10 BECKET STREETVA
` CITY OF SALEM, MASSACHUSETTS
120 W,\SFIING'rON STREEI',4' 1 17 COR
TEL (978) 741-1800
KIMBEItLEY llRiSCOLL FAX (978) 745-0343
MAYOR Iramdin@salem.com
- LARRI'RAIIIDIN,RS/RH IS,CFIO,CP-PS _--
HISAI:rII
CERTIFICATE OF FITNESS
CERTIFICATE#404-11
DATE ISSUED: 10/17/2011
Property Located at: 10 Becket Street UNIT#2
Owner/Agent: 10 Becket St LLC
Address: 100 Cabot Street
City/Town: Beverly, MA Zip Code: 01915 24 Hour Phone:
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 II"
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
LARRY RAMDIN
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
• CITY OF SALEM, MASSACHUSETTS
BOARD OF HPAI:t'H
120 W S IING1 ON STMFSr,4"' n oo iZ ��
r'I;L. (978) 741-1800
KIMBERLY DRISCOLL FAX (978) 745-0343
MAYOR LunalulNnsnl.r:�Lronl
L✓�ItRY R:A.^-!!)IN,RS�RI(I IS,(:I10,(T-:,S.
HP.AI.I'II A(il'.N I'
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION"
FEE: $50.00
PROPERTY LOCATED AT /o '✓ l::YG 4,r-(— UNIT#
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
/
OWNER/LESSER IpgGG�etF •f 1i / (G , MANAGER/AGENT j4tq!q '
&1^ ^
NO P.O. BOX �^•
ADDRESS l00 eISe f- <S+I ADDRESS d?e4,e-"1yAv . /Q/S
CITY, STATE,ZIP CITY, STATE,ZIP
RESIDENCE PHONE BUSINESS PHONE (24HRS)
BUSINESS PHONE �78 90L •ZS"`f
TOTAL NUMBER OF ROOMS:_�
ROOM USE: 1. G � 2. 64ea/ 3. 4. 5
6. 7. 8. 9. 10.
THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE IS PAYABLE AT THE TIME OF INSPECTION
APPLICANT'S SIGNATUREDATE
/ P
d �
Inspectors use only
Date on initial inspection: I I / � 1 Date of reinspection:
/
Date of issuance of certificate: �I (�� Date fee paid: 0
Type of unit: Dwelling �ther Check#Check date: 1
1
11"1 11
Notes: u b(i4
C e of cement Inspector