CHEVAL AVENUE • vg,�coxorT
cC CERT.# 616-00
_ FEE $25.00
a DATE: 09/29/2000
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET
HEALTH AGENT Tel:(978)741-1800
Fax:(978)740-9705
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 2 Cheval Avenue UNIT #: House
OWNER/AGENT: Richard Bresnahan
ADDRESS: 60 Bay View Avenue
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-4910
AN INSPECTION OF YOUR VACANT DWELLING/ROOMING UNIT AT THE ABOVE ADDRESS HAS
BEEN APPROVED AND IS IN COMPLIANCE WITH 105 CMR 410.000: MASSACHUSETTS STATE
SANITARY CODE, CHAPTER II, "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" .
THEREFORE, THIS CERTIFICATE IS ISSUED BY THE CODE ENFORCEMENT DIVISION OF THE
SALEM .BOARD OF HEALTH AND THE UNIT MAY NOW BE RENTED AND/OR OCCUPIED.
MAXIMUM NUMBER OF OCCUPANTS, BASED ON 105 CMR 410.000 : MASSACHUSETTS STATE
SANITARY CODE, CHAPTER II, "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" .
SECTION 410 .400 (B) : DWELLING UNIT (X) AND 410 .400 (C) : ROOMING UNIT
MINIMUM SQUARE FOOTAGE FOR SLEEPING PURPOSES: .
NOTE: THIS APPROVAL DOES NOT CERTIFY COMPLIANCE WITH THE STATE LEAD LAW FOR
OCCUPANTS UNDER 6 YEARS OF AGE. FOR MORE INFORMATION CALL 978-741-1800.
FOR THE
NN ABOARD OF HEALTH
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JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
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CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT,MPH, RS,CHO NINE NORTH STREET
HEALTH AGENT APPLICATION FOR CERTIFICATE OF FITNESS Tec(978)741-1800
Fax: (978)740-9705
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT �y � � J UNIT# bUs
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSE - W21f— 'MANAGER/AGENT�"
No P.O. Bo No P.O. Box
ADDRESS ADDRESS
CITY �GL��l CITY
RESIDENCE PHONE - ZILlr -15F 16 BUSINESS PHONE (24 HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:.
ROOM USE: 1.99w
THERE IS A TWENTY-FIVE($25.00)DOLLAR FEE, PAYABLE BY CHECK OR MONEY
ORDER TO THE CITY OF SAIX ALT EPA TMENT THIS FEE IS PAYABLE AT THE
TIME OF INSPECTION.
APPLICANTS SIGNATUR DATE
,�4�
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION : d_ 6 u DATE OF REINSPECTION_.
DATE OF ISSUANCE OF CERTIFICATE. °DATE FEE PAID:
TYPE OF UNIT: DWELLINGOTHER_._ CHECK#LIJ 7 7 CHECK DATE f
NOTES:
CODE ENFORCEMENT INSPECTOR 9/28/98