CEDAR CREST ROAD F -
CITY OF SALEM, MASSACHUSETTS
+ � s BOARD OF HEALTH
>¢ 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAx 978-745-0343
Kimberley Driscoll WWW.SALEM.COM
Mayor JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE# 112-07
DATE ISSUED: 3/19/2007
Property Located at: 14 Cedarcrest Road UNIT#House
Owner/Agent: Doreen Marquis
Address: 7 Cedarhill Road
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-744-1599
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
f
OANNE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, M"SA.CHUSE M
' 130ARD OF HEALTH
120 WASHINOTON STREET, 4TH FLOOR 1' -0 f
SALEM, MA 01970 (j
TEL. 978-741-1900
FAX 979-745.0943
JOANNE SCOTT, MPH, RS, CHO
Kimberley Driscoll HEALTH AGENT
Mayor
i
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 I
IS THIS UNIT DESIGNATED ASIH GFiT LEFT FRONT BACK PLEASE CIRCLE ONE
OWN ERII ESSER , nn.fil 4 Aq&a_0S' MANAGERIAGENT---
No P.O, Box No P.O.Box
ADDRESS- i�Fli! t�� s, 4__fADDRESS _
CITYYtCITY__ _ 7 (/
RESIDENCE PHONEa7� 74,V—L l_BUSINESS PHONE (24 HRS.)-Ce J ~� 3
BUSINESS PHONE____,____. �" ___-
TOTAL NUMBER O,rF}ROOMS:_jj.,_ /
ROOM USE: 1�..� /rjS - - 2'-J 3 _,6d -`1 -
THERE IS A TWENTY-FIVE (525.00) 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
INSPECTL)_PS U-,E- NLY j
r
DATE OF INITJAL Ir iSP�CTigN .�,' D DATE OF 13EINSPFCTION
DATE OF ISSUANCE OF CGP TIFICATE}� ��� -o.7 DATE FEF PAID: _ r l c+ J0 7
TYPE OF UNIT. DWE_LIN , OTIIF3T CHL-CK P134 -7 CHECK PATr
�..._ ..
NOTES
GO!?f. C NPpfiCi:.ML".N i iNSili=ta OH T:18 X73