23B-059 123 South Main St, Florence roof permit � r
Department use onh
City of N rth n Statu of Penni
BUidling pa urb ut/Driv"ay Permit
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Roo 10 ate ell Availabildy
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� pp OLDINf.INSPEGT'O 0 S to of Structural Plans
phone 413-587-124 IF AMM .e Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION /IS + /V q�
1.1 Property Address. This section to be completed by office
IA J S wh So- Map Lot t7 J ,tUnit
yA� Zona Overlay District
I04'CZ '1 Eim SL DIe41ct CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
1n R ord- L -1
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03 S - 1a1 Sf- d✓e-e- VIAIA
Name(Print) Meilig
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2.2 A h zed A t:
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Name(Pont) Current Mailing Address:
I --7-7q - (c33- � 3`�6
Signature Telegwne
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed bv permit applicant
1. Building _I L ' lu (a)Building Peri[Fee
2. Electrical (b)(b)Estimated Total Cost of
Construction frau 6
3. Plumbing Building Permit Fee / ,[/le
4. Mechanical(HVAC)
5. Fire Protection
S. Total=(1 +2+3+4+5) Check Number O
This Section For Official Uss Only
Date
Building Permit Number. Issued:
Signature:
Building Commissionerimspector of Buildings Date
@ 4S - L LG Com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)