 Acres, less than 20 Acres | AC | 242
: Greater than 20 Acres, less than 50 Acres | AC | 193
: Greater than 50 Acres, less than 200 Acres | AC | 145
: Greater than 200 Acres, Less than 500 Acres | AC | 97
: Greater than 500 Acres | AC | 48.4
Clear and [NAME] (only without [NAME]) | EA | 65
DRAINAGE CONSTRUCTION PERMITS
Base Permit Fee, Plus |  | 50
: Storm Drain and Irrigation Pipe | LF | 1.1
: Storm Drain and Irrigation Manhole | EA | 80
: Underground Retention | CF | 0.3
: Headwall / Handrail | EA | 80
: Catch Basin | EA | 120
: Scuppers (Includes Spillway / Handrail) | EA | 120
: [NAME] | EA | 65
: Drywells or [NAME] with Standard Treatment Chamber | EA | 500
: Drywells with Specialized Treatment Chamber | EA | 1000
: Specialized Treatment Chamber (Stand alone) | EA | 500
: Slope Protection ([NAME], [NAME], [NAME], etc.) | SY | 0.65
Private Improvements - 20% Reduction
SEWER CONSTRUCTION PERMITS
Base Permit Fee, Plus |  | 50
: [NAME] | LF | 1.1
: Sewer Service | EA | 23
: Manhole | EA | 185
: Force Main | LF | 1.5
: Cleanout | EA | 50
: Drop Connection | EA | 60
: Pipe Encasement | LF | 30
: Tie-in Fee | EA | 350
: Air / Vacuum Release Manhole / Value | EA | 400
: Residential/Commercial Sewer Tap to Existing Main | EA | 600
: Monitoring Vault and Special Structures | EA | 1500
Private Improvements - 20% Reduction
WATER CONSTRUCTION PERMITS
Base Permit Fee, Plus |  | 50
: [NAME] | LF | 1.1
: Water Service | EA | 23
: Flush / Curb Stop / Blow-off | EA | 25
: Fire Line | LF | 1.1
: [NAME] | EA | 60
: Backflow Device up to 3 inches | EA | 80
: Backflow Device greater than 3 inches | EA | 150
: Sampling Station / Air Release Valve | EA | 90
: Tapping Sleeve and Valve / Tie-in | EA | 300
: Mainline / Lateral / Fire Hydrant Valve | EA | 30
: Residential/Commercial Water Tap to Existing Main | EA | 600
Private Improvements - 20% Reduction
STREET LIGHTING CONSTRUCTION PERMITS
Base Permit Fee, Plus |  | 50
: Street Light | EA | 50
CONCRETE CONSTRUCTION PERMITS
Base Permit Fee, Plus |  | 50
: Sidewalk and [NAME] and Trail | SF | 0.05
: [NAME] and [NAME] Ramp | EA | 80
: Curb and Gutter / Ribbon Curb | LF | 0.25
: Valley Gutter / Apron | SF | 0.4
: Driveway / Alley Apron | EA | 55
: Return Style Driveway and Bus Bay | SF | 0.3
: Cut-off Wall | LF | 1.5
Private Improvements - 20% Reduction
PAVING CONSTRUCTION PERMITS
Base Permit Fee, Plus |  | 50
: A/C Paving (Per Lift - Includes Striping) | SY | 0.45
: Concrete Paving | SY | 0.5
: [NAME] and Overlay | SY | 0.3
: Slurry / Micro Seal | SY | 0.1
: Adjustments:  Manholes, Blow-offs, Water Valves, Gas Valves, Utility Adjustment, Clean-outs, Survey Monument Hand Holes, etc. | EA | 60
: Survey Monument
: Type A | EA | 25
: Type B | EA | 15
: Street Sign | EA | 25
: Barricade / Guardrail | LF | 4
: Pavement Utility Pothole | EA | 65
Private Improvements - 20% Reduction
DRY UTILITY PERMITS (RIGHT-OF-WAY ONLY)
: Utility Vaults / Manholes | EA | 95
: Utility Splice / Repair Pits | EA | 75
: Utility Valves | EA | 30
: Utility Trench | LF | 0.8
OTHER (Includes Base Application Fee and Right-of-Way Permit Fee)
Structures ([NAME], Flood Retarding Structures, [NAME], Channel Energy Dissipation Structures, [NAME], [NAME], etc.) | COST | 0.03
Water (Booster Stations, In-line Boosters, Wells, Pressure Reducing Stations, etc.) | COST | 0.03
Sewer (Lift Station) | COST | 0.03
Traffic Signal | COST | 0.03
Other | COST | 0.03
PAVEMENT RESTORATION FEES
 |  | Total Square Yards :
: Less than 100 SY, plus | SY | 26
: Next  100 SY, less than 500 SY, plus | SY | 7
: Next  500 SY, less than 1,760 SY, plus | SY | 2
: Next  1,760 SY or greater | SY | 0.8
NOTE:  Other Utility Items -  refer to individual utility fees for additional items
CLASS PERMITS
Class 1 Permit:  Minor Encroachment Permit (Block Party - Police Department)
:  Permit Application Process Fee |  | No Fee |  | 0
Class 1 Permit:  Minor Encroachment Permit (Public Telephones, News Racks, Placing Temporary Traffic Barricades in Street, Placing Merchandise on Sidewalk for Temporary Sale, Curb Address Painting)
:  Permit Application Process Fee | EA | 160
Class 2 Permit:  Encroachment Permit for Sidewalk Furniture (Tables, Chairs, Umbrellas, Benches, Planters, Flower Pots)
:  Permit Application Process Fee | EA | 160
Class 3 Permit:  Encroachment Permit for Landscape Maintenance
:  Permit Application Process Fee | EA | 160
Class 4 Permit:  Encroachment Permit for Telecommunications
:  License Application Fee | EA | 160
:  Special License Review | HOUR | 100
:  Permit Application Fee | EA | 160
:  Additional Permit Services (Inspection, Construction Maintenance and Operations) | HOUR | 100
:  Pavement Restoration Fee | See Pavement Restoration Section Above
Class 5 Permit:  Encroachment Permit for Fiber Optic Cable, Interstation Services and Other Communication Facilities Excluded from the Definition of "Telecommunications"
:  License Application Fee | EA | 160
:  Special License Review | HOUR | 100
:  Permit Application Fee | EA | 160
:  Additional Permit Services (Inspection, Construction Maintenance and Operations) | HOUR | 100
:  Pavement Restoration Fee | See Pavement Restoration Section Above
Class 6 Permit:  Encroachment Permit for Cable Television
:  Permit Application Fee | EA | 160
:  Additional Permit Services (Inspection, Construction Maintenance and Operations) | HOUR | 100
:  Pavement Restoration Fee | See Pavement Restoration Section Above
Class 7 Permit:  Encroachment Permit for Utilities
:  Permit Application Fee | EA | 160
:  Additional Permit Services (Inspection, Construction Maintenance and Operations) | HOUR | 100
:  Pavement Restoration Fee | See Pavement Restoration Section Above
Class 8 Permit:  Encroachment Permit for Street Excavation
:  Permit Application Fee | EA | 160
:  Additional Permit Services (Inspection, Construction Maintenance and Operations) | HOUR | 100
:  Pavement Restoration Fee | See Pavement Restoration Section Above
Total Calculated Fees
 |  |  | TOTAL PERMIT FEE:
***PLEASE NOTE:  BASE FEES ARE TO COVER TOWN STAFF AND DO NOT COVER ADDITIONAL FEES CHARGED BY TOWN ATTORNEY.
PLEASE SIGN THAT YOU HAVE READ AND UNDERSTAND THE STATEMENT ABOVE.
SIGNATURE OF APPLICANT _________________________________________________