CHURCHILL STREET [;oND
a City of Salem, Massachusetts
th
I � a
Board of Health
120 Washington Street, 4th Floor, Salem, PubaiCBB
MA 01970 Prevent.Promole. Protect.
Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, RENS, CHO
Mayor health@salem.com Health Agent
CERTIFICATE OF FITNESS
CERTIFICATE#: GHL-16-326
DATE ISSUED: 8/30/2016
Property Located at: 12 CHURCHILL STREET UNIT#1
Owner/Agent: John Trethaway
Address: 573 Cabot Street
City/Town: Beverly, MA Zip Code: 01915 24 Hour Phone:(617) 875.0882
Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division 3, Section 705: Certificate of fitness of
rented dwelling unit, apartment or tenement. An inspection of your vacant Dwelling/Rooming Unit at the above address has
been approved and is in compliance with 105 CMR 410.000: Massachusetts State Sanitary Code, Chapter II "Minimum
Standards of Fitness for Human Habitation".
Therefore, this Certificate is issued by the Code Enforcement Division of the Salem Board of Health and the unit may now
be rented and/or occupied.
Maximum Number of occupants, must comply with 105 CMR 410.000.
Certificate valid for one year from date of issuance or until the current tenant vacates, whichever is later.
This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy.
Note: This approval does not certify compliance with the state lead law for occupants under 6 years of age.
1; 4s ,�
Larry Ramdin, MPH, REHS, CHO
HEALTH AGENT SANITARIA
CITY OF SAL1E,M. MASSACHUSETTS
BOARD OF HE-ATs TH
120 WASHINGTON STREET,4'"FLOOR
TEL. (978) 741-1800
KIMBERI EY DRISCOL1, FAX(978) 745-0343
MAYOR LIL9bn)INQSALE.%1.COM
LARRY RAMDIN,RS/RENS,CHO,CP-FS
HLAL'm AGENT
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE,CHAPTER 11, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION"
FEE: $550. /00
PROPERTY LOCATED AT A A Y l/ , )-4-. UrIT#
IS TRIS IJIVIT DISIGr4XTED AS RIG Imo' LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER MANAGER/AGENT '¢6
NO P.O.BOX
ADDRESS l a ADDRESS
CITY, STATE,ZIP CITY, STATE,ZIP �j
RESIDENCE PHONE BUSINESS PHONE(24HRS)
BUSINESS PHONE L0 -L— �-
TOTAL NUMBER OF ROOMS:_ 9
ROOM USE: 1. 2. 3. Z:�
6. 7. 8. 9. 10.
THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE PAYABLE AT P4JE TIME OF INSPECTION ( /
APPLICANT'S SIGNATURE DATE d" D c�
Inspectors use only
Date on initial inspection: ZS f 2 E Date of reinspection:
Date of issuance of certificate- 2 sl2-019 Date fee paid:0WAV)aL 6
Type of unit: DwellinOther Check# Check date: OX/?Ohne
Notes: )4m e w 6LL1f I�c�3� G q� as ori Ke,,
Mllrceme5p6ector
,ONDIT
y! '° CERT.# 266-99
3, FEE $25.00
DATE: 05/27/99
�IMINB
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: 16 Churchill Street _ UNIT #: House
OWNER/AGENT: Phoenix Real Estate Trust c/o Thomas Bubier
ADDRESS: 36 Wolf Hill Road
CITY/TOWN: Gloucester, MA ZIP CODE: 01930 24 HOUR PHONE: 283-8853
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 BOARD OOFHEALTH p
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
�yeq�me
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 Tee (978)741-1800
Fax:(978)740-9705
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT 16 C.4mre4i/I �K UNIT#�v52
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER-7 f ` 7_v`0 MANAGER/AGENT �
No P.O. Box a No P.O. Box
ADDRESS 5e' ADDRESS
3 (, 0001- t1 i L L �fl�
CITY �liZlJyiceyrr�� /1`4 Oly3o CITY
RESIDENCE PHONE97�-d3- �'3BUSINESS PHONE (24 HRS.)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: Iq
ROOM USE: 1At"Ll 2_4 21"1 3. / 4.
5. 6.-7.-8.
THERE IS A TWENTY-FIVE($25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY
ORDER TO THE CITY OF SALEM HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE
TIME OF INSPECTION. / /
APPLICANTS SIGNATURE A 4746 - 7 DATE 7
INSPECTORS �ONNLLYY
DATE OF INITIAL INSPECTION DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATES 'a '�C� DATE FEE PAID: 3 7 -f
TYPE OF UNIT: DWELLINGOTHER_ CHECK#_CHECK DATE��77
NOTES:
CODE ENFORCEMENT INSPECTOR 9/28/98
v��CONDIT '
5j 3 l h
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT 03/24/99 Tel: (978)741-1800
Bank of New York Fax:(978)740-9705
101 Barclay Street
New York, NY 10007
PROPERTY LOCATED AT 16 Churchill Street UNIT # House
Dear Sir/Madam:
It has come to our attention, that you may be considering renting a dwelling unit
at the above address.
In accordance with Chapter 11, Article XIII of the City of Salem Code of
Ordinances, Section 2-334,titled "Certificate of Fitness," each dwelling unit must be
inspected and certified prior to allowing occupancy. The inspection will be conducted
in accordance with 105 CMR; State Sanitary Code, Chapter I: General Administrative
Procedures and 105 CMR 410.000; State Sanitary Code, Chapter II: Minimum Standards of
Fitness for Human Habitation.
Please notify us if you do not intend to rent the unit.
Please contact this department within 24 hours of receipt of this notice at
978-741-1800, to schedule an appointment for an inspection. Our office hours are Monday
thru Wednesday from 8:00 a.m. - 4:00 p.m. Thursday 8:00 a.m. - 7:00 p.m. and Friday 8:00
a.m. - 4:00 p.m.
Failure to comply with this procedure, may result in a fine of Twenty (20) dollars
per day for every day that the dwelling unit is occupied without a Certificate of
Fitness. -
A $25.00 check payable to the City of Salem is required for each unit inspected at the
time of inspection.
A property owner is required to pay gas and electricity for residential tenants if there
is not a written letting agreement stating the tenant is responsible for those
utilities and if the meter(s) records electricity and gas use which is not used
. ' exclusively by that tenant. The. Department of Public Utilities. has billed property
owners for their tenants' entire utility bil-Is retroactive to the date of initial
occupancy in cases in which cross-metering has been proven to exist.
R THE BOARD - REPLY TO
Joanne Scott, MPH,RS,CHO PABLO VALDEZ
Health Agent CODE ENFORCEMENT INSPECTOR