CEDARCREST AVENUE CEDARCREST AVENUE
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�� Q9 CERT.# 33-96
FEE $25.00
DATE: 01/25/96
CITY OF SALEM BOARD OF HEALTH
- Salem,-Massachusetts-01970-3928 -
JOANNE SCOTT,MPH,RS,CHO - NINE NORTH STREET
HEALTH AGENT Tel:(508)741-1800
Fax:(508)740-9705
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 5 Cedarcrest Avenue UNIT #: 2
OWNER/AGENT: Stephen & Marie Nickerson
ADDRESS: 5 Cedarcrest Avenue
CITY/TOWN: Salem, MA -ZIP CODE: 01970 24 HOUR PHONE: 745-6511
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 HEALTH DEPARTMENT AND THE UNIT MAY NOW BE RENTED AND/OR OCCUPIED.
MAXIMUM NUMBER OF OCCUPANTS, BASED ON 105 CMR 410.000: MASSACHUSETTS STATE
SANITARY CODE, CHAPTER II, "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" .
SECTION 410.400 (B) : DWELLING UNIT (X) AND 410.400 (C) : ROOMING UNIT
MINIMUM SQUARE FOOTAGE FOR SLEEPING PURPOSES: .
NOTE: THIS APPROVAL DOES NOT CERTIFY COMPLIANCE WITH THE STATE LEAD LAW FOR
OCCUPANTS UNDER 6 YEARS OF AGE.
FOR THE BOARD OF HEALTH
JOANNE SCOTT, MPH,RS,CHO
V
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
33��
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT Tel:(508)741-1800
APPLICATION FOR CERTIFICTE OF FITNESS Fax:(508)740-9705
j' IN ACCORDANCE WITH STATE SANITARY: CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM
STANDARDS OF FITNESS FOR HUMAN HABITATION".
i
PROPERTY LOCATED AT CL'7�/�Y\ ( /<CU� •/4UG UnT.I
OWNER/LESSER S 1 ��1 e h -i-,PM16 /, j6k'Q/JGQNAGER/AG£NT__&6A�e'
ADDRESS h5 �e �./2PJT AU( ADDRESS
�} J
CITYSri I L-� / / CITY _
.-RESIDENCE PHONE 06 -7� ( -&S / ! BUSINESS PHONE (24 HRS.)
BUSINESS PROVE_ AZA
TOTAL NUMBER OF ROOMS: `Y � ` 77 \ '"" ��
ROOM USE: 1. (T� Q 2._ Q�(J}'{'t 3. �ii)IA ��•14 . beA
5. 6. 7, 8,
THERE IS A TWENTY-FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK OR HOMEY ORDER TO THE
CITY OF SALEM HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TI2ffi OF INSPECTION
APPLICANTS SIGNATURE JC I �JL�f��i 1I DATE
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION: - l{ DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: / }_ _ _C DATE FEE PAID:
TYPE OF UNIT: DWELLING OTHER
NOTES:
CODE ENFORCEMENT INSPECTOR