BUCHANAN ROAD CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
♦ `�' 3j 120 WASHINGTON STREET, 4TH FLOOR
? Sp SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#374-04
DATE ISSUED: 08/10/2004
Property Located at: 2 Buchanan Road UNIT# 1
Owner/Agent: John Tachuk
Address: 2 Buchanan Road
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 744-2673
An inspection of your vacant Dwelling/Rooming Unit at the above address has been approved and is in
compliance with 105 CMR 410.000: Massachusetts State Sanitary Code,Chapter If'Minimum Standards
of Fitness for Human Habitation".
Therefore,this Certificate is issued by the Code Enforcement Division of the Salem Board of Health and
the unit may now be rented and/or occupied.
Maximum Number of occupants, must comply with 105 CMR 410.000.
Certificate valid for one year from date of issuance or until the current tenant vacates,whichever is later.
This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy.
FOR THE BOARD OF HEALTH'
JOANNE SCOTT, MPH, RS, CHO d
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
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`OFyHEALTH
• � 124 WASHINGTONSTREET 4TH FLOOR
`SALEM f A 62970
" TEL 928-741 7800
,I r ".. ... FAX 97.8-745-0343
STANLEY USOVICZ, JR. .LOAN NE SCOTT, MPH, RS, CtiO
' MAYOR 14EALTH AGENT
APPLICATION FOR CERTIFICATE OF FITNESS
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
PROPERTY LOCATED AT �g ,I � I�� – UNIT# I
t
IS THIS UNIT DESI(G}N�ATED AS RIGHT LE FRO BACK PLEASE CIRCLE ONE
OWNER/LESSER rM. MANAGER/AGENT
No P.O. Bax !/ No P.O.Box
ADD _ADDRESS —
CITY .AA-ImlCITY
RESIDENCE PHONEgIU`IYY->?4,73 BUSINESS PHONE(24 HRS.)_
BUSINESS PHONE /
TOTAL NUMBER OF ROOMS: T
ROOM USE: 1.
5. fill 6. 7. 8.
THERE IS A TWENTY-FIVE($25.00)DOLLAR FEE, PAYABLE BY CHECK OR MONEY
ORDER TO THE CITY OF SALEM HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE
TIME OF INSPECTION.
APPLICANTS SIGNATURE_(I-tL A sdd v-L DATE_J. j�_
INSPECTORS VISE ONLY
DATE OF INITIAL INSPECTION � O `v DATE OF REINSPECTION_
DATE OF ISSUANCE OF CERTIFICATES.-(0 -0 `e DATE FEE PAID:. RS �
TYPE OF UNIT: DWELLING
OTHER_ _ CHECK#_lCHECK DATEI
NOTES:
CODE ENFORCEMENT INSPECTOR 9/28/98