6 DEVEREAUX AVENUE#1 CITY OF SALEM, MASSACHUSETTS
n g� BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
4
Fax 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#354-05
DATE ISSUED: 6/1/05
Property Located at: 6 Devereaux Street UNIT# 1
Owner/Agent: John Riley& Beverlie McSwiggen
Address: 30 Japonica Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:
An inspection of your vacant Dwelling/Rooming Unit at the above address has been approved
and is in compliance with 105 CMR 410.000: Massachusetts State Sanitary Code, Chapter 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 OFF HEALTH p fa
ll /
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
4 a jow-5, fW
CITY 4F SAt.,EM, MA5SACHUSEI'["S
BOARD OF HEALTH
120 WASHINGTON'STREET.4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343 ('.}jt--{�w/')�
STANLEY USOVICZ. JR_ - y
JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
APPLICATION FOR CERTIFICATE OF FITNESS
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410-000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
PROPERTY LOCATED AT tk f%� .f� UNIT u
IS THIS UNIT DESIGNATED AS RIGHT VFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER , ` L NPAN AGE T_
No P.O.Bo r Na P.O.Box
ADDRESS O C� 1 ADDRESS�_� n />
CITY i ,�,/ CITY // t_lGl/ L/
RESIDENCE PHONE�I�_&__A//_BUSINESS PHONE (24 HRS )`
BUSINESS PHONE
TOTAL_ NUMBER OF ROOMS:
ROOM USE 1.__ — 2 _3„
5._-tt
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 'CxK�L \ DAIE ✓ b) r '�J
I
INSPECTORS USE ONLY
r
DAl_C OF INITIAI-__INSPECTION ..5 DATE 01 PLIN PI=CI IOM
JA 11: OF ISSUANGF OF CFRTI!'KATE a e "� ' Dl
;1f_ I'EE PAII,)
TYPE OF UNIT DVVELLINCXt!/0IHcR CHECK t! �,;I_ 6
C DI l i�li o Ii k l} lAi N l INSi'i C i t)I7 I?1;'8p.itt
CITY OF SALEM, MASSACHUSETTS
' �,.x BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
I
, CERT.# 509-03
, SALEM, MA 01970 FEE $25.00
TEL, 978-741-1800
FAX 978-745-0343 DATE: 10/01/03
STANLEY USOVICZ, JR, JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
1
CERTIFICATE OF FITNESS
I
PROPERTY LOCATED AT: 6 DEVEREAUX STREET UNIT #: 1
OWNER/AGENT: JOHN P. RILEY
ADDRESS: 30 JAPONICA STREET
CITY/TOWN: SALEM ZIP CODE: 01970 24 HOUR PHONE: 978_745-9672
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 (%) AND 410.400 (C) : ROOMING UNIT
MINIMUM SQUARE FOOTAGE FOR SLEEPING PURPOSES: .
NOTE: THIS APPROVAL DOES NOT CERTIFY COMPLIANCE WITH THE STATE LEAD LAW FOR
OCCUPANTS UNDER 6 YEARS OF AGE NOR BUILDING RELATED CODES. FOR MORE
INFORMATION CALL 978-741-1800.
FO THE BOARD OF HEALTH
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT
NIOR SANITARIA`N~
t CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH 2
• 120 WASHINGTON STREET, 4TH FLOOR r0 y� (J
't SALEM, MA 01970 /h
"v
TEL. 978-741-1800
FAX 978-745-0343
STANLEY LlSOVICZ, 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 '�� UNIT#Z
IS THIS UNIT DESIGNATED AS GHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER MANAGER/AGENT
No P.O. Box No P.O. Box
ADDRESS 4 ADDRESS
CITY CITY
nn h e�
RESIDENCE PHONED ' /�S�ls BUSINESS PHONE (24 HRS.)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ROOM USE: 1._4 2. 3. _4.
5. 6. 7. 8.
THERE IS A TWENTY-FIVE($25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY
ORDER TO THE CITY OF SALEM HEALTH DEPART THIS FEE IS PAYABLE AT THE
TIME OF INSPECTION 5
APPLICANTS SIGNATOR DATE 0
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION 13a71o.T DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: 9 _DATE FEE PAID: _,9 A)
TYPE OF UNIT: DWELLING OTHER_ CHECK# 51461 CHECK DATE 9/»
a25
NOTES: e vnoy
C0DfE_ENrMCEMENT 1141PECTOR 9/28/98
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
a 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
John Riley
30 Japonica Street
Salem, MA 01970
PROPERTY LOCATED 6 Devereaux Street Unit# 1
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