DIPIETRO AVE CONDPGt U
City of Salem, Massachusetts
Board of Health
a 120 Washington Street, 4th Floor, Salem, PublicHealth
MA01970 Prevent. Promote. Protect.
Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, RENS, CHO
Mayor Iramdin@salem.com Health Agent
CERTIFICATE OF FITNESS
CERTIFICATE M GHL-16-171
DATE ISSUED: 5/20/2016
Property Located at: 1 DIPIETRO AVENUE UNIT#
Owner/Agent: Susan Spinale
Address: 30 Ocean Street#11
City/Town: Lynn, MA Zip Code: 01902 24 Hour Phone:(781) 581-2238
Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division 3, Section 705: Certificate of fitness of
rented dwelling unit, apartment or tenement. An inspection of your vacant Dwelling/Rooming Unit at the above address has
been approved and is in compliance with 105 CMR 410.000: Massachusetts State Sanitary Code, Chapter II "Minimum
Standards of Fitness for Human Habitation".
Therefore, this Certificate is issued by the Code Enforcement Division of the Salem Board of Health and the unit may now
be rented and/or occupied.
Maximum Number of occupants, must comply with 105 CMR 410.000.
Certificate valid for one year from date of issuance or until the current tenant vacates, whichever is later.
This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy.
FOR THE BOARD OF HEALTH
a
Larry Ramdin, MPH, REHS, CHO
HEALTH AGENT SANITARIAN
' CITY OF SALEM, MASSACHUSETTS V
BoARD OF HEALTH
120 WASHINGTON STREET,4m FLOOROR".a w.n
TF2. (978)741-1800 FAX(978)745-0343
KIMBERLEY DRISCOLL Iramdin@salem.com
' MAYOR _ LARRY RAMllIN,RS/KERS,CRO,CP-f•'f
HL;Arm 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
IS THIS UNIT DISIGNATED ASRIGHT EFT FRONT ORD PLEASE CIRCLE ONE
OWNER/LESSER SllSc3 ' �c% 1 MANAGER/AGENT
NO P.O.BOX 3o 0CP�� T ADDRESS U✓1 �� i
ADDRESS S
CITY, STATE ZIP_LTn MA CITY, STATE ZIP 0
RESIDENCE PHONE ���� 3 BUSINESS PHONE(24HRS) 6 1-7 7a d 3c7 S�
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:��
ROOM USE: 1. 2. 3. 4. 5.
6. 7. 8. 9. 10.
THERE IS A FIF'T'Y($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE IS P LE TIME OF INSPECnON
APPLICANT'S SIGNATURE DATE K
Inspectors use only
Date on initial inspection:0F�17/2�26 Date of reinspection:
Date of issuance of certificate: Z Date fee paid: 2LLY202C
Type of unit: Dwelling Other Check# `� 2. Check date: 0� 7�201�
Notes:
�Ibd/o, oPlemrnt 10fleclor