BAKERS ISLAND - BUILDING INSPECTION (5) pL. MSVWT.�BEff *944"D APPROVE0 BY T+IE
,IWECI J;I PWR TD.A.PERW BEING GRANTED
CITY OF SALEM
No. Data
L7
is Pmpany Located in Location of k r
irle Historic Distdd? Yes No X linl.Iding Q e" S 1 j
S L A N
Is Roperty Located In
the CwaeivedW Ares? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: S xso A Jdk -ik cn,
PLEASE FILL OUT LEGIBLY a4 COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name J a` , es L T
� Cp M A C R Nlt03o54�
Address & Phone 53 L,aw R e N c tog)
Architect's Name
Address & Phone j t
Mechanics Name
Address & Phone t n
What is the pwpow of buiidbg? fld�t lr a K CoTT q G L
t id"of buY<Ytq? N a dwelling,for how nmy larn bes?
wbl=.conionn to law? Y L Asbestos? I V O
l:adr o Cqy Lim"r N A state License a
Rom Lprmeeent X � RLiz, 0 (,Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
ISV4 129L. /'I �ci-tvti , /Qc,Qc/( liA,,o DLCL 6j-7- x 36r-T
7-,fy Orr ep77/q64�.
MAIL PERMIT TO• ZY
No.
APPLICATION FOR
PERMIT TO
.DzrkfA geEA
LOCATION
PERMIT GRANTED
9 . 2.W6
APPROV�D
ECTOR O UILDINGS
CITY OR SAL[Mp MASSACHUSSTTS
x�
PUBLIC PROP[RTV D[PARTM[NT
120 WASNJNQTON 9TR[[T 3Ro FLOOR
15ALt14. MASSACNUS" 01970
r TULpNONS: 97&749-9e9a W. 3e0_ _. FAX. 978-740.9e4e
HOMEOWNER UcWSE um"noN
Plena Print.
Dal `f
job Location L o T S. [ q j1j
Ham O!rnar Addeen S _ A �v R C t i (-C (-�D G K fU 44 0 3 c)5 �
HamgOmwTelepbW (o 3 7 9 0
Pre�t Addc�esa s o
WSW imfividual
� eaamptioa at"Homeowners''way ester to incfide owner.00cupie�d
dwelliaga ottwo Units a kss and ro allo�r sgcp
hire who doe not pones a Hceaea,provided that the owlan• for
as mqmntm.
DEFINITION OF H011etB V/M
Person(sj who own a pa vd.of two"which hdshe
which dmre is;9r is intended to be.a om or two Ada or intends t0 residq aB
stroctutes acceaaory to a wh use and/or Sna Iy dwelling,attached or detached
dmo one home in a two year period shall not der d�� ownw.who more
Sud
"homeownce shah submit to the Building Ofcial,on a form
Official,gut he/she be responsible for all such wort ale to the Building
Permit performed under the Building
The undersigrmd"homeowner"assumes responoWfity for compHaam with the State
Building Code and other applicable by-laws and msuladons.
The undersigned"homeowner"entitle that W"be underst�the City of Salem
wrlllw g Departrneat minimum inspection proOcedure and requiremQ and that Wshe
mpiy with acid procedure and mquiremcM
HOMEOWNERS SIGNATURE -,,,, ���
APPROVAL OF BUILDING INSPECTOR
See other side for state code
f
t /1
MOON
wodt fOr wlvoh a Buikb9 Parma's
T1ke Code stag that: "�downs r' _of the s.(S.,dm 109.1.1 I.lCamni
Of act as Supavim,
h Homeowner
d0 aoeh work ars uosaso��Y as dw
rmars who use this exO0°, Rulaand Rem 16r Lice
M�mY H ' Sys m App��' off""mew Ofm ra°As m eaiow
jUs lack
Suparv`sor% �Some wm b4tal MUCAmed �
_ca "
dw udica ued 04 m' 1a
The
PW-1 ss wpar�� ' '�
is tW1Y aware of hislhat n>t ► that
To ensure that the Homeowner hcatio°, ,ID goumDw y
cpmmurutt�n a4 a R�of the permit App, _ On the last psV of this issue u a
� lidas of a Supan and adopt a
he/do mdustmOb umed� tom, You nW care W aaia�d
fonds fa uie is Yovt c�tY:.
r
ICAIO `I�Isoos
James E. Stiles
--- — --
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Rd.
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acGale Vale 39 kNH 03054
603 429=0642
Globe Valve
.. 31
31
Angle Val"
29
ButterflyValve
Circuit Server n
26
Ban Valve25
24
Motorized Valve
23
22
Solenoid
Operated Vave20
Sell-Operated 19
Valve
Pressure
Reducing Valve1a
Check Valve
14
PrQW
aRelieef Vve11
Flow Switch
10
9J _ f
A9uasttUnion 6
IL
Pressum Switch
a
GsPressre ak
lv AM em
G a �
h-I1 —_---
..i
—_--,
--
—
—___--_
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Regulator 2
Air Vent
0 1 2 13 4 ! 5 G J 8 9 : le III 12 113 , 14 15 16 1 17 i8 19 )e )1 11 13 2< ;25 2G 12) 129
James E. Stiles
Lot 7 Baker's Island
Home address: 53 Lawrence Rd.
Merrimack,NH 03054
603 429-0642
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Salem
Home addr8�53 awrenc d.
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