DERBY STREET 136-r
-sumo,
CERT.# 175-00
FEE $25 .00
DATE: 03/08/2000
71 r.
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: 136 Derby Street UNIT #: 1
OWNER/AGENT: Vanda Kohn
ADDRESS: 138 Derby Street
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-2829
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 A
JOANNE SCOTT, MPH,RS,CHO -
HEALTH AGENT - CODE ENFORCEMENT INSPECTOR
61)
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
Fav(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_/ 3 6, ✓G Y S7 UNIT#_1
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSERJ]A h•�?g &g 9jiJ MANAGER/AGENT
No P.O. Box No P.O.Box
ADDRESS-_Z_3_9 _vim- �( 51 - ADDRESS_
CITY -2 O CITY
7,
RESIDENCE PHONE BUSINESS PHONE(24 HRS.)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. /G 2. L 3. _�4.
5. 6. 7. $.
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-315 ��
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION � Sl� U� _DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE:`,S'Y-Q DATE FEE PAID: `; - 5- 0 O
TYPE OF UNIT: DWELLING OTHER CHECK# a 94 a CHECK DATE, 3' T--_(5�__��,,. -¢ ,
CODE ENFORCEMENT INSPECTOR 9/28/98
CERT.# 144-96
FEE $25.00
1�� SIF DATE: 03/12/96
MING
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: 136 1/2 Derby Street' UNIT #: 2
OWNER/AGENT: Thaddeus & Vanda Kohn
ADDRESS: 138 Derby Street
CITY/TOWN: Salem, MA. ZIP CODE: 01970 24 HOUR PHONE: 933-7347
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) : ROOMINGUNIT
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 7
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT,MPH,RS,CHO
HEALTH AGENT NINE NORTH STREET
TH:-(506)7419800
APPLICATION FOR CERTIFICTE OF FITNESS Fax:(508)740-9705
IN ACCORDANCE WITH STATE SANITARY'CODE, -CHAPTER II, 105 CMR 4 10.000 "MINIMUM
STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATEDA MT /
OWNER/LESSER !'MINE} 1\® M&NAGER/AGENT
ADDRESS
JW ADDRET
CITY CITY
RESIDENCE PHONE 1 `jam �o�� " " BUSINESS PHONE (24 HRS.) tp 3?j J 7
BUSINESS PHONE
TOTAL NUMBER OF /ROOMS:
3 t �1�
ROOM USE: 1. LVb IN^� 2.�3. /LO0 4• -?{
5. b. 7. 8.
THERE IS A TWENTY-FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE
CITY OF SALEM'BEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION
APPLICANTS SIGNATURE ✓U G} Y t ?o � -�rr(� DATE_ 3 M61
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION: —j Z 6 DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: DATE FEE PAID:
TYPE OF UNIT: DWELLING x OTHER
NOTES: J—'
CODE ENFORCEMENT INSPECTOR
r Y 6
3 gj
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: 08/09/95 Fax:(508)740-9705
Thaddeus & Vanda Kohn
138 Derby Street
Salem, MA 01970
PROPERTY LOCATED AT 136 1/2 Derby Street UNIT # 2
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.
SFE ENCLOSED SECTION 105 CMR 410.354 METERING OF GAS & ELECTRICITY
Very truly yours,
FE BOARD OF A TH REPLY TO
Joanne Scott, MPH,RS,CHO PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
_ _ ♦ CO. ..
r t CERT) 398-94
a � FEE: ..$ 95.0(1
DATE:
S/Q/94
CITY OF SALEM HEALTH DEPARTMENT
BOARD OF HEALTH
Salem, Massachusetts 01970
4 NORTH STREET
508.741-1800 - -
CERTIFICATE OF FITNESS
. PROPERTY LOCATED AT 136, Derby Street UNIT # 2
OWNER/AGENT Vanda Kahn
ADDRESS 138 Derby Street
CITY/TOWN Salem, MA ZIP CODE 01970 24 HOUR PHONE 516-933-7347
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 THE BOARD OF HEALTH
Aw 4 1 La,
CODE ENFORCEMENT INSPEOTOR
HEALTH AGENT
`'r OFFICH USE ONLY
. i
CERT',.—i
s
DATE:
CITY OF SALEM HEALTH DEPARTMENT
BOARD OF HEALTH
Salem, Massachusetts 01470
ii08ER*-E,86ENKHORFI
HEALTH AGENT - 9 NORTH STREET .
. � -: .._ '.. �. - - - ::-'
50e7e11800 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 L ' UNIT #
OWNER/LESSER ` KQ MANAGERjAGENT - - - r Jf{fZ
ADDRESS 13 _k ADORESS ern E
JkE
_ r
CITYI- .. a PITY K 'Y Lam. , '!
RESIDMI PHONE BUSINESS PHONE (24 HRS.) ,33
,. x ;
"; BIISIHESS: ONE �r� --._
TOTAL NUMBER OF ROOMS: �?
ROOM USE: 1.L441IIJ► 2. ✓ empom 4.
5. 6. 7. 8.
THERE IS A.TRENTY FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK OR HONEY ORDER TO THE
_CITY OF SAUX HEALTH DEPARTMENT UPON COMPLIANCE AND ISSUANCE OF CERTIFICATE.
APPLICANTS SIGNATURE C �/ / �. ,r�1 DATE
rI SPECTORS USE ONLY
DATE OF INITIAL INSPECTION: J DATE .OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: r(� DATE FEE PAID: 'GJ
TYPE OF UNIT: DWELLING OTHER_
NOTES:
CODE ENFORCEMENT INSPECTOR
}
A.
'CITY'OF :SALEM t HEALTH�DEPARTM EHT
`BOARD(OF pHEALTH
'Salem, lMassachusetts01970
'ROBERT E.BLENKHORN• - - 9 NORTH STREET
11JEALTH AGENT
SM-741-181100 .,....-, "4f?;i roi t'zY:.. ... ,.. � . r,.
DATE: Nom• I I�I�13 ._ r
Tt-���� Val•,�a,_ Kol-il-,
� -. . �.
PROPERTY LOCATED.AT --_I3L. 12.- -- -$F UNIT 0 -2—
DEAR-
DEAR SIR/MADAM:,,,,... ._'
It has come to-our atteation, that-you are about to allow rental of "a dwelling unit
at the above address:"'""
It is incumbent upon you aswowner(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. r, :•..
Each dwelling unit must be'iaspected-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 400.000: State Sanitary Code; Chapter I:
General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chap-
ter II: 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,
Certificates of Fitness.
There is a twenty-five (25) dollar fee payable by check, or money order to the City
of Salem Health Department upon issuance of Certificate.
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 8a.m. - 4p.m. , Thursday 8a.m. - 7p.m. , or Friday 8a.m. to
noon to schedule an appointment for an inspection.
SEE ENCLOSED SECTION 105 CMB 410.354 METERING OF GAS & ELECTRICITY
Very t4tiy'yours,
FOR THE BOARD OF HEALTH REPLY TO:
,00
Robert E. Blenkhorn, C.H.O.
Health Agent Code Enforcement Inspector
CERT.# 271-95
a s FEE $25.00
DATE: 05/08/95
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: 137 Derby Street UNIT #: 1
OWNER/AGENT: Robert A. Dana
ADDRESS: P.O- Box 1225
CITY/TOWN: Marblehead, MA ZIP CODE: 01945 24 HOUR PHONE: 639-8425
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.
OR THE BOARDO HEALTH
V
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
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, CHAPTER II, 105 CMR 4 10.000 "MINIMUM
STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT " > 7 tt?a`I ST. UNIT I
OWNER/LESSERA MANAGER/AGENT
ADDRESS ADDRESS
CITY 14RBuftbz ,� r P A Dia±vim. CITY —
RESIDENCE PHONE . "I - �r� — � Z� BUSIHESS'PHONE (24 HRS.)
BUSINESS
TOTAL NUMBER OF ROOMS: _ I�
ROOM USE: ). pgooN 2.� . 3._�..L �4
7. 8.
THERE IS A TWENTY-FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY •ORDER TO THE
CITY OF SAIMr HEALTH D 2 THIS FEE ISP LE AT THE TIME OF INSPECTION
APPLICANTS SIGNATURE j. DATE
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION: �/ J DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: Sf' J— DATE FEE PAID: % f"
TYPE OF UNIT: DWELLING OTHER
NOTES:
CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
3 m 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#344-07
DATE ISSUED: 7/31/2007
Property Located at: 137 Derby Street UNIT#2
Owner/Agent: D & P Properties, Inc.
Address: 63 Peach Highlands
City/Town: Marblehead, MA Zip Code: 01945 24 Hour Phone: 639-8113
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.
FOR THE BOARD OF HEALTH f
il 4,..
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
— CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
• 120 WASHINGTON STREET, 4TH FLOOR 1
ILI SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0943
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 !aLEFT
UNIT#�IS THIS UNIT DESIGNATED AS IR GHFRO Tf BACK PLEASE CIRCLE ONE / G`6
OWNER/LESSER_� �C-5 _MANAGERfAGENT�Yr��FdxcS �<K�
No P.O. Box No P.O. Box
ADDRESSG3_' Tc�ea 1l ADDRESS '� �
CITY
RESIDENCE PHONE / BUSINESS PHONE (24 FIRS)����'�1L�
BUSINESS PHONE 1_`/ �,S->5/
TOTAL NUMBER OF ROOMS _
ROOM USE:
THERE IS A TWENTY-FIVE(525.00) 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 SIGNATU �� —DATE_ �/
NSI PECTOFS USE ONLY
DATE OF INITIAL INSPECTION = 'J 7 .DATE OF REINSPECTION__
DATE OF ISSUANCE OF CERTIFICATE7., 'o2_DATE FEE PAID:_ =-3-L;9_-7
TYPE OF UNIT: DWELLING OTHERCHECK# � GHECK DATE_ i L.—
NOTES:_._.
CODE ENFORCEMENT INSPECTOR 9/28/98
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
June 11, 2003
Robert Dana
P.O. Box 1225
Marblehead, MA 01945
PROPERTY LOCATED 137 Derby Street Unit#3
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 1: General Administrative Procedures and 105 CMR 410.000; State
Sanitary Code, Chapter 11: 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 ($20.00) dollars per day for
every day that the dwelling unit is occupied without a Certificate of Fitness.
A$25.00 check payable to the City of Salem is required for each unit inspected at the time of
inspection.
A property owner is required to pay gas and electricity for residential tenants if there is not a written letting
agreement stating the tenant is responsible for those utilities and if the meter(s) records electricity and
gas use which is not used exclusively by that tenant. The Department of Public Utilities has billed
property owners for their tenants' entire utility bills retroactive to the date of initial occupancy in cases in
which cross-metering has been proven to exist.
For the Board of Health Reply to
Joanne Scott MPH, RS, CHO Pablo Valdez
Health Agent Code Enforcement Inspector
CERT.# 191-94
@
FEE: ..$ 25.00 ..
a
DATE: 3/24/94
CITY OF SALEM HEALTH DEPARTMENT
BOARD OF HEALTH
Salem, Massachusetts 01970
9 NORTH STREET
508-741-1800
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT 137 Derby Street UNIT # 3
OWNER/AGENT Estate of Thaddeus Wlodyka
ADDRESS 6 Jenness Street
CITY/TOWN Beverly, MA ZIP CODE 01915 24 HOUR PHONE 922-3660
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 THE BOARD OF HEALTH
CODE ENFORCEMENT INSPE OR
ACTING HEALTH AGENT
7"- • e�,, OFFICE USE ONLY
a
CERT.—I
,o,.,M,M"� DATE:CITY OF SALEM HEAH DEPARI
t�
BOARD OF HEALTH � �99G
Salem, Massachusetts 01970
N
ORTH sTREEL._
Roac-RAE. AENICHORN' >Tu
HEALTH AGENT �!�rxv SAL-- '
508-741-1800 APPLICATION FOR CERTIFICATE OF FITNiAALTH DEPTr
IN ACCORDANCE WITH STATE SANITARY CODE, ,CHAPTER II, 105 CMR 410.000 "MINIMUM
STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT 137 Derby StreetT #
OWNER/LESSEREstate of .Thaddeus Wlodyka MANAGER/AGENT Robert Picone
ADDRESS 6 Jenness Street ADDRESS 6 Jenness Street
CITY Beverly, MA 01915 CITY Beverly, MA 01915 _
RESIDENCE PHONE 922=3.660 BUSINESS PHONE (24 HRS.) None
BUSINESS PHONE None —
TOTAL NUMBER OF ROOMS:
ROOM USE: 1 . Kitchen 2, Den 3.Living RM 4. Bedroom
5. Bedroom 6. Bathroom 7. 8.
THERE IS A TWENTY—FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE
CITY OF SALEM HEALTH DEPARTMENT UPON COMPLIANCE AND ISSUANCE OF CERTIFICATE.
APPLICANTS SIGNATURE. Robert Picone DATE 3/21 /94
INSPECTORS USE ONLY
DATE OF. INITIAL INSPECTION: DATE ,OF REINSPECTIONi
DATE OF ISSUANCE OF CERTIFICATE:73, 111'�' DATE FEE PAID:
TYPE OF UNIT: DWELLING OTHER
NOTES:
C0,09- ENFORCEMENT INSPE OR
COl y,l
3a ,
CITY OF SALEM HEALTH DEPARTMENT
BOARD OF HEALTH
Salem, Massachusetts 01970
ROBERT E. BLENKHORN 9 NORTH STREET
HEALTH AGENT
508-741-1000
DATE: March 8, 1994
Thaddeus G. Wlodyka F:
c/o R6bert Picone
6 Jenness Street
Beverly MA 01915
PROPERTY LOCATED AT—] 37 Derby Srraar UNIT 11 I
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 127B,
of. the Massachusetts General Laws, 105 CMR 400.000: State Sanitary Code, Chapter I:
General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chap-
ter II: 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 upon issuance of Certificate.
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 8a.m. - 4p.m. , Thursday 8a.m. - 7p.m. , or Friday 8a.m. to
noon to schedule an appointment for an inspection.
SEE ENCLOSED SECTION 105 CMR 410.354 METERING OF GAS 6 ELECTRICITY
Very duly yours,
FORTHE BOARD OF /HEALTH REPLY TO:
QD
Robert E. Blenkhorn, C.H.O. PABLO VALDEZ
Health Agent Code Enforcement Inspector
l
- CO.W,��
CITY OF SALEM HEALTH DEPARTMENT
BOARD OF HEALTH .
Salem, Massachusetts 01970
ROBERT E. BLENKHORN 9 NORTH STREET
HEALTH AGENT
508-741-1800
DATE: June 8, 1992
Thaddeus G. Wlodyka
137 Derby Street
Salem, MA 01970
PROPERTY LOCATED AT 137 Derby Street UNIT A 3
DEAR.SIR/MADAM:
Ithiscome 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 127B,
of. the Massachusetts General Laws, 105 CMR 400.000: State Sanitary Code, Chapter I:
General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chap-
ter 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 upon issuance of Certificate.
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 8a.m. - 4 .m. Thursday 8a.m. - 7p.m. , or Friday 8a.m. to
noon to schedule an appointment for an inspection.
SEE ENCLOSED SECTION 105 CHR 410.354 METERING OF GAS & ELECTRICITY
Very nrulI yours,
FOR THE BOARD OF HEALTH REPLY TO:
E
Robert E. Blenkhorn, C.H.O. Pablo Valdez
Health Agent Code Enforcement Inspector
,� ry
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: 07/28/97 Fax:(508)740-9705
James & Claire Bailey
P.O. Box 3062
Salem, MA 01970
PROPERTY LOCATED AT 140 Derby Street UNIT # 1
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.
SFE ENCLOSED SECTION 105 CMR 410 .354 METERING OF GAS & ELECTRICITY.
Very truly yours,
FOR THE BOARD OF HEALTH REPLY TO
Joanne Scott, MPH,RS,CHO PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
w
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„W
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: 06/12/97 Fax:(508)740-9705
James & Claire Bailey
P.O. Box 3062
Salem, MA 01970
PROPERTY LOCATED AT 140 Derby Street UNIT # 1
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
Joanne Scott, MPH,RS,CHO PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
I.
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3
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INK
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: 10/30/95
Fax:(508)740-9705
James & Claire Bailey
P.O. Box 3062
Salem, MA 01970
PROPERTY LOCATED AT 140 Derby Street UNIT # 1
Dear Sir/Madam:
It has come to our attention, that you may be considering renting a dwelling unit
at the above address. r
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
Mondav 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,
F0�RD OF HEALTH REPLY TO
Joanne Scott, MPH,RS,CHO PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
I
In CERT.# 870-96
FEE 25.00
1
DATE: 12/16/96
Vary._fig
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetis 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: 149DerbyStreet UNIT #: B
OWNER/AGENT: Margaret From
ADDRESS: 6 Xos6iusko Street
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-6313'
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 THE BOARD OF HEALTH
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
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 CERTIFTCTE OF FITNESS Fax:(508)740-9705
IN ACCORDANCE WITH STATE SANITARY CODE, .CHAPTER II, 105 CMR 4 10.000 "MINIMUM
STANDARDS OF FITNESS FOR HUMAN HABITATION"-
PROPERTY LOCATED AT I tft UNIT #-_L�_
OWNER/LESSER , _= MANAGER/AGENT
ADDRESS ADDRESS
CITY ,� d/1� o / C/ {j CITY
RESIDENCE PHONE : ;-o 8 7 Y V(/1 .3 J BUSINESS PHONE (24 HRS.)
BUSINESS PHONE —
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 TIM OF INSPECTION
APPLICANTS SIGNATIIRE GJ� /IOYk DATE_ A- G
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION: f Itst DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE:41 16 DATE FEE PAID: G,Z %�
TYPE OF UNIT: DWELLING OTHER_
NOTES:
CODE ENFORCEMENT INSPECTOR
1a /'F 9i
CITY OF SALEM BOARD OF HEALTH
Salem, Massachuse8s 01.970-3928
JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT Tel:(508)741-1800
Date: 11/21/96 - Fax:(508)740-9705
Richard & Margaret Krom
6 Kosciusko Street -
Salem, MA 01970
PROPERTY LOCATED AT 149 Derby Street UNIT # B
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, lll, 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 3.1, 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
Joanne Scott, MPH,RS,CHO PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR -
CERT.# 997-94 ,
FEE $25.00
R DATE: 11/29/94
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: 149 Derby Street UNIT #: B
OWNER/AGENT: Richard Krom
ADDRESS: 6 Kosciusko Street
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-6313
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.
gFO
THE BOARD OF HEALTH
V
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
OFFICE US�EE OO/NLLYY�/
CERT,.
a
"�'p,wwea
DATE:
CITY OF SALEM HEALTH DEPARTMENT
BOARD OF HEALTH
Salem, Massachusetts 01970
9 NORTH STREEE
soe-gat-teoo APPLICATION FOR CERTIFICATE OF FITNESS
IN ACCORDANCE WITH STATE SANITARYCODE, CHAPTER II , 105 CMR 410.000 "MINIMUM
STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED
AT �79 �IeQ�/���_ liJ� UNIT # _
OWNER/LESSER 'r1mlYll MANAGER/AGENT
ADDRESS (01!�n.sh7/sVi .r)�" ADDRESS
CITY <5002-pi7 j7'11//T CITY
RESIDENCE PHONE 7 H r{!/� BUSINESS PHONE (24 HRS.)
BUSINESS PHONE —
TOTAL NUMBER OF ROOMS: d�
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 UPON COMPLIANCE AND ISSUANCE OF CERTIFICATE.
APPLICANTS SIGNATURE DATE
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION: DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: DATE FEE PAID:
TYPE OF UNIT: DWELLING OTHER
NOTES:
CODE ENFORCEMENT INSPECTOR
CERT.# 1020-94
3 - FEE $25.00
DATE: 12/05/94
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: 149 Derby Street UNIT #: C
OWNER/AGENT: Harbor Realty
ADDRESS: 111 Derby Street
CITY/TOWN: Salem- MA ZIP CODE: 01970 24 HOUR PHONE: 744-3778
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 NOWBERENTED 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 THE BOARD OF HEALTH
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
w OFFICE USE ONLY
w�jly. P CERT: # (}
'MIPB
DATE:
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970.3928
JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT "` Tei:(508)741-1 B00
APPLICATION FOR CERTIFICATE OF FITNESS Fax:(508)740-9705
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM
STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT UNIT # �
OWNER/LESSER MANAGER/AGENT
ADDRESS ADDRESSjr� t�
CITY { CITY ,
RESIDENCE PHONE 7 ` Q �j BUSINESS PHONE (24
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: 1
ROOM USE: I . _ 2. �_3. 4 .
S. 5. 7. —8.—
THERE
.THERE IS A TWENTY—FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK. OR MONEY ORDER TO THE
CITY OF SALEM HEALTH DEPAR UPON CO IANCE AND ISSUANCE OF CEjRTIFICATE.
APPLICANTS STNAT DATE )� _
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION:1 — `i t DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE:j DATE FEE PAID:i��
TYPE OF UNIT: DWELLING OTHER_
NOTES:
CODE ENFORCEMENT INSPECTOR
,J
CERT.# 820-94
3 FEE $25.00
4 fi
��l apt DATE: 09/21/94
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: 149 Derby Street UNIT #: C
OWNER/AGENT: Robert Maaro
ADDRESS: 37 Karolyn Circle
CITY/TOWN: Nahant, MA ZIP CODE: 01908 24 HOUR PHONE: 596-8789
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 THE BOARD OF HEALTH
v
E� d
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
OFFICE USL ONLY
CER' . i
s '
DATE:
CITY Of SALEM HEALTH DEPARTMENT
BOARD OF HEALTH
Salem, Massachusetts 01970
4JoBERFE.-8"NR44ORN- 9 NORTH STREET
HEALTH AGENT ,
548.741.1800 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� ��/ 7— UNIT # ' (2 .
OWNER/LESSER 00—C 2T /nd(5:Ofb MANAGER/AGENT
ADDRESS 3 7 i6moLy.v C)OCI L E ADDRESS
CITYCITY
RESIDENCE PHONE zoom 7 BUSINESS PHONE (24 HRS.)
BUSINESS PHONE s`4 & 7`KI—
TOTAL NUMBER OF�ROOMS:
�p
ROOM USE: 1 ���T —2 5
xO�f .. 3.
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 UPON COMPLIANCE AND ISSUANCE OF CERTIFICATE.
APPLICANTS SIGNATURE
INSPECTOR�Sy USE ONLY
DATE OF INITIAL INSPECTION: i DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: , DATE FEE PAID:
TYPE OF UNIT: DWELLING_ OTHER
NOTES:
CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
• '� BOARD OF HEALTH
\ 120 WASHINGTON STREET,4".FLOOR
TEL. (978) 741-1800
IQMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR D(;RFE.NBAUM@SA1EM, .Conn
DAVID GRu'.FNIMUM
ACTING HIr.Ai-n-I.AGI:
?NT
CERTIFICATE OF FITNESS
CERTIFICATE #387-09
DATE ISSUED: 8/14/2009
Property Located at: 149 Derby Street UNIT#D
Owner/Agent: Harbor Rental &Realty-John Twomey
Address: 111 Derby Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-852-0650
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
AVD IDGREENB ,M
ACTING HEALTH AGENT COD NF RCEMENT INSPECTOR
t f..
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH � fl,.��
120 WASHINGTON STREET, 4TH FLOOR t
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 li, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT jqq 92fhl UNIT#_D
IS THIS UNIT DESIGNATED AS RIGHT WFT K PEASE
E CIRCLE ONE l L
OWNERILESSER _—MANAGER/AGENTLIA� wL-J_#
No P.O. Box No P.O. Box
ADDRESS --ADDRESS-
C1
ADDRESSCITY CITY cJQ lY�
RESIDENCE PHONE /� BUSINESS PHONE (24 HRS.) 54 06 50
BUSINESS PHONE /- IJ3'99
TOTAL NUMBER OF ROOMS:�
ROOM USE: 1L !JM 2. 3.__ 4.
THERE IS A TWENTY-FIVE($25.00) DOLLAR FEE,PAYABLE BY CHECK OR MONEY
ORDER TO THE CITYOF SALEM H A TH DEP NT THIS FEE IS PAYABLE AT THE
TIME OF INSPECTION. �/ c�
APPLICANTS SIGNATURE _DATE f r (`
SPC Ojr
)TAT OF INITIAL INSPECTION 6l1� DATE OF REINSPECTION_��
DATE OF ISSUANCE OF CERTIFICATE:4 /V DATE FFEE PAID:_ g//��
TYPE OF UNIT: DWELLINGOTHER_._ CHECK# L°�`CHECK DATE
IvoTEs: r�p IGGvI�,.SfiU ue.. ,
CODE E�NFORCEME2NSP COR 9/28/98
CERT.# 808-95
/ ° s FEE $25.00
3 �1lP DATE: 10/25/95
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: 149 Derby Street UNIT #: F
OWNER/AGENT: Bruce Fallette v
ADDRESS: 2 Venice Street
CITY/TOWN: Danvers MA ZIP CODE: 01923 24 HOUR PHONE: 777-6191
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 THE BOARD
O/FHEALTH
.
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
4 RD p2gyrD
OCT 4 1995
CITY OF SALEM BOARD OF HEALTH CITY O=SgLER,1
Salem, Massachusetts 01970-3928 HEAL I`"GI=�'
i
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, CHAPTER II, 105 CMR 4 10.000 "MINIMUM
STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT (?'� UNIT /
OWNER/LESSER.� � MANAGER/AGENT
ADDRESS 71�e�n1cQ ,�y ADDRESS
CITY�)o m -V��.^�^� ( ( CITY
.-RESIDENCE PHONE
{( t i il-LOI� (;(� BUSINESS PHONE (24 HRS.) —
BUSINESS PHONE \00 —
TOTAL NUMBER OF ROOMS: j
ROOM USE: l. � 4 . �(U
5. 6. 7. 8.
THERE IS A TWENTY-FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE
CITY OF SALEM'BEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTIONS
APPLICANTS SIGNATURE !!'` "7 .. DATE /C/ 3 S it
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION:(? '1 DATE OF REINSPECTION /
DATE OF ISSUANCE OF CERTIFICATE: DATE FEE PAID: / l�
TYPE OF UNIT: DWELLING OTHER
NOTES:
CODE ENFORCEMENT INSPECTOR
p b
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: 09/27/95 Fax:(508)740-9705
Bruce & Salvatore Fallette
9 Collins Street
Danvers, MA 01923
PROPERTY LOCATED AT 149 Derby Street UNIT # F
Dear Sir/Madam:
It has come to our attention, that you may be considering renting a dwelling unit
at the above address. r
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
Joanne Scott, MPH,RS,CHO PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
I .
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
s 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
Fax 978-745-0343
www.SALEM.COM
Kimberley Driscoll
Mayor JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#260-06
DATE ISSUED: 5/24/2006
Property Located at: 149 Derby Street UNIT#G
Owner/Agent: Jim Sullivan
Address: 168 E. Woodcrest Drive
City/Town: Melrose, MA Zip Code: 02176 24 Hour Phone: 781-301-1594
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 If'
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!=
OANN< MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
_ . "CM OF SAZ.EWR; 1CHUSLT'rS
DOMO OF HEALTH
r.. Ito VYASHIHCTON STREET'.4TH FLOOR
SAL614. MA 01970 Y//0-07`
TEL.979-7411-11800
FAX 979-74541949 .
STANLEY USOV4C2.JR. JOANNE SCOTT, MPH. RS. CHO
MAYOR HEALTH AGENT
APPLICATION FOR CERTIFICATE OF FITNESS
IN ACCORDANCE WITH STATE SANITARY CODE.CHAPTER II, 145 CMR 410.400
'MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION'_
PROPERTY LOCATED AT ---t1NIT k j.�
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER y-�}[lT MANAGER/AGENT--,--
No
ANAGERIAGENTJ ,"_No P.O. Box No P.Q.Box
ADDRESS
169- i &-7ADDRESS _.
_CITY.—, 7. �
RESIDENCE PHONE;�; BUSINESS PHONE (24 HRS)-7? /
BUSINESS PHONE
TOTAL N1JM8ER OF ROOIviS._Z-/_
ROOM USE 1.1) YiA; 1"Z2.KrTC
THERE IS A TWENTY-FIVE ("$25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY
ORDER TO THE CITY OF SALEM HEALTH DEPAR AM1F T THIS FEI- IS PAYABLE AT THE
TIME OF INSPECTION.
APPLICANTS SIGNATURE --- — DATE
N-SPECI ODS U-S-E ONLY
(LAJE OFINITIAL INSPI-Cl IQNl -12-7
123 DAT(_ Of- 17k.iPISPI:CI ION
OAT4 OF ISSIHANCE 01 CG4il'14 it:nli S-� ,3 �� bili�i1 I IJ i'i�II7 r)- 3 t O
l-YPi C?i- UN11
fJoi I ';
� ;i 1111 i{ { IdV " riis:I tali I'll lkr ,"1 - 1 , )I ; . .
i
8
CITY OF SALEMO HEALTH DEPARTMENT
BOARD OF HEALTH
Salem, Massachusetts 01970
y 9 NORTH STREET
508.741-1800
DATE: April 28, 1994
Joanne Bresnahan Miller
149 Derby Street UJ
Salem, MA 01970
PROPERTY LOCATED AT 149 Derby Street UNIT 0 J
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 127B,
of. the Massachusetts General Laws, 105 CMR 400.000: State Sanitary Code, Chapter I:
General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chap-
ter II: 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 upon issuance of Certificate.
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. (SO8) 741-1800
Monday thru Wednesday from 8a.m. - 4p.m. , Thursday 8a.m. - 7p.m. , or Friday 8a.m. to
noon to schedule an appointment for an inspection.
SEE ENCLOSED SECTION 105 CMR 410.354 METERING OF GAS 6 ELECTRICITY
Very ttiily yours,
FOR THE BOARD OF HEALTH REPLY TO:
PABLO VALDEZ
Cf Code Enforcement Inspector
HEALTH AGENT
• E �
CERT.02L.3 -93
FEE: „$ _5S
DATE: /�
CITY OF SALEM HEALTH DEPARTMENT
BOARD OF HEALTH
Salem, Massachusetts 01970
ROBERT E.BLENKHORN 9 NORTH STREET
HEALTH AGENT
508-741-1000
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT / 6_5n Den b SFDNIT. / O�
OWNER/AGENT P `t2 �h=_T^P_1117� —
ADDRESS a asL ST'
CITY/TOWN S Q ZIP CODE_O t 1 O 24 HOUR PHONE `71G 1'�-0 �o S
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 STAPARDS OF FITNESS FOR HUMAN HABITATION",
SECTION 410.400 (B): DWELLING UNIT p� 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
]KIRT E. BLENKHORN, C.H.O. �_,s ziz_�
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
OFFICE USEONLY
a �
CERT.
Rro,.,,uc WKS -
DATE: �-- —�
CITY OF SALEM HEALTH DEPARTMENT
BOARD OF HEALTH
Salem, Massachusetts 01970
,iiOBEA�£.$1.-ENKHORH•... .,., - - _ 9 NORTH STREEL
HEALTH AGENT
508.741•1e00
APPLICATION FOR CERTIFICATE OF FITNESS
IN ACCORDANCE WITH STATE SANITARY' CODE, CHAPTER LI, 105 CMR 410.000 "MINIMUM
STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED ATf J UNIT #
OWNER/LESSER ! G+t +E1 MANAGER/AGENT ,. ..
ADDRESS X2 2 .6,120,X, SJR ADDRESS
CITY ,�7 fit'G +� CITY
'RESIDENCE PHONE * 39" 7p / BUSINESS PHONE (24 HRS.)
BUs SS PR Ng
TOTAL NUMBER OF ROOMS:
ROOM USE: I. �1V/ 2.
5. Kii+ b. 7. 8.
THERE IS A TWENTY--FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE
CITY OF SALEM HEALTH DEPARTMENT UPON COMPLIANCE ISSUANCE OF CERTIFICATE.
APPLICANTS SIGNATURE �+GA"O( _ ! DATE 11!/4YIf
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION: 1I GI Gj -2, DATE ,OF REINSPECTION t J /
DATE OF ISSUANCE OF CERTIFIICATE: U c'1'3 DATE FEE PAID: e'—2
TYPE OF UNIT: DWELLING ✓ OTHER
NOTES:
CODE FOR E�MENT INSPECTOR
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET
HEALTH AGENT 01/13/2000 Tel:(978)741.1800
Fax:(978)740-9705
Stephen Buehler
155 Derby Street
Salem, MA 01970
PROPERTY LOCATED AT 155 Derby Street UNIT # 3
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
h 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.
p OR THE BOARDF HEALTH REPLY TO
Joanne Scott, MPH,RS,CHO PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
i
I
r
COO
�IJJMMC R"
CITY OF SALEM HEALTH DEPARTMENT
BOARD OF HEALTH
Salem, Massachusetts 01970
ROBERT E. BLENKHORN 9 NORTH STREET
HEALTH AGENT
508-741-1800
DATE: April 12, 1993
Wharfside Condo Trust
William F. Quinn et al Trust
222 Essex Street
Salem, MA 01970
PROPERTY LOCATED AT X55 Derbv SrrPar UNIT A IA?
DEAR SIRJMADAM:
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 III , Sections 127A and 127B,
of. the Massachusetts General Laws, 105 CMR 400.000: State Sanitary Code, Chapter I:
General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chap-
ter II: 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 upon issuance of Certificate.
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 withi6 .24 hours of receipt of' this notice. (508) 741- 1800
Monday thru Wednesday from 8a.m. - 4p.m. , Thursday 8a.m. - 7p.m. , or Friday 8a.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:
Robert E. Blenkhorn, C.H.O. PABLO VALDEZ
Health Agent Code Enforcement Inspector
'r
CITY OF SALEM HEALTH DEPARTMENT
BOARD OF HEALTH
Salem, Massachusetts 01970
ROBERT E. BLENKHORN 9 NORTH STREET
ItEALTH AGENT
508-741-1800
DATE: June 17, 1991
Wharfside Condo Trust
William F. Quinn, Etal Trustee
222 Essex Street
Salem, MA 01970
PROPERTY LOCATED AT 155 Derby Street UNIT 0 3A2
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 III , Sections 127A and 127B,
of. the Massachusetts General Laws, 105 CMR 400.000: State Sanitary Code, Chapter I:
General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chap-
ter II: 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 upon issuance of Certificate.
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 thr.0 Wednesday from 8a.m. - 4p.m. , Thursday 8a.m. - 7p.m. , or Friday 8a.m. to
noon to schedule an appointment for an inspection.
SEE ENCLOSED SECTION 105 CMR 410.354 METERING OF GAS 6 ELECTRICITY
Very rruly'yours ,
FOR THE BOARD OF HEALTH REPLY TO:
.10�''E
Robert E. Blenkhorn, C.H.O. PABLO VALDEZ
Health Agent Code Enforcement Inspector
L
• CITY OF SALEM, MASSACHUSETTS V
BOARD OF HEALTH
120 WASHINGTON STREET,41°FLOOR PublicHealth
rre.rn,.rramow.rroi<m.
TEL. (978) 741-1800 FAx (978) 745-0343
KIMBERLEY DRISCOLL Iramdin a,salem.com
LnaRY R;\nnxN,Rs/Rri ts,crro,cr-rs
MAYOR
I-IP iL'L'H AGGNT
CERTIFICATE OF FITNESS
CERTIFICATE#355-14
DATE ISSUED: 10/6/2014
Property Located at: 156 Derby Street UNIT#2
Owner/Agent: Spiro Kounsalieh
Address: 156 Derby 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 BOARD OF HEALTH
LAWY RAMDIN
HEALTH AGENT SANITARIAN
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTONSTREET,4"`FLOOR PablicHealth
FcapnL Vromoie.ported.
TEL. (978) 741-1800 FAx(978) 745-0343
KIMBERLEY DRISCOLL Iramdinasalem.com
MAYOR LARRY RADi171N,RS/RE.IiS,C1.10,C;P-f+5
HF.AJ rHAGE.N1r
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: $50.0Q /
PROPERTY LOCATED AT ���D _ ✓/7 rI cG✓( ` � �J�� IT#
IS THIS UNIT DISIGNA`FED_A ISAGGHT LEFT FRONT OR BAC PLEASE CIRCLE ONE
OWNER/LESSER ;�J✓C� IrL�Uf2SCz,6/fJ�, MANAGER/AGENT_
NO P.O. BOX
ADDRESS kilo {T�r'yGrl >T ADDRESS
CITY, STATE,ZIP OR R CITY, STATE, ZIP dl 74
RESIDENCE PHONE Q� Y��'�I7f Z BUSINESS PHONE(24HRS)tz
BUSINESS PHONE �-
TOTAL NUMBER OF ROOMS:
ROOM USE: I. 2. 3. 4. 5.
6. 7. 8. 9. 10.
THERE IS A FIFTY($50)DOLLAR F ,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE IS LE AT THE TIME OF INSPECTION
APPLICANT'S SIGNATURE DATE
Inspectors use only
Date on initial inspection: 0 - Date of reinspection:
Date of issuance of certificate: 1.0- 6—N Date fee paid: /d^16-1
Type of unit: Dwelling_c Other Check#2sS3 Check date: 49- �a I
Notes: ZameA l ati S,-40cta e Iti S +�LF�- f o$M1+i n ts. LaLAA 0") td I to 13.E
1 01
Code Enforcement Inspector
CERT.# 416-96
3 S FEE $25.00
DATE: 0 07/08/7/08/
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: 188 Derby Street UNIT #: 2L
OWNER/AGENT: Helen Mvsliwv
ADDRESS: 188 Derby Street
CITY/TOWN: Salem. MA ZIP CODE: 01970 24 HOUR PHONE: 744-8915
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 THE BOARD OF HEALTH
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
4
(b h -`
GITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT Tei:(508)741.1806
APPLICATION FOR CERTIFICTE OF FITNESS Fax:(508)740.9705
IN ACCORDANCE WIT41 STATE SANITARY:CODE, CHAPTER II, 105 CMR 410,000 "MINIMUM
STANDARDS OF FITNESS FOR HUMAN H�Af)BITATION". O
PROPERTY LOCATED AT 1PAO --ITNIT ! d(_s
MANAGER AGENT
OWNER/LESSER MANAGER/AGENT'
ADDRESS _
ADDRESS .' .
l
µ
CITY CITY
�./ .�sz�
RESIDENCE PHONE / /5�.' ' BUSINESS PHONE (24 HRS.)
BUSINESS PHONE
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 SALEH"HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TIRE OF INSPECTION
APPLICANTS SIGNATURE �r��V��ryy,,� .. DATE —_--
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION: 7— O ` (0 DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: } (o DATE FEE PAID: i �o
TYPE OF UNIT: DWELLING OTHER
NOTES:
CODE ENFORCEMENT INSPECTOR
Ku.0
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH, RS,CHO
HEALTH AGENT Tel: (978)741-1800
05/29/2001 Fax:(978)740-9705
Helen Mysliwy
11 Hodges Court
Salem, MA 01970
PROPERTY LOCATED AT 188 Derby Street UNIT # 2R
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.
/fpR THE BOARD HE TH REPLY TO
oanne Scott, MPH,RS,CHO PABLO VALDEZ
Health Agent CODE ENFORCEMENT INSPECTOR
i
S
v�
CERT.# 417-96
"• FEE $25.00
3 gj
DATE: 07/08/96
MrB
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT Tel:(508)741-1800
Fax:(508)740-9705
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 188 Derby Street UNIT #: 2R
OWNER/AGENT: Helen Mvsliwy
ADDRESS: 188 Derby Street
CITY/TOWN: Salem. MA ZIP CODE: 01970 24 HOUR PHONE: 744-8915
AN INSPECTION OF YOUR VACANT DWELLING/ROOMING UNIT AT THE ABOVE ADDRESS HAS
BEEN APPROVED AND IS IN COMPLIANCE WITH 105 CMR 410.000: MASSACHUSETTS STATE
SANITARY CODE, CHAPTER II, "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" .
THEREFORE, THIS CERTIFICATE IS ISSUED BY THE CODE ENFORCEMENT DIVISION OF THE
SALEM HEALTH DEPARTMENT AND THE UNIT MAY NOW BE RENTED AND/OR OCCUPIED.
MAXIMUM NUMBER OF OCCUPANTS, BASED ON 105 CMR 410.000: MASSACHUSETTS STATE
SANITARY CODE, CHAPTER II, "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" .
SECTION 410.400 (B) : DWELLING UNIT (X) AND 410.400 (C) : ROOMING UNIT
MINIMUM SQUARE FOOTAGE FOR SLEEPING PURPOSES: .
NOTE: THIS APPROVAL DOES NOT CERTIFY COMPLIANCE WITH THE STATE LEAD LAW FOR
OCCUPANTS UNDER 6 YEARS OF AGE.
FOR THE BOARD OF HEALTH
i /
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT Tei:(508)741-1800
APPLICATION FOR CERTIFICTE OF FITNESS Fax:(508)740-9705
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM
STANDARDS OF FITNESS FOR HUMAN HABIT44A--TION".
PROPERTY LOCATED AT f { Q 1lYJ 7 s� ••\ UNIT
�I #
OWNER/LESSER m`,I 5 I1 W�_ MANAGER/AGENT r1 Q+
ADDRESS 1� �QJ�� ADDRESS �
CITY S 'MA 01910 CITY Rgzq 9�—�
RESIDENCE PHONE BUSINESS PHONE (24 HRS:)
BUSINESS PHONE)
TOTAL NUMBER OF{�R1OOM$: ✓ ( j�
ROOM USE: 1. r�`0�f. ^QM 2. ��Wl 3. L. �S��Wv—A 4.
5. QL rWm 6. 7. 8.
THERE IS A TWENTY—FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE
CITY OF SALEM' HP.ALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION
APPLICANTS SIGNATURE
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION: : (o DATE OF REINSPECTION G c
DATE OF ISSUANCE OF CERTIFICATE: ;7_5 —�6 DATE FEE PAID:
TYPE OF UNIT: DWELLING OTHER
NOTES:
CODE ENFORCEMENT INSPECTOR
' pONI11T
n 9,
M.
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
01/29/2001
Helen Mysliwy
11 Hodges Court
Salem, MA 01970
PROPERTY LOCATED AT 188 Derby Street UNIT # 3L
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
978-741-1900, 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.
F T , BOARD E REPLY TO
oanne Scott, MPH,RS,CHO PABLO VALDEZ
Health Agent CODE ENFORCEMENT INSPECTOR
�r
CERT.# 907-94
FEE $25.00
DATE: 10/24/94
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: 188 Derby Street UNIT #: 3L
OWNER/AGENT: Helen Mvsliwv
ADDRESS: 188 Derby Street Apt- 1R
CITY/TOWN: Salem MA ZIP CODE: 01970 24 HOUR PHONE: 473-3529
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 THE BOARD OF HEALTH
�OANNE SCOTT, MPH,RS,CHO ---------------
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
3 (J/
NE
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT - Tel:(508)741-1800
APPLICATION FOR CERTIFICATE OF FITNESS Fax:(508)740-9705
I
IN ACCORDANCE WITH STATE SANITARY CODE , CHAPTER II , 105 CMR 410.000 "MINIMUM
STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT jQj (g � QA"QA" �� SC,9LD.�AA �T ;
OWNER LESSER 4� )'�(� si--S Iyi (� IQA
WAGER AGENT E�e'�/6. . y5�(Wf1/
ADDRESS I a 2J�� > yT R ADDRESS �a1 �\OGt`� �PIQ 11
CITY 1Q q CITY m.A o a,1 `�"d
..RES IDENCE PHONE��O � .� `� 7 { I,� BUSINESS PHONE (24 RRS. ) 6 1 1 173155
BUSINESS PHONE �SD•M,Q 0.j
TOTAL NUMBER OF ROOMS: 13
ROOM USE: 1 . 2. (WM 3. �1V1
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 cUPPONN COMPLIANCE AND ISSUANCE OF CERTIFICATE. `µI
APPLICANTS SIGNATUREU�a) /( , ,o/ f2�_ DATE I® + � 1
INSPECTORSUSEONLY
DATE OF INITIAL INSPECTION: /(j a y �� DATE OF REINSPECTION ` �p
DATE OF ISSUANCE OF CERTIFICATE: DATE FEE PAID:
TYPE OF UNIT: DWELLING )( OTHER
NOTES : –7—
CODE ENFORCEMENT INSPECTOR
Oe
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: 9/27/94 Fax:(508)740-9705
Helen, Wanda & Irving Mysliwy
11 Hodges Court
Salem, MA 01970
PROPERTY LOCATED AT 188 Derby Street UNIT # 3
Dear Sir/Madam:
It has come to our attention, that you may be considering renting a dwelling unit
at the above addresssss.
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.
SFE ENCLOSED SECTION 105 CMR 410 .354 METERING OF GAS & ELECTRICITY
Very truly yours,
FOR THE BOARD OF HEALTH REPLY TO
Joanne Scott, MPH,RS,CHO PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
o CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
6 SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#490-04
DATE ISSUED: 10/25/2004
Property Located at: 195 Derby Street UNIT#C
Owner/Agent: Linda Ley Hanson
Address: 195 Derby Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-745-0518
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.
F R THE BOARD O HEALTH
CJOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
T
CITY OF t/ SALEM, MASSACHUSETTS
HOARD OF HEALTH �/�=
120 WASHINGTON STREET, 4TH FLOOR 11
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_/ 1 UNIT #C,
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER oS }��7:•MMANAGER/AGENT /
No P.O. Box --1No P.O. Box
r
ADDRESS 15 �. ADDRESS
S ---'1—� U
CITY J .- lom .�-CITY-
RESIDENCE
ITY_RESIDENCE PHo /E?j_ _ _a0Z_BUSINESS PHONE (24 HRS.}
1'�l
BUSINESS PHONE _
TOTAL NUMBER OF
ROOM USE: 1.�![U 2. 3. LL _4.-
5___6._T__8._
.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� /� t_ r
DATE it
' V c
INSPF ORS USG ONLY
DATE OF INITIAL INSPECTION/ _'U _DATE OF REINSPECTION______
DATE OF ISSUANCE OF CERTIFICATE f cT DATE FEE- PAkD
lYPEOFUNIL DWELLING UIiiER CHECK 7I g �� CHECK DATE
NOTES:
CODE= ENFORCEMENT INSPECTOR 9/28/98
TO
CRAM
Date e z lime U J - O PM
WHIL/E� YOU W7RE OUT
M / CXR-e[�
of d:LA L
Phone
Area Code Number Extension
TELEPHONED - PLEASE CALL
CALLED TO SEE YOU WILL CALL AGAIN
WANTS TO SEE YOU URGENT
RETURNED YOUR CALL -
Message
reorder 23-700 Operator
G'm ^Green Cycle'"
�i� RECYCLED PAPER
CITY OF SALEM, MASSACHUSETTS
r'
BOARD 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 �V /! � �: UNIT #C�_
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSERS rjQ)k7 MANAGER/AGENT_ J
No P.O. Box No P.O. Box
ADDRESS. 9 d ADDRESS
CITY Jw-,
RESIDENCE PHONE90--).X KAQ7 BUSINESS PHONE (24 HRS ) 7 / 7✓ �sj
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:_,
ROOM USE: 1. 2. _3._�
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 _ d
INSPE ORS U/SE ONLY
DATE OF INITIAL INSPECTION jp_"_} .__U 1!_.-DATE OF REINSPECTION__
DATE OF ISSUANCE OF CERT,,IFIIC�CATE. f '�S'=U _DATE FEE PAID.
TYPE OF UNIT. DWELLING,/ OTHER CHECK N g ��- CHECK DATE I D 3 v
Fel// ��
NOTES
CODE ENFORCEMENT INSPECTOR 9!28/9£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: 01/11/96 Fax:(508)740-9705
Elaine M. Paglia
195A Derby Street, Bodwitch Building
Salem, MA 01970
PROPERTY LOCATED AT 195 Derby Street UNIT # 3A
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.
SES ENCLOSED SECTION 105 CMR 410.354 METERING OF GAS & ELECTRICITY
Very truly yours,
FOR THE BOARD OFF HEALTH REPLY TO
GJoanne Scott, MPH, RS,CHO PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
0 UAM
Date z Time / 1 LE"PM
WHILE YOU nWn � ERE OUT
M � C 4-1--v �t-�
of
Phone,—) °7q-/—•SS, �
Area Code Number Extension
TELEPHONED PLEASE CALL
CALLED TO SEE YOU WILLCALLAGAIN
WANTS TO SEE YOU URGENT
RETURNED YOUR CALL
Message
G°DFo� i(SZL�JJ
/99 Q.
Operator
AMPAD REORDER
®EFFICIENCY® #za-000
a h
3
.61
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: 06/24/96 Fax:(508)740-9705
John & Priscilla Hopkins
199B Derby Street, Bowditch Building
Salem, MA 01970
PROPERTY LOCATED AT 199B Derby Street UNIT # Bldg. F
i
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.
SFE ENCLOSED SECTION 105 CMR 430.354 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
CIiY Of' Sal Iii DEPARTM04T
St3i'i,R{� OFsNFJICTFt .
Salem;'fiAssraduaettx 01470
. - - C mom STREET
aoe�nc AGM
sos-uaraoo
UTE: �- 1
saw
PWPF.M LOCA D`:AT _ UNIT 1'-r'—
> Sm/KAM-
I'has come to our atteitiou, that you are about to allow rental of a duelling unit
at the above address_
It is incumbentuponyou as owner(s) to contact the City of Salem Health Department
co apply for a Certificate of Fitness before any vacant dwelling unit is rented or
occupied_
Each dwelling unit waist be-inspected and certified by the Salem Health Department
prior to allowing occupancy in accordance with Chapter Ill , Sections 127A and 127B,
of the Hassacimsetts General Laws, 105 CHIC 400.000_ State Sanitary Code, Chapter 1:
General Administrative Procedures and 105 CMR 410.000= State Sanitary Code, Chap-
ter II: Nin-+ .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 tveaty-five (25) dollar fee payable by check, or money order to the City
of Salem Health Department upon issuance of Certificate.
Failure to comply with this procedure , -ill result in a fine o1 (wen(y ( 20) dollars
per day for every day that the dwelling unit is occupied vithout approval of the
Code Enforcement Division of the Salem Health Deparcment .
Contact this department within 24 hours of receipt of this notice ( 508) )ti - ISMO
Monday thru Wednesday from Ba.m. - 4p.m. , Thursday Ba.m. - 1p.m. , or Friday Ba .m. to
noon to schedule an appointment for an inspection.
SEB ENCLOSED SECTIOR 105 C2{R 410.354 HETGRIRG OF CAS 6 ELECTRICITY
very tv-61y youts,
FOR THE BOARD OF HEALTH REPLY TO
Robert E. Blenkhorn, C.H.O. _
Health Agent Code Enforcement Tnspeccor
¢ CITY OF SALEM, MASSACHUSETTS
BOARD OF HF LTH
120 WASHINGTON STREET,4t"FLOOR S
Prevene.Promote.Protect.
TEL. (978)741-1800 FAX(978) 745-0343
KIMBERLEY DRISCOLL lramdin@a alem.eam
LARRY IL1DIUlN,RS/RBHS,CHP,CP-PS
MAYOR HErl A'ti AGFNT
CERTIFICATE OF FITNESS
CERTIFICATE#168-13
DATE ISSUED:4/29/2013
j Property Located at: 214 Derby Street UNIT#2R
Owner/Agent: Thomas Pelletier
Address: 182 Lowell Street
City/Town: Peabody, MA Zip Code: 01960 24 Hour Phone: 978-407-7736
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 IP'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.
e.0 Ta�O tD OF ALTH It ��j,,:
LARRY RAMDIN V C '
HEALTH AGENT SANITARIAN
CITY OF SALEM, MASSACHUSETTS 1_T
BOARD OF HEALTH u�.
120 WASHINGTON STREET,4"t FLOOR �y_�.u—v__
Prevent Promote.Prlth
TEL.(978)741-1800 FAx(978)745-0343
KIMBERLEY DRISCOLL Iramdin@saletn.com
MAYOR LARRY RAbiDIN,1LS/RL•;HS,CHQ CP-FS
HEAL'T'H 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 5le-kh /% 61920 UNTf# I-9
IS THIS UNIT DISIGNAT1 ED AS RIGHT LEFT FRONT OR BAM PLEASE CIRCLE ONE
OWNER/LESSER J / —n7 q �/ �!/�i'rL MANAGER/AGENT
NO P.O.BOX
ADDRESS 1 �io w y �'j1' ADDRESS
CITY,STATE,ZIP Eeq k ,:> bCITY, STATE,ZIP 01 S 6 6
T
RESIDENCEPHONE �2 �Fr �3> 605- -BUSINESS PHONE(24HRS) �1`7� "-107 _5;735'-
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:_
ROOM USE: 1. t3rcj( 2. 3. iu. 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
Inspectors use only
Date on initial inspection: q/a 3 Date of reinspection:
Date of issuance of certificate: Date fee paid:
Type of unit: Dwelling Other Check# MR Check date:
Notes:
J
Co rcement Inspector
�'4'a'').r; �'d,,D�' war
Ivnn 42aai Ri„Ke� 'i! SY.�r
CITY OF SALEM BOARD OF HEALTH SKY ted W' INC
Salem, Massachusetts 0 970-3928
JOANNE SCOTT,MPH,AS,CHO NINE NORTH STREET
HEALTH AGENT Tel:(508)'741.1800
Date: 01/05/96 FaX:(508)7409705
Donald J. Michaud '
12 Savoy Road, P.O. Pox 627
Salem, MA 01970
PROPERTY LOCATED AT 224 Derby Street 'UNIT # 2A '
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 CER'T`IFICATE 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 127E, of
the Massachusetts General Laws, 105 CMR 400. 00; State Sanitary Code, Chapter 1: General
Adminialrative 'Rtocedures and 105 CMR 410.000; State Sanitary Code, Chapter 11: Minimum
,standards of Fitness for Human Habitation, and in accordance with Chapter 11, Article
X111 of the City of Salem Code of Ordiances, Section 2-1134, :Certificate of Fitness.
:'here is a twenty-five (25) dollar fee payable by check, or money order r-o the City
of Sa12m 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 dray for every day that the dwelling unit is occupied without approval of the Cc.de
Enforcement Division of the Salem Health Department.
Contact this department within 24 hours of receipt .of this notice. (508) _741-1300
Monday thru Ided-,iesday £:cora 8:00 a.m. - 4:00 p°.m:-Thursday 2:00 a.m,. -- 7 :00 p.m. or
Friday 8:00 a.m. to noon to schedule an appointment for an inspection.
a
5EE_E11CLOSED SECTION 105 CMIJ 41Q 35d MFTFF.TNG of GAS & FLECTRTOTTY.
Very truly yours,
FOR THE BOARD OF HEALTH REPLY TO U
Joanne Scott; MPH;•RS,CHO ' _ - PABLO VALDEZ - -
HEALTH-AGENT CODE ENFORCEMENT INSPECTOR
wmaed Y. Iflichaud
P.O. BOX 627 -SALEM, MASS. 01970- (508) 745-7668- FAX (508) 745-7759
January 11 , 1996
JAN 1 6 1996
City of Salem Board of Health _
Nine North Street
Salem MA 01.970-3928
Attn : Mary
RE : Property located at 224 Derby St .
Unit # 2A
Dear Mary :
Pursuant to our phone conversation today regarding the above
referenced unit for a Certificate of Fitness , this is to verify
that Unit # 2A is now occupied by Mr . Donald J . Michaud ' s
daughter and son-in-law , Louise Michaud Skerry and Michael Skerry ,
who are also part owners of the property .
The Skerrys are occupying this unit while the third floor is
being completely renovated , at which time they will be returning
to the third floor , and Mr . Donald Michaud will be occupying the
second floor unit # 2A for his personal use .
You statedthat when units are owner occupied , they do not have to
be inspected for a certificate of fitness .
Thank you for your assistance .
Sincerely ,
Marguerite T . Slaven , Bkkp .
for Donald J . Michaud
enclosure
3
"Al
rrrp�
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970 3928
JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET
HEALTH AGENTp//-- Tel:(508)741-1800
Date: 01/05/96 '�/� / KJ Fax:(508)740-9705
Donald J. Michaud
12 Savoy Road, P.O. Box 627
Salem, MA 01970
PROPERTY LOCATED AT 224 Derby Street UNIT # 2A
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
'J -
r. V
Joanne Scott, MPH,RS,CHO PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CO. ..
CERT.# 46-94
' 6 t
FEE: ..$ 25.00 .. ,
_ a
DATE: 1/27/94
CITY OF SALEM HEALTH DEPARTMENT
BOARD OF HEALTH
Salem, Massachusetts 01970
ROBERT E.BLENKHORN 9 NORTH STREET
HEALTH AGENT -
508-741-1800
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT 224 Derby Street UNIT# 2A
OWNER/AGENT Donald J. Michaud
ADDRESS 12 Savoy Road
CITY/TOWN Salem, MA ZIP CODE 01970 24 HOUR PHONE 744-7988
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 THE BOARD OF HEALTH
ROBERT E. BLENKHORN, C.H.O. / C
HEALTH AGENT COD ENFORCEMENT INSPECT
f - �?s"�o•'°44 OFFICE USE ONLY
r
DATE:
CITY OF SALEM HEALTH DEPARTMENT
BOARD OF HEALTH
Salem, Massachusetts 01970
eooER*A cHoaH 9 NORTH STREET
HEALTH AGENT
'7e1't 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 41;1 _ A ,I-c / Um I
LBSSER AMANAGEAGE
NT
ADDRESS t�J SIIlia� ADaREssSfi 39
CITY CITY 5AePL
'RESIDENCE PHONE 70 ZILE BUSINESS PHONE (24 HRS.) 7�
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ROOM USE: 2. �•�lU1IIJG�Px�1M 4-
5. b. 7. 8.
THERE IS A TWENTY-FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO TBR
CITY OF SALEM HEALTH DEPARTMENT UPON COMPLIANCE AND ISSUANCE OF CERTIFICATE.
APPLICANTS SICNATURZ M / �DATE�
INSPECTORS A ONLY
DATE OF INITIAL INSPECTION: "/ 7—?IfDATE ,OF REINSPECTION y �J
DATE OF ISSUANCE OF CERTIFICATE: _ DATE FEE PAID: l ( r
TYPE OF UNIT: DWELLING X OTHER
NOTES:
CODE E�NT4"SPECTOR
r
• ,3�� '�p CERT.# 1008-94
FEE $25.00
DATE: 11/30/94
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: 224 Derby Street UNIT #: 2B
OWNER/AGENT: Donald J. Michaud
ADDRESS: 12 Savoy Road, P.O. Box 627
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-1178
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 THE BOARD OF HEALTH
/aJOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
01�o� - OFFICB USE ONLY I.
CERT. ,
DATE
CITY OF SALEM HEALTH DEPARTMENT
BOARD OF HEALTH
Salem, Massachusetts 01970
9 NORTH STR£EI
508-741-1800 APPLICATION FOR CERTIFICATE OF FITNESS
IN ACCORDANCE WITH STATE SANITARY' CODE „CHAPTER II, 105 CMR 410.000 "MINIMUM
STANDARDS OF FITNESS FOR HUMAN �HABIT�ATION".
PROPERTY LOCATED AT -UNIT
� �yl &
JJ(� A �T "f" <�
OWNER/1ZSSEIt��y / 7e� JuM
� MANAGER/AGENT �f , V_,-14�
ADDRESS D U ADDRESS da
CITY //l J CITY
c / G
RESIDENCE PHONE DIP- SL- Z21 BUSINESS PHONE (24 HRS.I.,fVA �1�1-//7y
BUSINESS PHONE 76 (oD
TOTAL NUMBER OF ROOMS,
ROOM USE: 1 . Z 2. 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 UPON COMPLIANCE AND ISSUANCE OF CERTIFICATE.
APPLICANTS SIGNATURE
INSPEECTOR�SG USE ONLY
DATE OF INITIAL INSPECTION: 7 D ( % DATE .OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: a -1 DATE FEE PAID: ! �S 6 ✓
TYPE OF UNIT: DWELLING OTHER
NOTES:
CODE ENFORCEMENT INSPECTOR