CONNERS ROAD City of Salem, Massachusetts
a Board of Health
>s�� •4 120 Washington Street, 4th Floor, Salem, PubliCHealth
R D�
MA01970 Pcavam. Pl.mo11. PYM,e ,.
Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, RENS,CHO
Mayor Iramdin@salem.com Health Agent
CERTIFICATE OF FITNESS
CERTIFICATE #: GHL-15-380
DATE ISSUED: 11113/2015
Property Located at: 10 CONNERS ROAD UNIT#
Owner/Agent: Michael Lowe
Address: 49 Dearborn Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(978)979-9924
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 Cade 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
0,
Larry Ramdin, MPH, REHS, CHO
HEALTH AGENT SANITARIAN
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4"°FLOOR
TEL. (978) 741-1800
KIMBERL.EY DRISCOLL FAX(978)745-0343
MAYOR LRAhIDIN@SALEM.COM
LARRY RAMDIN,RS/REHS,CHO,CP-FS
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"
FEE: $50.00
PROPERTY LOCATED AT S le-19 `9 b UNIT#
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER /h a E Lo cc9 C MANAGER/AGENT
NO P.O.BOX
ADDRESS ADDRESS
CITY, STATE,ZIP S� E m m o 9 7 CITY, STATE, ZIP
RESIDENCE PHONE 97 7 9 – 9 9 2-4-/ BUSINESS PHONE(24HRS)
BUSINESS PHONE '� -7 8 – 7�4r–S 3 1 L
TOTAL NUMBER OF ROOMS:
ROOM USE: 1.k1ruaE aJ 2. 1-/A/ :AJ6 413. Dg J 4. BEbl2b') 5. -4
6. 8ED400M 7. 00>Rsoo7 8. %z /547-H 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 A��/ T THE TIME OF INSPECTION
APPLICANT'S SIGNATURE /h—,I ,/(01� DATE /d - /o– /S
Inspectors use only
Date on initial inspection: Date of reinspection:
Date of issuance of certificate:' 1 Date fee paid: 11 J 2 D.1-S
Type of unit: Dwellin r Other Check# I{30 6 Check date: D/�Ql2Q 1
Notes: Ct �aCJ�o cQ
Coe fo ement In ector
Inspection of Ljh a- ji Date 1.1-1 W1,2- lrTime
NameII Address 10 � nn IC
De -S' o�.
Owner_ M 11C W Love, Tel. No. _1 7X— g71—pT72V
Type of Inspection_Cer-}li-if,+e, of F7,'+na5 Inspector .J2f f2V p"&Cy
( ' ) Remarks and Violations are listed below:
- _1s-i Fl.�nr
LIVi?ln I/ODWI w�doNy f xV'AAS YAM &oil+ dor' IS ➢niccl la srxeeii
RR II CC 0.,C. II I/ ln/ �Yf1
° ✓0.T�r'O(7wI 0.S wrin�oW wf�'h ryf lSS lrl�a / dem Y (ha r 2 /S/J
from bCIna oOenNA, r�yne, Wlm k", 5, Gn\z,-.., l 1�j r('r
° ( a Ae,ln, nttnws above— 91"nk avr b04 rtilJssrn eenS, _
—2R�,�L Floor,
' vQf ��n�ow ccs �OV'n Sc✓%v_v
° B2 rr)on on I Y �n11Oi10.S a t wk
e.&-e. J r Leii hJpl/ wl A l+I r Ssrrvl��
SQC_I'e.��. /__ I 1 1 ./
° 8aror)m , oml ✓' I'qw 6"Ien iarr r� �nArooa,�S Jyi,kldow WA 40P-n
SGYerer) r' r ✓ r' r
° Bjd b l r,OYn 4 f4 K 11AA LAI c inr h ea � .b2jf n .
r
r
Report Received by: