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266 CANAL STREET, BUILDING 3 - WATER & SEWER SUBMETER CERTIFICATES MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitaty Code, Chapter II,the"Housing Code"),the following dwelling unit is eligible for submeterin_water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3201 #Of units in bldg.64 Citv/Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ✓❑ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ////� p Kristen Poulin, The Residences on Canal Street,LLP &44— f"a� Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date -ETThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L C. Date Submitted to Local Health 186§22- Depar ent• Prior Owner's Signature Date AECEIVE-. NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3202 #Of units in bldg.64 City/Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: NMT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, §22(p),does not require the installation of a submeter. William Lane ' : , 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)1 will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, �� Q Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP /I M.Av— row— Owner's Representative Name of Owner Signature of Owner Date The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- DepartRECEIVED Prior Owner's Signature Date NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitaty Code, Chapter II the "Housing Code" ,the following dwelling unit is eligible for submetering,water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3203 #Of units in bldg.64 Citv/Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: NMT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. ❑ The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L.c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, M////� �� Q�-" '��" Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP HAy" ra —� Owner's Representative- Name of Owner Signature of Owner Date The properly has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Depart+MWE-'C E I V E D Prior Owner's Signature Date NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitar►�Code, Chapter II the"Housing Code" the following dwelling unit is eligible for submetering.water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3204 #Of units in bldg.64 City/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VerSaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L .c. 186,§22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Si__nature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4) The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ////� �� Q- , _ Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP K4MJv" PaJ Owner's Representative Name of Owner Signature of Owner Date LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G1 c. Date Submitted to L`OcaL alth 186§22- Depart4t E-C E I V C Prior Owner's Signature Date NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, §22 and 105 CMR 410.000:Minimum Standards of fitness for Human Habitation, State Sanitary Code, Chapter H the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3205 #Of units in bldg.64 City/Town: Salem MA zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 144-111 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ////� �� p Kristen Poulin, The Residences on Canal Street,LLP AUAV— f�`--�Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date S �ealth 186§22- Depar= 0/ Prior Owner's Signature Date Nov 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitaty Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3206 #Of units in bldg.64 _Cit%/Town: Salem MA zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L.c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ��//� �� Q , _ Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP 11MMs/— �aA� Owner's Representative Name of Owner Signature of Owner Date The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted t0 Local Health 186§22- Departgleftd E w ED Prior Owner's Signature Date HHtt NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3207 #Of units in bld;-.64 City/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VerSaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane ��/ / 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)1 will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, �� O Kristen Poulin, The Residences on Canal Street,LLP KIU `- raAJ�+�- Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date RECEIVED NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 ^CITY OF SALEM MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter H(the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3208 #Of units in bldy 64 City/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VerSaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22). (4) The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, � �� Q_ ,�- Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP /WM�/`' ram Owner's Representative Name of Owner Signature of Owner Date The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM EOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3209 #Of units in bldg.64 City/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. 1-1 The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane ' 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION 1 certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)1 will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, �///�� Q- , _ Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP KuJ — faA� Owner's Representative Name of Owner Signature of Owner Date The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owners Signature Date RECEIVE D NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the "Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3210 #Of units in bld-.64 City/Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Laney+�i � 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, l�_�_ Kristen Poulin, The Residences on Canal Street,LLP /y�yAs/�' f p akA*A06 Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date The properly has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date ECEIVED NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3211 #Of units in blk 64 City/Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. /J William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ////� �� pp&A�o Kristen Poulin, The Residences on Canal Street,LLP &Jv— Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date LJThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§zz- Departm_etn (� Prior Owner's Signature Date ? n : E V E NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3212 #Of units in bldg.64 City/Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ✓❑ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, §22(p),does not require the installation of a submeter. William Lane _ _ 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above. (3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy,a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ////� J&� Q ,� Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP lVl — fa&A Owner's Representative Name of Owner Signature of Owner Date LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date RECEIVED NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II(_the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3213 #Of units in bldg.64 City/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. 1 have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane ' :'';� 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ��//� �� " ��" Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP Ku4A&— Pam- Owner's Representative Name of Owner Signature of Owner Date The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L C. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date RECEIVED 410-23-Submetering of Water and Sewer Certification Form 5-12-23 NOV 0 3 2025 CITY OF SALEM MP AMM!1C UC AI TN MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3214 #Of units in bldg.64 City/Town: Salem MA zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: NMT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane / 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L.c. 186, § 22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)1 will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ////� Kristen Poulin, The Residences on Canal Street,LLP &4J& Q- ,� _" Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date RECEIVED NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3215 #Of units in bldg.-64 City/Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L .c. 186,§22(p),does not require the installation of a submeter. William Lane ;� ` . 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22). (4) The water meter or submeter measures the water usage exclusive to this unit. (5) I will provide to the tenants of this dwelling unit,prior to occupancy,a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, �l�� Q Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP ILl/tiAv�- r�AM� Owner's Representative Name of Owner Signature of Owner Date LlThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date BECEIVED NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3216 #Of units in bldg.64 City/Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VerSaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, §22(p),does not require the installation of a submeter. 1 William Lane �' , 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, // Kristen Poulin, 70-37-2025 The Residences on Canal Street,LLP Owner's Representative Name of Owner Signature of Owner Date LlThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date RECEIVED NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering,water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3301 #Of units in bldg.64 City/Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, §22(p),does not require the installation of a submeter. / 3 ,William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ////� �� p- ,�- Kristen Poulin, The Residences on Canal Street,LLP 444A�/`' `-- Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date LlThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code"),the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3302 #Of units in Bldg.64 City/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane F 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L.c. 186, §22). (4) The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP MAtiA�/" Owner's Representative Name of Owner Signature of Owner Date LJThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department* Prior Owner's Signature Date EC E I V E D NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3303 #Of units in bld,,.64 City/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: NMT VersaMag Manufacturer Model# _ LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. VI have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane % ,' ';t_r _ ` 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy,a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ��//� Kristen Poulin, The Residences on Canal Street,LLP AuAr— Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L C. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date 410-23-Submetering of Water and Sewer Certification Form 5-12-23 NOV 0 3 2025 CITY OF SALEM RnARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code"),the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3304 #Of units in bldg.64 City/Town: Salem MA zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model # LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ 1 have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Si nature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)1 will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ////� �� QQ-- ,, __ Kristen Poulin, The Residences on Canal Street,LLP AmAv— ram' Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date RECEIVED NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitar•Code, Chapter II(the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3305 #Of units in bld .64 City/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: NMT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): 2✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ✓❑ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. ❑ The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. / William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, � �� " Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP lVIHA��' rOWw► Owner's Representative Name of Owner Signature of Owner Date LlThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date RECEIVED 410-23-Submetering of Water and Sewer Certification Form 5-12-23 NOV 0 3 2025 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitaiy Code, Chapter II(the "Housing Code"),the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3306 #Of units in bld-,.64 Cil\/Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ////� Q_ _ Kristen Poulin, The Residences on Canal Street,LLP &Ukl.' fa.' - Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§zz- Departmmf Rtb EIV E� Prior Owner's Signature Date NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3307 #Of units in bldg.64 City/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ////� ��ujy & Kristen Poulin, The Residences on Canal Street,LLP / — 4A— Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date FIECEIVED 410-23-Submetering of Water and Sewer Certification Form 5-12-23 NOV 0 3 2025 CITY OF SALEM onnon nC WPA1 TH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitaty Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3308 #Of units in bldg.64 City/Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ 1 have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ////� �� Q� �� Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP /VIMAa" AI JA Owner's Representative Name of Owner Signature of Owner Date The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: t— Prior Owner's Signature Date I F NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II(the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3309 #Of units in bldg.64 City/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: NMT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, �N y� p Kristen Poulin, The Residences on Canal Street,LLP � &)M A--Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date RECEIVED NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3310 #Of units in bldg.64 Citv/Town: Salem MA zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: NMT _ VerSaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑� I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)1 will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, // Kristen Poulin, The Residences on Canal Street,LLP *UJ& - Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department:RE Prior Owner's Signature Date r—S IVGD NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3311 #Of units in bldg.64 ChN/Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, //// Kristen Poulin, The Residences on Canal Street,LLP K444A&- PW.A vP Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date LlThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date RE -FIVE-ED NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3312 #Of units in bldg.64 City/Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: NMT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ 1 have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. /J William Lane j` �Lf1'� 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ��//� ��— Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP /1� Owner's Representative Name of Owner Signature of Owner Date LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date RECEIVED 410-23-Submetering of Water and Sewer Certification Form 5-12-23 NOV 0 3 2025 CITY OF SALEM BOARD OF HFAI TH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Cha)ter II(the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3313 #Of units in bl&.64 City/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: NMT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑� I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. �1 William Lane fi' ' 8318 10/21/2025 t, Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ////� � "�� QQ-- ,,�-- Kristen Poulin, 70-31-2025 The Residences on Canal Street,LLP /yUM;/ ( Owner's Representative Name of Owner Signature of Owner Date LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date BECEIVED NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEMI BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3314 #Of units in bldg.64 City/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: NMT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane LA& 8318 10/21/2025 Licensed Plumber's Name Plumber' Sijknature License# Date OWNER CERTIFICATION 1 certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4) The water meter or submeter measures the water usage exclusive to this unit. (5)1 will provide to the tenants of this dwelling unit,prior to occupancy,a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, � �� Op� �� Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP //VIM(/`" fOKM�`� Owner's Representative _ Name of Owner Signature of Owner Date Troperty has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date submitted to Local Health 186§22- Department: Prior Owner's Signature Date NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the "Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3315 #Of units in bldg.64 Citv/Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. ❑ The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, // �� p Kristen Poulin, The Residences on Canal Street,LLP V f )i O Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health I86§22- Department: Prior Owner's Signature Date NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3316 #Of units in bldg.64 City/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ✓❑ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L.c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ��//� �� QQ� �� Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP &44A/— f� Owner's Representative Name of Owner Signature of Owner Date LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L C. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date RECEIVED NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3401 #Of units in bldg.64 City/Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): 7 I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. ❑ The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)1 will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, I // Q Kristen Poulin, The Residences on Canal Street,LLP wkp- raA Owner's Representative 70-31-2025 Name of Owner Signature of Owner Date LlThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date RECEIVED NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3402 #Of units in bldg.64 City/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ✓❑ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. PWilliam Lane '" 8318 10/21/2025 `f Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION 1 certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, � �� Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP lam" Owner's Representative Name of Owner Signature of Owner Date LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date RECEIVED NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II(the"Housing Code" ),the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3403 #Of units in bldg.64 City/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. �❑This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, §22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, �� Kristen Poulin, The Residences on Canal Street,LLP /W�" &JA_ Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186 22- Department: § Prior Owner's Signature Date RECEIVED NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3404 #Of units in bldg.64 Citv/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ✓❑ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane _� 8318 10/21/2025 ,,r, Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ////� �� p Kristen Poulin, The Residences on Canal Street,LLP Amkp— raA�+w Owner's Representative 70-31-2025 Name of Owner Signature of Owner Date LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date RECEIVED 410-23-Submetering of Water and Sewer Certification Form 5-12-23 NOV 0 3 2025 CITY OF SALEM BOARD OF HFAI TH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the "Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3405 #Of units in bldg.64 City/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ✓❑I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane , , _ 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy,a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ��// � p- Kristen Poulin, The Residences on Canal Street,LLP KU44 -' ,V Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date RECEIVED NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitaiy Code, Chapter II the"Housing Code"),the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3406 #Of units in bld:1 64 City/Town: Salem_ MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: NMT VerSaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, §22(p),does not require the installation of a submeter. / William Lane , '' ' 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, �///� �� QQ-- ,,�__ Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP &"k_ row Owner's Representative Name of Owner Signature of Owner Date LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- DepartrCEIVED Prior Owner's Signature Date NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ),the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3407 #Of units in bldg.64 City/Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ 1 have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, §22(p),does not require the installation of a submeter. William Lane ,/!j.l��.i ,�, 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4) The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy,a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, � �� Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP /VIHA�/`' Owner's Representative Name of Owner Signature of Owner Date LlThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- VV C Departs E I D Prior Owner's Signature Date fiEVE NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II(the"Housing Code" ),the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3408 #Of units in bldg.64 Citv/Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4) The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ////� �� Q� , � Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP KUJ&— �01� Owner's Representative Name of Owner Signature of Owner Date The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health lab§22- Department: Prior Owner's Signature Date NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3409 #Of units in bldp,.64 City/Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. 0 The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. �J i William Lane !� ' , ", 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, // O- , 4 Kristen Poulin, The Residences on Canal Street,LLP KuJvn &JA Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date LlThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department. _ Prior Owner's Signature Date REGRIVED NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3410 #Of units in bld .64 City/Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. 1 William Lane - %;r� 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ��//� �� pp� ,, -- Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP &4&— f�J� Owner's Representative Name of Owner Signature of Owner Date LlThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department Prior Owner's Signature Date RECEIVED NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary,Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3411 #Of units in bldg.64 City/Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane �: ,40 _ {„ 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, � �� p- ' - Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP /yl/aAf/`� fo1 Owner's Representative Name of Owner Signature of Owner Date The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3412 #Of units in bldg.64 City/Town: Salem MA Zi. Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag _ Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ��//� �� pp� �� Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP /l/U41y— ra�—� Owner's Representative Name of Owner Signature of Owner Date LlThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date REiCEIVED NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the "Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3413 #Of units in bldg.64 City/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VerSaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. 1 have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane !L , 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)1 will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, M��//� �� --� Kristen Poulin, The Residences on Canal Street,LLP 44A&-- AWk. Owner's Representative 10-31-2025 Name of Owner Shmature of Owner Date The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date _ EC E i V E D NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter H(the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3414 #Of units in bldg.64 City/Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ 1 have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L .c. 186,§ 22(p),does not require the installation of a submeter. �l William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, /�//� �� p_ , - Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP &44A&-" �aA� Owner's Representative Name of Owner Signature of Owner Date LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Depart 5nntt:. Prior Owner's Signature Date CEIVED NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitaty Code, Chapter II the"Housing Code"),the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3415 #Of units in bld •64 City/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑� I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane ' 8318 10/21/2025 7 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4) The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, �� Kristen Poulin, The Residences on Canal Street,LLP &44A& - Owner's ReP resentative 70-31-2025 Name of Owner Signature of Owner Date LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Depart Prior Owner's Signature Date Deart CEIVED NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitar Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3416 #Of units in bldu_64 City/Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VerSaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane — ,;s 1 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy,a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, p� ,�_ Kristen Poulin, The Residences on Canal Street,LLP tl� �J�--- Owner's Representative 10-31-2025 Name of Owner Sigmature of Owner Date LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Depart>I CEIVED Prior Owner's Signature Date NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3501 #Of units in bldg.64 City/Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, §22(p),does not require the installation of a submeter. William Lane � � �� , 8318 10/21/2025 Licensed Plumber's Name Plumber'Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ////� �� p Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP /1/U—" PotAMti Owner's Representative Name of Owner Signature of Owner Date -EfThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Prior Owner's Signature Date Depart RC,E I V E D NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitarjp Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3502 #Of units in bldg.64 City/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane ,,�/�i�', ,j 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit, prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, Q- ,�_ Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP ! -� Owner's Representative Name of Owner Signature of Owner Date The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date r NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter ff the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3503 #Of units in bldg.64 City/Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: NMT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): 0 I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. F711 have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane /f�� 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)1 will provide to the tenants of this dwelling unit,prior to occupancy,a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ////� � Q- , _ Kristen Poulin, The Residences on Canal Street,LLP AmJ&" fad— Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date RECEIVED NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II(the"Housing Code"),the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3504 #Of units in bldt,,.64 City/Town: Salem MA zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane 1., 8318 10/21/2025 Licensed Plumber's Name Plumber' Siznature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ////�� Kristen Poulin, The Residences on Canal Street,LLP AmAy— Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date LlThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date CEIVED NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter H(the"Housing Code"),the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3505 4 Of units in bldg.64 City/Town: Salem MA Zi p Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: NMT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ✓❑ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. 1 William Lane i" i 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)1 will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, �/ - , - Kristen Poulin, The Residences on Canal Street,LLP &4)& - ALUM— Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date submitted to Local Health 186§22- DepartC E I V E D Prior Owner's Signature Date NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3506 #Of units in bldg.64 Citv/Town: Salem NIA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L.c. 186, § 22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy,a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, � �� Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP /N�M�" Owner's Representative Name of Owner Signature of Owner Date LlThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L C. Date Submitted to Local Health 186§22- Departr 11 I EC c I v E Prior Owner's Signature Date I 11'' L� NOV 0 3. 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter H(the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3507 #Of units in bldg.64 Citv/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: NMT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, §22(p),does not require the installation of a submeter. / William Lane / 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4) The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, �� p- , - Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP / " r Owner's Representative Name of Owner Signature of Owner Date LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- DeparteC E I V E D Prior Owner's Signature Date NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering,water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3508 #Of units in bid,-,.64 Citv/Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L .c. 186,§22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION 1 certify that: (1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above. (3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4) The water meter or submeter measures the water usage exclusive to this unit. (5) I will provide to the tenants of this dwelling unit,prior to occupancy,a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, �Udv Kristen Poulin, The Residences on Canal Street,LLP IY — &A P Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanita,- Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3509 #Of units in bldL.64 City/Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VerSaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑� I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. FI have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Siunature License# Date OWNER CERTIFICATION I certify that: (1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4) The water meter or submeter measures the water usage exclusive to this unit. (5)1 will provide to the tenants of this dwelling unit,prior to occupancy,a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, � �� Q Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP /1M�lAy" Ta.- Owner's Representative Name of Owner _ Signature of Owner Date LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22_ Depart>R RECEIVED Prior Owner's Signature Date NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II(the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3510 #Of units in bldg.64 City/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: NMT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. 1 have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. /1 William Lane ,�� I% 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)1 will provide to the tenants of this dwelling unit,prior to occupancy,a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, // Kristen Poulin, The Residences on Canal Street,LLP &"J&' Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date . S— E NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3511 #Of units in bldg.64 Ci /Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4) The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, // Kristen Poulin, The Residences on Canal Street,LLP Aww- PW.LV Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health ls6§z2- Department: _ Prior Owner's Signature Date ^_'r NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitaty Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3512 #Of units in bldg.64 City/Town: Salem NM Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VerSaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. /J William Lane �� 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ////� �� Q� , - Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP M 44— l%1� Owner's Representative Name of Owner Signature of Owner Date The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- DepartiiC E I V Cc Prior Owner's Signature Date I t NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3513 #Of units in bldg.64 City/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VerSaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane ,/��' , ;,, y' , 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)1 will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ////� �� Q� , - Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP IVUMy`' r�RJ� Owner's Representative Name of Owner Signature of Owner Date The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§aa- Department: Prior Owner's Signature Date EC F f V-- NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3514 #Of units in bldg.64 City/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, /N////� �� Kristen Poulin, 10-31-2025 The Residences on Canal Street,LLP IP- Owner's Representative Name of Owner Signature of Owner Date LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health Departlr�>��O"C® 186§22- 1 1 V G Prior Owner's Signature Date NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3515 #Of units in bldg.64 City/Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VerSaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑� I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. 7 I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane ,:c� 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)1 will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, ////� �� Kristen Poulin, The Residences on Canal Street,LLP &44AV— PM.µ— Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- Department: Prior Owner's Signature Date NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State Sanitary Code, Chapter II the "Housing Code" ,the followin-dwelling unit is eligible for submetering water and sewer. PROPERTY INFORMATION Address: 266 Canal Street (Building 3) Unit# 3516 #Of units in bldg.64 City/Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for submetering for water and/or sewer services. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A Massachusetts licensed plumber must install the toilets and submetering equipment. Submetering equipment information: N MT VersaMag Manufacturer Model# LICENSED PLUMBER CERTIFICATION I certify that(check all that apply): ❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards. ❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards. The plumbing permit issued by the city/town,if required,is attached. This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p),does not require the installation of a submeter. William Lane 4// , 8318 10/21/2025 Licensed Plumber's Name Plumber' Signature License# Date OWNER CERTIFICATION I certify that: (1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law (MGL c. 186, §22). (2)All showerheads,faucets and toilets in this dwelling unit meet the conservation standards specified above. (3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, §22). (4)The water meter or submeter measures the water usage exclusive to this unit. (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form. (6) All information included on this certification is true and accurate to the best of my knowledge. THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING Signed under the pains and penalties of perjury, KThe Residences on Canal Street,LLP Kristen Poulin,/(y�fP- Owner's Representative 10-31-2025 Name of Owner Signature of Owner Date The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health 186§22- DepartnPLIC E I V E Prior Owner's Signature Date II�� NOV 0 3 2025 410-23-Submetering of Water and Sewer Certification Form 5-12-23 CITY OF SALEM BOARD OF HEALTH