CLAREMONT ROAD �coxon CITY OF SALEM, MASSACHUSETTS
6 BOARD OF HEALTH
3 0 120 WASHINGTON STREET, 4TH FLOOR
a SALEM, MA 01970 CERT.# 16-02FEE $25.00
TEL. 978-74 1-1 800
DATE: 01/09/2002
FAx 978-745-0343
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 4 Claremont Road UNIT #: 1
OWNER/AGENT: Mary Christopher
ADDRESS: 4 Locust Street
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-7062
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" .
1 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 OF HEALTH /
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
I
I
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL, 978-741-1800
a FAX 978-745-0343
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH 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".
T44 A4,
PROPERTY LOCATED AT —UNIT#-/
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNERfLESSERA4kjQ[(pj_S &�
'(6 - MANAGER/AGENT—
_P
No P.O. BoxNo P.O. Box
ADDRESS— -4 -7 —ADDRESS
CITY —CITY
RESIDENCE PHONE? _�� BUSINESS PHONE (24 HRS,)_
BUSINESS PHONE
TOTALNUMBER OF ROOMS: TALL
ROOM USE:
5.-
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.
SIGNATURE DATE /24-/_/7
APPLICANTS
$'ECTORS USE ONLY
DATE OF INITIAL INSPECTION DATE OF REINSPECTION____
DATE OF ISSUANCE OFCERTIFICATE:
!? -,2�DATE FEE PAIDJ_— (
TYPE OF UNIT: DWELLING—OTHER—, CHECK#_J_:5f CHECK DATE ,/,R ';2
NOTES:—
CODE ENFORCEMENT INSPECTOR 9/28198
•—r
h CITY OF SALEM, MASSACHUSETTS
HOARD OF HEALTH
• e, 120 WASHINGTON STREET, 4TH FLOOR
_ SALEM, MA 01970
TEL. 978-741-1800 -
- FAX 978-745-0343 '
STANLEY USOVICZ, JR. _JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
RELEASE
fn accordance with Massachusetts General Laws Chapter til ; Code of Massachusetts
R<!gulations 410.000 et. Seq. ; State Sanitary Code Chapter lI and Article XIII of
rhe City of Salem Ordinance, undersigned owner/lessor and tenant/lessee of a unit
of residential property, hereby authorize the Salem Board of Health or its author—
ized agents to inspect the residence identified below in accordance with the
aforementioned statutes, regulations and ordinances.
In the event it is necessary that said inspection be done in my/our absence, !/we
expressly authorize the same and for my/our successors and assigns hereby release
and discharge the City of Salem, Salem Board of Health and its authorized agents
j from any loss or injury sustained of whatever nature and description occasioned
by my/our absence during said inspection.
a/n FLocR —MA BCH Rzt$ 1 Dp tf�-_.__ —
TENAN 'lLESSE-' OWER/LESSOR.
Cr ��y�OAI f ib SAt�, S f SA1- M
170ItESSADDRESS
I
7 __ 446 _CGAWMoA)T A. S At_.F� r
AH?)RESS OF UNIT TOO ME IitSPECT D
otic----- -- _.�__
7 uAu T 1-ss&c
4 CtAREMOV f V)
�'�ORESS
CITY OF SALEM MASSACHUSETTS
6�`�`
�. BOARD OF HEALTH
'� 120 WASHINGTON STREET, ATH FLOOR
'< E CERT.# 19-03
a
SALEM, MAO 1970
TEL. 978-741-1800 FEE 01/13/
FAX 978-745-0343 DATE: Off 13/2003
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 6 Claremont Road UNIT #: 2
OWNER/AGENT: Mary Christopher
ADDRESS: 4 Locust Street
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-7062
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 OF HEALTH p
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
ecu CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH I
'i 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH 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".
�i
PROPERTY LOCATED AT CLARLMOVT N.D UNIT# 2-
IS
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER KWA CµR15TbP#61k MANAGER/AGENT
No P.O. Box No P.O. Box
ADDRESS 4 W WST- ST ADDRESS
CITY '54LE Al CITY 9/95
RESIDENCE PHONE 744_Z61 BUSINESS PHONE (24 HRS.)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: 7
ROOM USE: 1. ft R_ 2.80 R- 3. KITGNiiM 4, AtNiNG- 2
5.iJVW - 6.�7. PoRot�&Os Elia) U,j CK P6 IQ,-_Ic -o J�e N
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. , ,.J
APPLICANTS SIGNATURE G I'I(^"" �Dy DATE
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION 1 —( 3 —0 3 DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE / `/ -03 DATE FEE PAID: /— :2.— D �
TYPE OF UNIT: DWELLING OTHER_ CHECK 1 D 51 D CHECK DATE7 93
NOTES:
CODE ENFORCEMENT INSPECTOR 9/28/98