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CLIFTON AVENUE a _ 3 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Date: 09/12/95 Fax:(508)740-9705 Gerald & Claire Levesque 1 Clifton Avenue Salem, MA 01970 PROPERTY LOCATED AT 1 Clifton Avenue UNIT # lst Floor Dear Sir/Madam: It has come to our attention, that you may be considering renting a dwelling unit at the above address. It is incumbent upon you as owner(s) to contact the City of Salem Health Department to apply for a CERTIFICATE OF FITNESS before any vacant dwelling unit is rented or occupied, or to notify us of your intent for this unit. Each dwelling unit must be inspected and certified by the Salem Health Department prior to allowing occupancy in accordance with Chapter 111, Sections 127A and 127B, of the Massachusetts General Laws, 105 CMR 400.00; State Sanitary Code, Chapter 1: General Administrative Procedures and 105 CMR 410.000; State Sanitary Code, Chapter 11: Minimum Standards of Fitness for Human Habitation, and in accordance with Chapter 11, Article XIII of the City of Salem Code of Ordiances, Section 2-334, Certificate of Fitness. There is a twenty-five (25) dollar fee payable by check, or money order to the City of Salem Health Department. This fee is payable at the time of inspection. Inspection will not be performed without receipt of payment. Failure to comply with this procedure, will result in a fine of twenty (20) dollars per day for every day that the dwelling unit is occupied without approval of the Code Enforcement Division of the Salem Health Department. Contact this department within 24 hours of receipt of this notice. (508) 741-1800 Monday thru Wednesday from 8:00 a.m. - 4:00 p.m. Thursday 8:00 a.m. - 7 :00 p.m. or Friday 8:00 a.m. to noon to schedule an appointment for an inspection. SEE ENCLOSED SECTION 105 CMR 410.354 METERING OF GAS & ELECTRICITY. Very truly yours, FOR THE BOARD OF HEALTH REPLY TO i Joanne Scott, MPH,RS,CHO PABLO VALDEZ HEALTH AGENT CODE ENFORCEMENT INSPECTOR i 1 x CITY OF SALEM, MASSACHUSETTS IV BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR PublicHea ith Prevent.Promote.Protect. TEL. (978)741-1800 FAx(978) 745-0343 KIM13ERLEY DRISCOLL tramdinnsalein.com L.A RRY ILiMDIN,RS/RI:SFIS,CIiO,CP-I'S MAYOR f IVAIXI t AE;INT CERTIFICATE OF FITNESS CERTIFICATE#81-13 DATE ISSUED: 2/25/2013 Property Located at: 2 Clifton Avenue UNIT# 1R Owner/Agent: Rodney Maurice Address: 11 Appleton Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-314-9592 Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division3, 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. FOR THE BOARD OF HEALTH LA;QV RAMDIN A 21(i HEALTH AGENT PIAN 1 � 2 r, CITY OF SALEM MASSACHUSETTS BmRD OF HE.un-i 120 WASHINGTON STREET 4'P.FLOOR %blicHealth STREET, Prevont.Promote.Prol¢r. TEL. (978) 741-1800 FAx(978) 745-0343 IUMBLRLEY DRISCOLL Iramdin@salcm.com - LrAR721'IL\NIUIN,ILS/RG;HS,(1110,CP-IS MAYOR Hi-,Aun i A(xN'r - Application for Certificate of Fitness IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" C14 1J FEE: $50.00 PROPERTY LOCATED AT cZ C' S l 0 V -(fUNIT# �IS THIS UNIT DIISIGJNATED A IGHT EFr FRONT OR BACK PLEASE CIRCLE ONE OWNER/LESSER 1 o 64 &� / !4 uf�') c cf- MANAGER/AGENT - NO P.O. BOX / ADDRESS—// �/a o l �d� ADDRESS CITY, STATE,ZIPc�� 6%`i 7 d CITY, STATE,ZIP RESIDENCE PHON7 Q6-) -7 `/ — 2� /l/-3� BUSINESS PHONE(24HRS&7g BUSINESS PHONE TOTAL NUMBER OF ROOMS: 3 ROOM USE: 1. /t i 2.,R&Cd 40w� 3. iyl'hf k"t 4. 5. 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 PAYABLE AT THE TIME OF INSPECTION APPLICANT'S SIGNATURE DATES / Ins ectors use onl i Date on initial inspection: Date of reinspection: Date of issuance of certificate: -2 Z J� 1 3 Date fee paid: Type of unit: Dwelling ► ""' Other Check# 2 B r)3 Check date: 2- Notes: -Notes: Code Enforcement Inspector NDl� City of Salem, Massachusetts Board of Health 120 Washington Street, 4th Floor, Salem, PuIth MA 01970 Pr"ent.Promote. Proteet. Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, REHS, CHO Mayor health@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE #: GHL-16-442 DATE ISSUED: 11/10/2016 Property Located at: 2 CLIFTON AVENUE UNIT#2 Owner/Agent: Rodney Maurire Address: 11 Appleton Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(978)7442436 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. Jeff Larry Ramdin, MPH, REHS, CHO HEALTH AGENT SANITARIAN CITY OF SALEM, MASSACHUSF"TTS e BOARD OF HEALTH 120)VASHINGTON STREET,4'" FLOOR TEL. (978) 741-1.800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR LRAMD1N!>1SALFM.COn1 ^ LARRY RA.NfDrN,RS/REAS,CHO,CP-FS ^ I A,,^``1 0 Ma�6� v\k � HEALTH AGENT C ma 1 , l - ��l 111 h(Tt�¢i( , COQ Application for Certificate of Fitness IN ACCORDANCE WITH STATE SANITARY CODE, C14APTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" FEE: $50.1001^ PROPERTY LOCATED AT U*Z)V-) y�Y `'U� / UNIT#—Z SIS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE OWNERILESSER I lS�CJ V � < <�e MANAGER/AGENT NOP.O.BOX 401 ADDRESS ADDRESS ® CITY, STATE,ZIP �n �l I ` -?�CITY, STATE,ZIP jol RESIDENCE PHONE l ` BUSINESS PHONE (24HRS) BUSINESS PHONE 6 J/ r / L (rC TOTAL NUMBER OF ROOMS: /� /� ROOM USE: 1. Ci Yl:jA, 2. rt( �2w 3. P�0-tVE'1 4. Vim(00At 5. Xvofti 6. q;11 i�� 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 PAYABLE IT T E OF INSPECT N. APPLICANT'S SIGNATURE DATE 7 - Inspectors use only Date on initial inspection: Date of reinspection: Date of issuance of certificate- Date fee paid:l--Z/n7�? E Type of unit: Dwelling z Other Check ��heck date:-u-/oy2-,Q-t4 Notes: lf,z, 14 Code Enforcement Inspector City of Salem, Massachusetts Inspectional Services 120 Washington St,3rd Floor Salem,MA 01970 0 Tel.(978)745-9595 x5641 Fax.(978)740-9846 Kimberley Driscoll Thomas J. St. Mayor Inspection Report Pierre p p Director Address : 2 CLIFTON AVENUE Apt: Permit Number Inspection Type : Certificate of Fitness ( 11/7/2016 11:11:33 AM ) Inspector : Jeffrey Barosy Inspection Description Status Comment 410.482: Smoke Detectors and Carbon FAIL smoke detector in front hall leading to front door is broken. No Monoxide Alarms Carbon monoxide detector near upstairs bedroom. 410.500: Owners Responsibility to FAIL Living room window has front sash that does not stay up. Kitchen Maintain Structural Elements window has falling front and rear sash. Official Name: JBarosy v 1 geNDIT 6 n � ��/MIIVgYP CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH, RS,CHO NINE NORTH STREET HEALTH AGENT 06/24/99 Tel:(978)741-1800 Jon-Heath Realty Trust,, c/o Robert Roy, Jr. Fax:(978)740-9705 11 Appleton Street Salem, MA 01970 PROPERTY LOCATED AT 2 Clifton Avenue UNIT # 3 R1 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 thetenant 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. THE BOARD EA REPLY TO i nne Scott, MPH,RS,CHO PABLO VALDEZ Health Agent CODE ENFORCEMENT INSPECTOR ��OONUfT c & d CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO 120 Washington Street HEALTH AGENT Tel: (978) 741-1800 07/19/2001 Fax: (978)-745-0343 Louis Seibert 8 Clifton Avenue Salem, MA 01970 PROPERTY LOCATED AT 6 Clifton Avenue UNIT # 1 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 the 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 One Week 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. 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 eo exist. F04 THE BOARD OF41EALTH REPLY TO Joanne Scott, MPH,RS,CHO PABLO VALDEZ HEALTH AGENT CODE ENFORCEMENT INSPECTOR CERT.# 569-00 FEE $25.00 DATE: 08/31/2000 9g��MINE W 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: 11 Clifton Avenue UNIT #: 1 OWNER/AGENT: J. Richard Julien ADDRESS: 17 Clifton Avenue CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-2283 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 4:0 ANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR ��9 iCJV 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 Tel: (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 I I G L- / ErO N 19 (/G UNIT# IS THIS UNIT DESIGNATED AS RIGHT EFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER J7. 1Z/CKA-RO TUL/ENMANAGER/AGENT No P.O. Box No P.O. Box ADDRESS 17 C G l F7'-04/ Af-� ADDRESS CITY S'/�L M, /)V A- 0 (9/70 CITY RESIDENCE PHONE BUSINESS PHONE (24 HRS.) BUSINESS PHONE_ ) q `- 2 �' TOTAL NUMBER OF ROOMS: 6 ROOM USE: 1. K17-"K2. g61R^3. WA^ 4. 5. D f /V 6. 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 SIGNATURYINSPECTORS DATE 31O U ONLY DATE OF INITIAL INSPECTION _ 1 - 5 DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE:9 -31.&' DATE FEE PAID: R '3 - y 0 TYPE OF UNIT: DWELLING OTHER_ CHECK# �a�CHECK DATE 'f'O�fd� '- NOTES: `\ CODE ENFORCEMENT INSPECTOR 9/28/98 Y YM1 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 RELEASE In accordance with Massachusetts General Laws Chapter III ; Code of Massachusetts Regulations 410.000 et. seq. ; State Sanitary Code Chapter II and Article XIII of tiie C..ity 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 aforementi-orted statutes, regulations and ordinances. In the event it is necessary that said inspection be done in my/our absence , 1/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 meals from any loss or injury sustained of whatever nature and description occasioned by my/our- absence during said inspection. TENANT/LESSE U' NE- /LESSOR - --- ---- ADD 11�1,:S S 7 IJ"%_�_Lov l� - I/ Ci- / F-7-°N ff vG ADDRESS OF UNIT TO BE INSPECTED 0 D TE --- a -- City of Salem, Massachusetts Board of Health 120 Washington Street, 4th Floor, Salem, tth PPubliCHea MA 01970 e, Protect Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin,MPH, REHS,CHO Mayor Iramdin@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE#: GHL-15-341 DATE ISSUED: 10/19/2015 Property Located at: 13 CLIFTON AVENUE UNIT#1 Owner/Agent: John Spinale Address: 34 Bridge Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(976)745-1607 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. FOR THE BOARD OF HEALTH Larry Ramdin, MPH, REHS, CHO SANITARIAN HEALTH AGENT 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH / 120 WASHINGTON STREET,4"{FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR i R" AMn�iN @ 5&XM c M LARRY RAMIAN,RS/REVS,(:t 10,(T-FS HEA niAGENT 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 \ (ZS�C—Xll UNIT# IS THIS UNIT DISIGNATED AS RIG LEFTFR TVl OR BACK PLEASE CIRCLE ONE OWNERILESSER��yy Sn K C7 1 VRA. _ MANAGERI AGENT ADDRESSc(J}t 1M , �"�, ( ADDRESS CITY, STATE,ZIP �l 4 CTIY, STATE,ZIP RESIDENCE PHONE BUSINESS PHONE(24HRS) BUSINESS PHONE-71L `T" !'cti!/7 TOTAL NUMBER OF ROOMS:_ ROOM USE: 123 4 5 6. 7. 8. 9. 10. THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY �C,K OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH TRIS FEE IS DYABLE ATTIME Q SPECTION y. G APPLICANT'S SIGNATURE 1 <' A-- �C/ DATE Inspectors use only Date on initial inspection:10/1 t?h 1 S Date of reinspection: Date of issuance of certificate= 2-d�_ _ Date fee paid: 1&Z ZLS Type of unit: Dwelling Other Check#1r 2 _Check date: LO/ZY/201 S Notes: 1 4- !. foc.-Si'kiY ,0 4n Yw eni5cZ C Ilf eluent pector CITY OF SALEM, MASSACHUSETTS BOARD OF I-IraLTH 120 WASHINGTON STREET,4...FLOOR PubSCHealt i Prev"n t.Pr"m,rt<.rrmen. TEL. (978) 741-1800 Fax(978) 745-0343 KIMBERLEY DRISCOLL Iramdin((1),salem.com MAYOR LARRY Rr\6'IDIN,RS/RL?I-IS,CI 10,CP-ISS Hli;\j;n[i1GLiN'I' CERTIFICATE OF FITNESS CERTIFICATE#24414 DATE ISSUED: 7/15/2014 Property Located at: 13 Clifton Avenue UNIT#2 Owner/Agent: John Spinale Address: 34 Bridge Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-740-1605 Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division3, 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. ^ ;FB ARD O EALTH /••/• LARRY RAMDIN ~k�C HEALTH AGENT SANITARIAN CITY OF SALEM, MASSACHUSETTS BOARD OF HE-1LTH IiCHei�th 120 WASHINGTON STREET,4" FLOOR Prove",Promote.Protect. TEL. (978)741-1800 FAX(978)745-0343 KIMBERLEY DRISCOLL lramdin@salem.com MAYOR LARRY li;\1vIDIN,RS/RI:IIS,CIIO,CP-FS Hi,,m xFI AG ENT 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: $50.00 PROPERTY LOCATED T# 2— IS IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE OWNER/LESSER ;;%7 MANAGER/AGENT NO P.O.BOX ADDRESS 7 S70it/C S 7.- ADDRESS CITY, STATE,ZII' �AO/9/5' CITY, STATE,ZIP RESIDENCE PHONE C 9 f 9 2 9— '2 —90 BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: d ROOM USE: 1. /</;e-.✓Gw 2. Ai.wi v< 3. L/vim vF 4. Afr� 5. G'G---A 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 PAYABLE AT THE TIME OF IINSPPEECTION APPLICANT'S SIGNATUREj� Gi'�i�'�— _DATE—? rr Inspectors use only Date on initial inspection: 1 Iiq Date of reinspection: Date of issuance of certificate: Date fee paid: / Type of unit: Dwelling Other Check# Jg� Check date: Notes: Co&"f cement Inspector CITY OF SALEM, MASSACHUSETI'S BOARD OF HEALTH 120 WASHINGTON STREET 4t°FLOOR PablicHeatth o Prevent.Promote.Protect. TEL. (978)741-1800 FAX(978) 745-0343 KIMBERLEY DRISCOLL lramdin@salem.com MAYOR LARRY RAMDIN,RS/RI?HS,(110,Cl'-I'S Hi.;m:rH AGEN'r CERTIFICATE OF FITNESS CERTIFICATE#008-14 DATE ISSUED: 1/14/2014 Property Located at: 13 Clifton Avenue UNIT#3 Owner/Agent: John Spinale Address: 34 Bridge Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division3, 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. FOR THE ARD HEALTH LARRY RAMDIN HEALTH AGENT SANITARIAN • s CITY OF SALEM, lY1ASSACHUSETrs BOARD OF HEALTH 120 WASHINGTON STREET,4m FLOOR Prevent.Pmmato.anter. TEL: (078)741-1800 FAX(978)745-0343 KIMBERLEY DRISCOLL k=din@salem.com MAYOR LAR1tY RAbIDIN,R.S/KERS,CRO,CP-I�S 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" ��pj t FEE:.$50.00 PROPERTY LOCATED AT L i 9—� UNIT# IS THIS UNrr DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE OWNER/LESSER o vl t , � �l A Q2 MANAGER/AGENT NO P.O. BOX ADDRESS ) _^ 211(( D ADDRESS CITY,.STATE,ZIP 9C&Oq,V \� CITY, STATE,ZIP p� RESIDENCE PHONE BUSINESS PHONE(24HRS) `7 n,ZO ` 2�-���r�9D r BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1. 2. 3. 4. 5. 6. L 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 FFE PAYABLE AT=F INSPECTION APPLICANT'S SIGNATURE DATE / Lectors use only . Date on initial inspection: I y') Date of reinspection: Date of issuance of certificate: 1`1�I l� C Date fee paid: ) `NN Type of unit: DwellinP ✓ Other Check# �I'�).l' Check date: /'i N 14 Notes: Code Enforcement Inspector CITY OF SALEM, MASSACHUSETTS • r • BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGRU'LN[1AUM�SN.EM.COM DAVID GREENBAUM ACTING HE"v 1.,TI-1 A(;FN'r CERTIFICATE OF FITNESS CERTIFICATE # 122-10 DATE ISSUED: 3/18/2010 Property Located at: 15 Clifton Avenue UNIT#2 Owner/Agent: John Spinale Address: 34 Bridge Street CityfTown: Salem, MA Zip Code: 01970 24 Hour Phone: 745-1607 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 D V1�/vv,,/I� 3REENBA M ACTING HEALTH AGENT CODE E F CEMENT INSPECTOR /12a0 CITY OF SALEM, MASSACHUSETTS j + BOARD OF HEALTH 120 WASHINGTON STREET,4`"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGREENBAUM&ALEM.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." C-,11WN FEE: $50.00 PROPERTY LOCATED AT UNIT#,t _ IS THIS UNIT DISIGNATkWAS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE OWNER/LESSER )y im 'S7%-vl&A5 MANAGER/AGENT NOP.O. BOX 2 ADDRESS *'/ T A(jja'T— 5-r- ADDRESS CITY, STATE,ZIP % yk CITY, STATE,ZIP IKQ— RESIDENCE PHONE BUSINESS PHONE(24HRS) BUSINESS PHONE t. TOTAL NUMBEROF ROOMS:_ ^� ROOM USE: I.? 2. �� 3. �. �� 4. 7 5. 6. 7. 8. 9. 10. THERE IS A FIFTY{$50)11�6LLAR EFEF E,'PAYABLeETIM OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTIQHIS FEE ISP AB F SPECTION APPLICANT'S SIGNATURE DATE (� Inspectors use only Date on initial inspection: 3 /I I to Date of reinspection: Date of issuance of certificate: 3 deg O Date fee paid:�JLSIlO Type of unit: Dwelling �er Check# 7 a G N Check date: 3 /r /0 Notes: Code E ore ment Inspector ' v��CONOiT�i CERT.# 119-99 53 FEE $25.00 DATE: 03/10/99 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: 15 Clifton Avenue UNIT #: 3-2nd Floor OWNER/AGENT: JDS Realty Trust ADDRESS: 34 Bridge Street CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-1607 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 HEALTH DEPARTMENT 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 0 / 11� I- Q VOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR • �pONU1T .. i Ale3 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 it 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABIT TION". PROPERTYLOCATED AT U IT IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE `_` C 4 OWNER/LESSER V _MANAGER/AGENT L Yt No P.O. Box a No P.O. Box / ADDRESS Y` ADDRESS /nCI l4 11r S _I . CITY ZCITY RESIDENCE PHONE_ ) BUSINESS PHONE (24 HRS.)-_�Z� �C�� t6D r// BUSINESS PHONE 6'0 TOTAL NUMBER OF ROOMS: r ROOM USE: 1. 2._ 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 DEPART NT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. APPLICANTS SIGNATURE DATE J INSPECTOR SE ONLY DATE OF INITIAL INSPECTION -/0 Y DATE OF REINSPECTION DATE OF ISSUANCE OF C/E/RTIFICATE: �1 DATE FEE PAID: 3 — 10 TYPE OF UNIT: DWELLINq�—OTHER__ CHECK#—Z SCHECK DATE _S —�b y NOTES: /\ CODE ENFORCEMENT INSPECTOR 9/28/98 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT 02/22/99 Tel: (978)741-1800 JDS Realty Trust c/o John Spinale Fav (978)740-9705 71 Columbus Avenue Salem, MA 01970 PROPERTY LOCATED AT 15 Clifton Avenue UNIT # 3R 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 . P Y 4 9FO THE BOARD OF HEALTH REPLY TO anne Scott, MPH,RS, CHO PABLO VALDEZ Health Agent CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS o BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 "0NB TEL. 978-741-1800 FAx 978-745-0343 W W W.SALEM.COM Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO Mayor HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#301-06 DATE ISSUED: 6/26/2006 Property Located at: 28 Clifton Avenue UNIT# Owner/Agent: North Shore Heritage Assoc. Address: 64 Holton Street City/Town: Danvers, MA Zip Code: 01923 24 Hour Phone: 978-762-4878 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 / / J ANNE SCOTT,JqAMPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • 120 WASHINGTON STREET, 4TH FLOOR a SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO Kimberley Driscoll HEALTH AGENT Mayor 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 08 Mgyn &e, c'iuhm /+14 UNIT#_ IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSERNorfll shot / 4kdGER/AGENTALdrA S" occ J�C�,7 9tf � No P.O. BoxNo P.O. Box ADDRESS 6,/ �l©lffn S�. n/tr5 ADDRESS -- 71,4 0192-3 CITY �/�14e,15 .cam .144 ON?- RESIDENCE PHONE 178F -7`'10VUSINESS PHONE (24 HRS.) Q '16 4?'7 V BUSINESS PHONE qr/? 762 '10'7k' TOTAL NUMBER OF ROOMS: ROOM USE: 1. 2. 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 _DATE INSPECTORS USE ONLY DATE OF INITIAL INSPECTION �l'— CI ' L� DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: r -0-6 DATE FEE PAID:�7 (9 6 TYPE OF UNIT: DWELLING; OTHER_ CHECK#; D R%3 CHECK DATE- NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 x_ CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • • 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT Kimberley Driscoll Mayor RELEASE In accordance with Massachusetts General Laws Chapter III ; Code of Massachusetts R. !gulations 4 ;0.000 et . seq . ; State Sanitary Code Chapter 1.I and Article XIII of Che 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 agent.s to inspect the residence identified below in accordance with the aforementioned statutes, regulations and ordinances. I'n the event it is necessary that said inspection be done in my/our absence , i_ /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 agc_-s .`.roni any loss or injury sustained of whatever nature am description occasiouea by my/cur absence during said i.nspecti.cc . TSNANT/LESSEE O'r'NER/i,E S SOR- ADD:iESS ADDRI'SS 11.i)11Rr:SS or UNIT TO 1sT: r�<sh�:cTED !Ilea 0 ZH15 I Tenant Certification Form Required Federal Lead Warning Statement Housing built before 1978 may contain lead-based paint. Lead from paint, paint chips,and dust can pose health hazards if not managed properly. Lead exposure is especially harmful to young children and pregnant women. Before renting pre-1978 housing,lessors must disclose the presence of known lead-based paint and/or lead-based paint hazards in the dwelling. Lessees must also receive a federally approved pamphlet on lead poisoning prevention. The Massachusetts Tenant Lead Law Notification and Certification Form is for compliance with state and federal lead notification requirements. Owner's Disclosure (a) Presence of lead-based paint and/or lead-based paint hazards(check(i)or(ii) below): (i)_Known lead-based paint and/or lead-based paint hazards are present in the housing(explain). (ii)_Owner/Lessor has no knowledge of lead-based paint and/or lead-based paint hazards in the housing. (b) Records and reports available to the owner/lessor(Check (i)or(ii)below): (i) Owner/Lessor has provided the tenant with all available records and reports pertaining to lead -based paint and/or lead-based paint hazards in the housing(circle documents below). Lead Inspection Report; Risk Assessment Report; Letter of Interim Control; Letter of Compliance (ii)13�0_Owner/Lessor has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in the housing. Tenant's Acknowledgment(initial) (� ant has received copies of all documents circled above. (d) Tenant has received no documents listed above. (e)WV9`ant has received the Massachusetts Tenant Lead Law Notification. Agent's Acknowledgment(initial) (()_Agent has informed the owner/lessor of the owner's/lessor's obligations under federal and state lav for lead-based paint disclosure and notification and is aware of his/her responsibility to ensure compliance. Certification of Accuracy The following parties have reviewed the information above and certify, to the best of their knowledge, that the information they have provided is true and accurate. W( (+k Shore Owner/Lessor --T Date Avner/Lessor �. D to Al2Tenant Date enan�� `'b`'ate� Agent Date Agent Date Owner/Managing Agent Information for Tenant (Please Print): Name Street Apt. City/town Zip Telephone _ "o agent) certify that I provided the l cnsmt 1-cad I.aw Notification/l errant Certification I-Orin and anv existing Lead Law documents to the tenant, but the tenant refusecl to siert this certification- The tenant gave the following re:+son:_ I he Massachusctus Lcad pmhihuu rcnr.+l di",r imination_ inclu•1in._ [rlusinn, to rent to f,unilic, with children or evictinst Lunilics with children because of lead paint. Cuntaa the Childhood Lead Poisoning Pn:VCn11011 Prugrani fur infonn:rtiun un th: :rvailabiliry of thu f�xm in Other languapcs. Tenant and owner most each keep a completed mid signed copy of Ihis Ibrni, c:A%,pi0VIcad199Wonns\clp9s-I l.wp PC,. 5/9H home is checked for the most serious lead hazards,which must be fixed right away.The risk assessor would give the landlord and you a written report of the areas with too much lead and the serious lead hazards. Lead inspectors and risk assessors have been trained, licensed by the Department of Public Health, and have experience using the state-approved methods for testing for lead paint. These methods are use of a sodium sulfide solution,a portable x-ray fluorescence machine or lab tests of paint samples. You can get a list of licensed lead inspectors and risk assessors from CLPPP. In Massachusetts,what must the owner of a home built before 1978 do if a child under six years old lives there? An owner of a home in Massachusetts built before 1978 must have the home inspected for lead if a child under six years old lives there. If lead hazards are found,the home must be deleaded or brought under interim control- Only a licensed deleader may do high-risk deleading work, such as removing lead paint or repairing chipping and peeling lead paint.You can get a list of licensed deleaders from the state Department of Labor and Workforce Development. Deleaders are trained to use safe methods to prepare to work, do the deleading- and clean up. Either a deleader, the owner or someone who works for the owner who is not a licensed deleader can do certain other deleading and interim control work. Owners and workers must have special training to perform the deieading tasks they may do. After the work is done,the lead inspector or risk assessor checks the home. lie or she may take dust samples to test for lead. to make sure the home has been properly cleaned up. If everything is fine. he or she gives the owner a Letter of Compliance or Letter of Interim Control. After getting one of these letters. the owner must take care of the home and make sure there is no peeling paint. What is a Letter of Compliance? It is a legal letter under state law that says either that there are no lead paint hazards or that the home has been deleaded. The letter is signed and dated by a licensed lead inspector, What is a Letter of Interim Control? It is a legal letter under state law that sans work necessary to make the home temporarily safe from serious lead hazards has been done. The letter is signed and dated by a licensed risk assessor It is hood for one year, but can be rcnewcd for another year. The owncr must fully delcad the home and get a Letter of l.;ompliance before the end of the second year_ r Where can I learn more about lead poisoning? Massachusetts Dcpanment of Public Health Your loc:O IcCad poisoning,prevention program Childhood Lead Poisoning Prevention Program (CLPPP) or your local Board of Health (I or more copic, of this form. as %cell as a full ranee of 1110 nation nn :,id pois�rzun_ prevention- tcnam> iiLhts U.� Consumer Product Saien- Coil till is,ion and responsihilitit:s under the NIA Lead L:tr�. hors. to (Inlormation ahout Iead in consumer products) clean lead dt;st anti chips, hcalthv foods to protect your 1-806-638-2772 childreu. Gu.rnei:d IwIp ti>i =xr'tt is. Die delcadmn� altd renovation worl:. :rnd soil testing.} U.S. Lnvironmental Protection Agency, Region I 017-751'-MOO, (Information about federal laws on cad) 6I 7-56S-3)4=() iMw,sachuscirs OcImitrilclifrefLah,rr :11x1 `,V'orktolcc National Lcarl Information Center List of (iccn;cd rlckarf r'rti) Fulcra) Veal poisoning information) 617-x169-71 '17- 11) �-Howl I-4O0-1.1.AI)TY1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH s 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll www.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#303-06 DATE ISSUED: 6/26/2006 Property Located at: 28 Clifton Avenue UNIT# Owner/Agent: North Shore Heritage Assoc. Address: 64 Holton Street City/Town: Danvers, MA Zip Code: 01923 24 Hour Phone: 978-762-4878 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 ll" 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. FO THE BOARD OF HEALTH r JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR Jun ,-07 06 11 : 45a Joanne Scott Salem BOH 878 745 0343 p. 2 CITY OF SALEM, MASSACHUSETT'S BOARD OF HEALTH • • 120 WASHINGTON STREET, 4TH FLOOR D SALEM, MA 01970 TEL. 978-741-1 600 FAX 978.745.0343 JOANNE. SCOTT, MPH, RS, CHO Kimberley Driscoll HEALTH AGENT Mayor 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 'fie( +un UNIT n______ IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER" Shore 'SPrj fat 992CMANAGER/AGENT __..._ No P.O. Box No P.O.Box ADDRESS.64 6 14r„ S�.�c n ADDRESS CITY_ �Ic132�-- RESIDENCE PHONEg1$ 791 05-7q-BUSINESS PHONE (24 HRS.)�'ti ro 17&21(gT!� BUSINESS PHON093 rlloQ- TOTAL NUMBER OF ROOMS: ROOM USE: 1......._.._-.--2.— 3. 4.__._.,.. .. 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 SIGNATUR ., TE_SGOZ 9 O Nflf INSPECTORS USE ONLY PATE OF INITIAL IN;PECTION {(j//= DATE OF REINSPECTION . ..._ DATE OF ISSUANCE OF CERTIFICATEC.1/J w-6,DATE FEE PAID: TYPE OF UNIT: DWELLING_OTHER___ CHECK fl /L(3CHECK DATE e/ .7 � NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 Jun 07 06 11 : 46a Joanne Scott Salem BOH 978 745 0343 p. 3 CITY OF SALEM, MASSACHUSETTS '� BOARD OF HEALTH • • 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-t BOO FAX 976-745-0343 JOANNE SCOTT, MPH, RS, CHO Kimberley Driscoll HEALTH AGENT Mayor RELEASE In accordance with MassaehuseCts General LawS Chapter II1 ; Code of Mnss»rhnanrrq Rr;gulationS 410.000 ec . Seq StaLe Sanitary Code Chapter lI and Article XIII of ( hc I;ity of Salem 0rditiarlce, undersigned owner/lessor and CenanL/lessen. Of a unit. propnrty, 11,2t',?by nilthori7r , hr Snlr-m Ilnr.rd of llvAlfh or itc -cthcr i.zed agent.S to inspect the resi.dertce identified below i.n aCCordance wiI-h Lhe a:oremcntioncd statutC+S, rQ gularious and ordinances, I.'.1 LI-nt UVCnL it i5 nCCC::;ulry Lhal Said be done in Iny/pOr dllaenCQ , 1/WV exprresely 'W1.1102-470 Lhe s,me and for my/Our successors ai;d a5si,};ns hcl:r,by :eLx�ae �!IIi diSeharSv [he Ci,-y ar Sa1enl, 5:.1nm 1>onru of Nnaj Cll ::nd i(g nuthorixnd .. ... :'o''I all}' :.055 JI i.u)uCv S':.stincd nI. 4'i CiLPvi1' nature an9 description eCCa:e i.i,itC ri b'J my/r,ur abseucrr ;luri:lg Said insnecl-iar, . JUN 0 6 rOnC �TeJer._ . 00 +o.rN Ake— Ll NDI{en S .�J)anve(6 C1V� ..... Saler MA DI4t�a p8 (% L,.n . rn Nth .lien .07 06 11 : 46a Joanne Scott Salem HCH 978 745 0343 p. 7 Tenant Certification Form Required Federal Lead Warning Statement Housing built before 1978 may contain lead-based paint. Lead from paint,paint chips,and dust can pose health hazards if not managed properly. Lead exposure is especially harmful to young children and pregnant women. Before renting pre-1978 housing,lessors must disclose the presence of known lead-based paint andtor lead-based paint hazards in the dwelling.Lessees must also receive a federally approved pamphlet on lead poisoning prevention. The Massachusetts Tenant Lead Law Nod fication and Certification Form is for compliance with state and federal lead notification requirements. Owner's Disclosure (a) Presence of lead-based paint and/or lead-based paint hazards(check(i)or(ii) below) (i)—known lead-based paint and/or lead-based paint hazards are present in the housing(explain). (ii)_,Owner/Lessor has no knowledge of lead-based paint and/or lead-based paint hazards in the housing. (b) Records and reports available to the ownerAessor(Check (i)or(ii)below); (i)_Owned Lessor has provided the tenant with all available records and reports pertaining.Ir,lead -based paint and/or lead-based paint hazards in the housing(circle documents below). Lead Inspection Report; Risk Assessment Report; Lencr of Interim Control; Letter of Compliance (iiUwner/Lesscr has no reports of Ick-oids pertaining to lead-based paint and/or lead-based paint hazard's in the housing. Truant's ACkuowledrmcrlt(initial) (c) Tenant has received copies of all document's circled above. (d). _._, Tenam has recctved no documents listed:bovc. (e)�enant has received the Massachusetts I enam Lcad I..aw Noul`rcanon, Agent's Acknowledgment(initial) (1)_Agent has infot'mcd the ownirrtlessor of the awuet'sAessor's obligations under federal and state late f'oi lead-ba.gcd paint discloswc cold notification and is aware of 1119/Iter respolvability tit cnOUle camlpllttncc Certification of Accuracy 'I he following parries hla,•e ucvicwcd Inc intoe nralnln almvr G11c1 velvfs•, tic the be.sl of their knowlod:,c. that the information the.• have provided is true: :u,d accurate JUN X06 OwnerIessor Dale Owner/Lessor Tall' (� 0S lar:r+rt D alr Il`IICIIII I)a Al:.cnt Dirk: Agcnl Date Owucr/Managin;;Agu•ut Information for*1 enact (Fica,e Yrint): Name iucrl Ait1 (ltyli own /it' elephollt' i IokV Ilk!flo t tM1')n",;111l'Iit)CcIIIIV that 1 pit lv It lull tilt' I1IIltit 1 r,u1 I .tar ids llll,.:1 I olv Ivi;IfIt i t'Ili tl 111tII1 1'4 ritt atId:nli I'.\Iit I l l!,. Lcad I.:nv(loci)Ilwim to thr w000l. hill Ir wmIIn tri li'.k'II Ill ,tl•I II11•. le It It .It I uu I It: wilmil Stavt' 11w tollmvinr+ It X,00 .. Ilr :U.rr,erhll•.rll, I.I-.til I as Inahtigl. rel.:! II1 ,IuuII1.d I,.II In,Iu. llll' I•"ltr.11r_111will I" I:nnllw,with,1111&cm9 Cvit Ilu., I.umlw"tvlill rinld+rn ixx au^,c of Irad isnill ( ,IIII(It'I (hr (allid1lood I.tatl P(ll",II III II', ISIorill wlI I'llIlk r;III I I'll ulhll 111111,111 till Illi'.I,,:ohl lullA 411111'. 1%itIII III otho hit I',UP:',,•" Truant amt uwuctuntil cr Nl I.I•I•p it c0111:01-Wd :nnl 1]2114'11 rapt al (hrs luno lap 01,-:let l4vSyta ur?.e.tt i"t',.I ; +,Il Ker- Ml,