CLEVELAND STREET CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR CERT.# 238-03
SALEM, MA 01970 FEE $25.00
TEL. 978-741-1800 DATE: 05/27/2003
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 5 Cleveland Street UNIT #: 2
OWNER/AGENT: Craig & Lauren Piper
ADDRESS: 5 Cleveland Street #1
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 740-0273
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 NOR BUILDING RELATED CODES. FOR MORE
INFORMATION CALL 978-741-1800.
OR THE BOARD'e/��H
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS -2
0BOARD OF HEALTH
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 FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT 56YVX�WIIIA 677/r_ _ UNIT N
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT AC PLEASE CIRCLE ONE
OWNER/LESSEF/;&&F1V (y/Ii /�%7� MANAGER/AGENT .
No P.O. Box No P.O. Box
ADDRESS_j "6h 2Wa9M A6DRESS
r
CITY CITY
RESIDENCE PHONE 2Z�-70 67'/� BUSINESS PHONE (24 HRS.),
BUSINESS PHONE-
TOTAL NUMBER OF ROOMS: 3
ROOM USE: 1
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 DATE.�J o2
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION-f-,)7 3 DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE 2 3 DATE FEE PAID:
TYPE OF UNIT: DWELLING, OTHER_ CHECK N %/ CHECK DATES 3 7 03
i
NOTES:
CODE ENFORCEMENT INSPECTOR 9/28/98
i
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4".FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR DGRETNBAUM2SALE COM
DAVID GREGNBAUM
ACTING HFALTI-I AGF,N'P
CERTIFICATE OF FITNESS
CERTIFICATE#412-09
DATE ISSUED: 8/26/2009
Property Located at: 7 Cleveland Street UNIT#
Owner/Agent: Kevin Hyde
Address: 3 Autumn View
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:
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.
FOR THE BOARD OF HEALTH
I
DA IV D GREENBAUM
ACTING HEALTH AGENT CODE 17
EMENT INSPECTOR
CITY1 OF SALEM, MASSACHUSETTS Y)�-�
BOARD OF HEALTH
120 WASHINGTON STREET,4".FLOOR
TEL,. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR COM
DAVID GREENBAUM,
ACTING 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."
1 _ FEE: $50.00
PROPERTY LOCATED AT C l�ye14 4 S7—
UNIT#
fIIS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER MANAGER/AGENT
NO P.O. BOX
ADDRESS ADDRESS
CITY, STATE,ZII—I IQ ���CITY, STATE, ZIP
RESIDENCE PHONE u l BUSINESS PHONE(24HRS)
BUSINESS PHONE l nj
TOTAL NUMBER OF ROOMS:_
ROOM USE: 1. Lill _ ��,r,, 3. 13z 4. 132(1. 5 pec
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 IS� THE TIME OF INSPECTION
APPLICANT'S SIGNATURE DATE_s7�
I
Inspectors use only p C
Date on initial inspection: �� / ct Date of reinspection: U /a
/G/
Date of issuance of certificate: I�j LP G l Date fee paid: /4
Type of unit: Dwelling-�,Z—OtherCh k-* / Check date:
Notes: 1 n Ck 6n b(44h. iA,1nrkw . jaw in 6je ),G
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14mi-�v komkq At,
Code Enforcemeri pet rr
CITY OF SALEM, MASSACHUSETTS
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1'I.1 (974)741-11,00
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