DERBY SQUARE CERT.# 798-96
FEE $25.00
1j 1�lF
DATE: 11/07/96
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
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 5 Derby Square UNIT #: 3
OWNER/AGENT: Michael J. O'Neill
ADDRESS: 5 Derby Square #3
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-7929
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 CZAR 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 THE BOARD OF HEALTH
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
s
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970.3928
JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT Tei:(508)741-1800
APPLICATION FOR CERTIFICTE OF FITNESS Fax:(508)740-9705
IN ACCORDANCE WITH STATE SANITARY'CODE, .CRAPTER II, 105 CMR 410.000 "MINIMUM
STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT �' �%�c1/ t� �c _UNIT I
OWNER/LESSER / C 4A L G. o/I/Ej[L MANAGER/AGENT
ADDRESS 5 72>e`,C B_V ir°!,'�L' ✓ ADDRESS
CITY �i L,01" CITY
RESIDENCE PHONE ,= ll ''/1111- g BUSINESS PHONE (24 HRS.)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. at'D20da12, lDiQ6D/(3./
5. 6. 7. 8.
THERE IS A TWENTY-FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE
CITY OF SALEH'HEALTR DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION
APPLICANTS SIGNATURE '�%? lC� DATE
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION: � � DAME OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: /f ,7� DATE FEE PAID:
TYPE OF UNIT: DWELLING OTHER ✓ 7
NOTES:
CODE ENFORCEMENT INSPECTOR
IMPORTANT MESSAGE"'
FOR - L
DATE - TIME SS P.M.
M
OF
PHONE
AREA CODE NUMBER EXIUSION
TELEPHONED PLEASE GALL
CAME TO SEE YOU WILL GALL AGAIN
WANTS TO SEE YOU RUSH T.
RETURNED YOUR CALL SPECIAL ATTENTION
MESSAGE
f F
fre �
SIGNED_
LITHO IN US.A
.BAS6CS,. 71100
F R
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970
JOANNE SCOTT,MPH,RS.CHO NINE NORTH STREET
HEALTH AGENT Tel:(508)741-1800
Date: July 28, 1994 Fax:(508)740-9705
B&M Realty Trust
R.E. Gauthier-E.J. Murphy JR TRS
130 Boston Street 7q4- 7(W
Salem, MA 01970
PROPERTY LOCATED AT . 5 Derby Square UNIT# 4
Dear Sir/Madam:
It has come to our attention, that you are about to allow rental of 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.
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 1276, of the Massachusetts General Laws, 105 CMR 400.000:
State Sanitary Code, Chapter 1: General Administrative Procedures and 105 CMR 410.000: Stale Sanitary Code,
Chapter 11: Minimum Standards of Fitness for Human Habitation, and in accordance with Chapter II, Article XIII
of the City of Salem Code of Ordinances, 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:
x x_ r.. .tth MPH,RS,CHO PABLO VALDEZ
,YEALTH AGENT CODE ENFORCEMENT INSPECTOR