KOSCUISKO STREET (02) E. o CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
3 120 WASHINGTON STREET, 4TH FLOOR
� SALEM, MA 01970 CERT.# 283-02FEE $25.00
TEL. 978-741-1800
FAX 978-745-0343 DATE: 05/31/2002
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 13 Kosciusko Street UNIT #: House
OWNER/AGENT: John Sarno
ADDRESS: 24 Valley Field Street
CITY/TOWN: Lexington, MA ZIP CODE: 02421 24 HOUR PHONE: 861-6554
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.
O��ARD O HEALTH D�� /70
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
f
' CITY OF SALEM, MASSACHUSETTS
o
BOARD OF HEALTH
3
L 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 Ii, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNES�/SS FOR HUMAN HABITATION".
PROPERTY LOCATED AT 1-3 IL Lasc/usc, _�7L UNIT# / �� louse)
!S TH!S UNIT DESIGN..T 'D EEAS RIGHT LEFT FRONT BACK PLEi,SCIRCLE ONE \
OWNER/LESSER-J70& 14A21V0 MANAGER/AGENT
No P.O. Box I r / / No P.O. Box
ADDRESS o2f VLlLLPADDRESS
CITY CITY MASS.
RESIDENCE PHONE BUSINESS PHONE (24 HRS.)
BUSINESS PHONEro/7- 367- a3-�2,3
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. 2. 3. 4.
5. B.—T-8.
THERE IS A TWENTY-FIVE($25.00) DOLLAR F YABLE BY CHECK OR MONEY
ORDER TO THE CITY OF SALEM HEAL PAR ENT THIS FEE IS PAYABLE AT THE
TIME OF INSPECTION.
APPLICANTS SIGNATURE DATE S SF—Oz'
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION Sr- 3 )— v DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE:'3 1— O ` DATE FEE PAID: s '3 ! �O z-
TYPE OF UNIT: DWELLING,�OTHER_ CHECK# 01 ��� CHECK DATE / D '—
NOTES:
CODE ENFORCEMENT INSPECTOR 9/28/98
.ca CITY OF SALEM, MASSACHUSETTS
�. '� BOARD OF HEALTH
3 ® 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
s - '
��'
TEL. 978-741-1800
FAX 978-745-0343
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
05/06/2002
John Sarno
24 Valley Field Street
Lexington, MA 02421
PROPERTY LOCATED AT 13 Kosciusko Street UNIT #
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 bills retroactive to the date of initial
occupancy in cases in which cross-metering has been proven to exist.
R THE BOARD O HEALTH REPLY TO
oanne Sco MPH,RO PABLO VALDEZ
Health Agent CODE ENFORCEMENT INSPECTOR
I