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ESSEX STREET 400 + CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 -J t•` TEL. 978-741-1800 / FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#507-04 DATE ISSUED: 11/11/04 Property Located at: 401 Essex Street UNIT# 1 L Owner/Agent: David Schaejbe Address: 401 Maple Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-2707 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 P f' JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS J •`f 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 OFFITNESSFOR HUMAN HABITATION". f-( PROPERTY LOCATED AT UNIT# IS THIS UNIT DESIGNATED AS RIGHT LEFT FROM BACK PLEASE CIRCLE ONE OWNER/LESSERI f 17 xJ E MANAGER/AGENT No P.O. Box �`,, No P.O. Box ADDRESS 'fOl /j�X Ci ADDRESS CITY 5,� � CITY RESIDENCE PHONE BUSINESS PHONE (24 HRS.) BUSINESS PHONE TOTAL NUMBER OF BROOMS: I/ 1 . ROOM USE: 1. 9, 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 THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. Q APPLICANTS SIGNATURE t DATE_J/_' 1� (� INSPECTORS USE ONa DATE OF INITIAL INSPECTION // / ' � DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE//I// ti '� DATE FEE PAID. l l '/ o D TYPE OF UNIT: DWELLING THER_ CHECK# _ CHECK DATE NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 29 120 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 10/21/04 David Schaejbe 24 Maple Street Salem, MA 01970 PROPERTY LOCATED AT 401 Essex Street Unit 1 L 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 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. to 7:00 p.m. and Friday 8:00 a.m.— 12:00 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 tenant's entire utility bills retroactive to the date of initial occupancy in cases in which cross-metering has been proven to exist. Fo a Board of Health Reply to Joanne Scott MPH, RS, CHO Pablo Valdez Health Agent Code Enforcement Inspector 1 .co CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH ' ♦ 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 CERT.# 9-03 FEE $25 .00 TEL" 878-741-1800 D FAx 978-745-0343 ATE: 01/07/2003 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 401 Essex Street UNIT #: 1 Right OWNER/AGENT: David Schaeibe ADDRESS: 23 Maple Street CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-2707 AN INSPECTION OF YOUR VACANT DWELLING/ROOMING UNIT AT THE ABOVE ADDRESS HAS BEEN APPROVED AND IS IN COMPLIANCE WITH 105 CMR 410.000 : MASSACHUSETTS STATE SANITARY CODE, CHAPTER II, "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" . THEREFORE, THIS CERTIFICATE IS ISSUED BY THE CODE ENFORCEMENT DIVISION OF THE SALEM BOARD OF HEALTH AND THE UNIT MAY NOW BE RENTED AND/OR OCCUPIED. MAXIMUM NUMBER OF OCCUPANTS, BASED ON 105 CMR 410.000 : MASSACHUSETTS STATE SANITARY CODE, CHAPTER II, "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" . SECTION 410 .400 (B) : DWELLING UNIT (X) AND 410.400 (C) : ROOMING UNIT MINIMUM SQUARE FOOTAGE FOR SLEEPING PURPOSES: . NOTE: THIS APPROVAL DOES NOT CERTIFY COMPLIANCE WITH THE STATE LEAD LAW FOR OCCUPANTS UNDER 6 YEARS OF AGE. FOR MORE INFORMATION CALL 978-741-1800 . FOR THE BOARD OF HEALTH JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 3 120 WASHINGTON STREET, 4TH FLOOR Z SALEM, MA 01970 - ge ^^� TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO - MAYOR HEALTH AGENT APPLICATION FOR CERTIFICATE OF FITNESS IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER Ii, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT C$S EJB S r UNIT#1 2 IS THIS UNIT DESIGNATED A IGH LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER ,D A:AaTJgF MANAGER/AGENT No P.O. Box No P.O. Box wYADDRESS� P T� ADDRESS CITY 4m" _CITY RESIDENCE PHONE *1'�''=® BUSINESS PHONE (24 HRS.) BUSINESS PHONE TOTAL NUMBER OF ROOMS: _ ROOM USE: 1. 2.-3._hC'Qj _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 TIME OF INSPECTION. APPLICANTS SIGNATURE dDATE INSPECTORS US NLY DATE OF INITIAL INSPECTION/ --0 DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: DATE FEE PAID:-/=-2 -03 TYPE OF UNIT: DWELLING/,((OTHER CHECK# J 7 to CHECK DATE NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH iZO WASHINGTON STREEr, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 W W W.SALEM.COM Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO Mayor HEALTH AGENT 5/18/06 David Schaejbe 24 Maple Street Salem, MA 01970 PROPERTY LOCATED AT 401 Essex Street Unit 2L 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 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. to 7:00 p.m. and Friday 8:00 a.m. — 12:00 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 tenant's entire utility bills retroactive to the date of initial occupancy in cases in which cross-metering has been proven to exist. F the Board of Hea Reply to Joanne Scott MPH, RS, CHO Pablo Valdez Health Agent Code Enforcement Inspector CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH s 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 STANLEY J. USOVICZ, JR. FAX 978-745-0343 MAYOR WWW.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#687-05 DATE ISSUED: 11/08/2005 Property Located at: 401 Essex Street UNIT#2 Left Owner/Agent: David Schaejbe Address: 401 Essex Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-745-2707 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. R THE BOAR HEALTH JOANNE SCOTT, MPH, RS, CHO � HEALTH AGENT CODE ENFORCEMENT INSPECTOR F' CITY OF SALEM, MASSACHUSETTS } BOARD OF HEALTH ,• 120 WASHINGTON STREET,4TH FLOOR SALEM, MA 01970 (�J- ' l7 (✓�„J 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 OFJ FITNESS FOR HUMAN HABITATION"- PROPERTY LOCATED AT t `� lj jC� X UNIT # IS THIS UNIT DESIGNATED AS RIGHT //L'�E ^^FRONT BACK PLEASE CIRCLE ONE OWNERJLESSER�TC� 465-6 %MANAGERIAGENT _ No P.O. Box e. X S - No P.O. Box ADDRESS. ) ADDRESS_`__. CITY 1t(- C� CITY_ VVV5�1� _ RESIDENCE PHONE 7�`/ ?—BUSINESS PHONE (24 HRS.) BUSINESS PHONE. `_ _` TOTAL NUMBER OF ROOMS: ROOMUSE: 1._ 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 INSPECTORS USE O Y DATE OF INITIAL INSPECTION /I_-Y 7 DATE OF REINSPECTION J U DATE OF ISSUANCE OF CERTIFICATE: 4 �!6' DAT E FEE PAID:__L:I r TYPE OF UNIT DWELLIN ' /OT CHECKCHECK DATE 11 � ' (- _ NOTES_ W l.,.<L � ,,.>. CODE ENFORCEMENT INSPECTOR 9/28!9£3 r i ` CI`I"Y OF SALEM, MASSAC_HUSETI'S F BOARD OF HF ur1-i LO WASHINGTON STREET,4'"I"LOOK KIMBERI Y DRISC:OLL TEL. (978) 741-1800 F A x(978)745-0343 MAYOR tramctinCalan COM LARRY RAMDIN,RS�RI:hrS,CI I('7,CP-PS _ H EJlt.;i l I t1G I•;i�"'I' i CERTIFICATE OF FITNESS CERTIFICATE#514-11 DATE ISSUED: 1215!2011 Property Located at: 401 Essex Street UNIT#3L i Owner/Agent: David Schaejbe Address: 401 R Essex Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-2707 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. FOR THE BOARD OF HEALTH 1 %LAY r HEALTH AGENT CODE ENFORCEMENTINSPECTOR A.I • «. CITY OF SALEM, MASSACHUSETTS � 13o,\Itr>or HF 1t.T[1 h, ' 120 WASHINGTON STREET,4O.FLOOR '111- (978) 741-1800 IUMBERL.EY DRISCOLL FAX (978) 745-0343 MAYOR LRAMIAN@C AL SM.COM LARRY RAMI)IN,RS/IWI IS,CI 10,CP-FS HHA1:ni AGISN'I' APPlicatiO13 for(7erfificate of Fitnegs IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" n FEE: $50.00 PROPERTY LOCATED AT_ �A IS TWSS�UNIT /,,�D�ISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE OWNER/LESSER.-B)W D I�' 44 5* P--MANAGER/AGENT NO P.O. BOX �( ( ADDRESS 1 I � ,� ��_ I� ADDRESS CITY, STATE,ZIP- CITY, STATE, ZIP 0 RESIDENCE PHONE-qW`7 rS —,9—/ 0BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1. � 2. 3. CA//(W( 4. 5. 6. 7. 8. 9. 10. THERE IS A FIFTY($50)DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FE PAYABLE AT E TIMINSPECTION OF SSPECTION APPLICANT'S SIGNATURE � / DATE / r Inspectors use only Date on initial inspection: I Z' S' t I Date of reinspection: Date of issuance of certificate: I I- S' I$ Date fee paid: Type of unit: Dwelling t/ Other Check# 12-s-11 Check date: 12 Notes:_IZe-4n� n U"&$ LO50tl) 10 1Ya1 k-4 VS) c,('3r• - � �'pV, C N\-M74) W,�e)•a Q d6� . 1 de Enforcement Inspector 4 CITY OF SALEM, MASSACHUSETTS o BOARD OFHEALTH S / 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 STANLEY J. USOVICZ, JR. FAX 978-745-0343 MAYOR W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#631-05 DATE ISSUED: 10/17/05 Property Located at: 401 Essex Street UNIT#3 Right Owner/Agent: David Schaejbe Address: 401R Essex Street CityfTown: Salem, MA Zip Code: 01970 24 Hour Phone: 745-2707 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 0F}1EALTH JOANNE SCOTT, MPH, RS, CHO (✓ �/ HEALTH AGENT CODE ENFORCEMENT INSPECTOR r CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • • 120 WASHINGTON STREET, 4TH FLOOR SALEM, AIA 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 SF�7 FOR HUMAN HABITATION". ? PROPERTY LOCATED AT I (i6.�Y S UNIT N J IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER ' If) h MANAGER/AGENT- -No P.O. Box �1� No P.O. Box ADDRESS 4-OI✓,L�E��,J� __ADDRESS CITY- CITY , CITY E �1 ` _. RESIDENCE PHONA 0 BUSINESS PHONE (24 HRS.)-_ BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1._ �J(Z- 2. (<,/(T_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 INSPECTORS USE ONLY DATE OF INITIAL INSPECTION f ( ( b DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE/6'1(� _DATE FEE PAID.--/O TYPE OF UNIT: DWELLING' OTHER.- CHECK H__1 %--/..-_ CHECK DATE NOTES f-, - CODE ENFORCEMENT INSPECTOR 9/28/98 r y(Q[ ♦t ItS Yq�.. it J ` 1�.. e, i I r i CITY OF SALEM, MASSACHUSETTS • • BOARD OF HEALTH 120 WASHINGTON STREET,4'"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR IDIONNF,@SeV.BM COM JANGI'DIONNE ACTING HIS✓A1:I1-1 AGI?N'1' CERTIFICATE OF FITNESS CERTIFICATE#582-08 DATE ISSUED: 11/12/2008 Property Located at: 407 Essex Street UNIT#2 Owner/Agent: Miroslaw Kantorosinski Address: 8 Almeda 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 O HEALTH JtN IONNErAING HEALTH AGENT CODE ENFORCEMENT I PECTOR 4, CITY OF SALEM, MASSACHUSETTS Y BOARD OF HEALTH 120 Wr1SHINGTON STREET,4"'FLOOR TEL.(978)741-1800 KIMBERLEY DRISCOLL FAX (978) 745-0343 MAYOR IDIONNF d,SALEM.COM JANET DIONNE, ACTING 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." rryy FEE: $5`0.00 PROPERTY LOCATED AT /a-7 �/_YJ.Q!{- � 7 � W9 Z o UNIT 2' IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BAC PLEASE CIRCLE ONE OWNER/LESSER .�A iV 05LA �&IV R9105'i<I MANAGER/AGENT ADDRESS Y A 6-� SJ- S A LQA,, 6!r ,-ADDRESS CITY, STATE,Zjp_ � )D CITY, STATE, ZIP RESIDENCE PHONEge y]`L -� 8 BUSINESS PHONE(241IRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: e ROOM USE: 1 J4 2 tb 3 612� 4 o-> 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 F E IS PAY OF INSPECTION { APPLICANT'S SIGNATURE DATE rj `G 'gyp Inspectors use only Date on initial inspection: 11- 1 I--o k Date of reinspection: Date of issuance of certificate: t l-17--o k Date fee paid: 1i S— Y Type of unit: Dwelling Other Check k1 Check date: 5'10 b' Notes: 1' Code Enfo cem nt Ins r th wNn City of Salem, Massachusetts n Board of Health 120 Washington Street, 4th Floor, Salem, PPt,revent.Promote.�MA 01970 Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, REHS, CHO Mayor health@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE#: GHL-16-320 DATE ISSUED: 8/26/2016 Property Located at: 409 ESSEX STREET UNIT#1 Owner/Agent: Henry Kantorisinski Address: 84 Linden Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(978) 744-0218 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. Note: This approval does not certify compliance with the state lead law for occupants under 6 years of age. &Jey arosy Larry Ramdin, MPH, REHS, CHO HEALTH AGENT SANITARIAN CITY OF SALEM, MASSACHUSETTS .i BOARD OF Hrar TH 120 WASHINGTON STREET,4'"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLI. FAX(978) 745-0343 MAYOR LRAAIDIN@SAL M.COM LARRY RAMDIN,RS/REHS,CHO,CP-FS HEALTH AGENT jy ix 4k� KQn.ti lS✓�SIJC�fr\t /eve e Application for Certificate of Fitness IN ACCORDANCE WITH STATE SANITARY CODE,CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" � y FEE: $50.00 PROPERTY LOCATED AT �0% 1!�Sr& S r UNIT# IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE MCLE ONE OWNER/LESSER �y >°� � �5%b1 CS tt MANAGER/AGENT lfGN7-y KAIJ-rzYPo, ,, wx, NO P.O.BOX ADDRESS 14� G1h4126d $r ADDRESS CITY, STATE,ZIP !R � / S CITY, STATE,ZIP (DICT 70 RESIDENCE PHONE,____0 V 6U/yp BUSINESS PHONE(24HRS) BUSINESSPHONE 97(f- OU19' TOTAL NUMBER OF ROOMS: ROOM USE: 1. 2. 3. 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 DATE Inspectors use only Date on initial inspection: !)yjy 12016 Date of reinspection: Date of issuance of certificate:�2sx2ed-C Date fee paid: OV2_512D.1if Type of unit: Dwelling�Other Check# 31 q6 Check date: 042_S 2fJJ Notes: A Coe if cement I)r ector co � City of Salem, Massachusetts { f K, i. q Board of Health 120 Washington Street, 4th Floor, Salem, PublicHeaith MA 01970 Prevent. Prnmote. Protect. Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, REHS, CHO Mayor Iramdin@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE#: GHL-15-123 DATE ISSUED: 6/18/2015 Property Located at: 409 ESSEX STREET UNIT#2 Owner/Agent: Henry Kantorisinski Address: 84 Linden Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(978) 7440218 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 Larry Ramdin, MPH, REHS, CHO HEALTH AGENT SANIT AN • CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX (978) 745-0343 MAYOR 1AANIDIN@SA ,EM.COM LARRY RANIDIN,RS/RI;I-IS,CI-IO,CP-FS H I;AI:II I AGI?N"1' 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 D tfSe X SS. UNIT# ;J IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE OWNER/LESSER HIFIV el JM1V7'014af/iJS4--'I/ MANAGER/AGENT NO P.O. BOX ADDRESS L1N1)Ct✓ Sr ADDRESS CITY, STATE, ZrP .SA M&S. 0197® CITY, STATE,ZIP RESIDENCE PHONE 9700- / 'f�F' 10a 18 BUSINESS PHONE (24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: to ROOM USE: 1. 2. 3. 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 FEEISPAYABLE AT THE TIME OF INSPECTION APPLICANT'S SIGNATUREd1�I7��1(Ah4,91yy5)1v5wI DATE 4" 10 a�J� Inspectors use only Date on initial inspection: III,[2P1,5— Date of reinspection: Date of issuance of certificate:0 V _2 L1 _ Date fee paid: 00-V2.0' r Type of unit: Dwelling—Z Other Check# 1192 Check date: (%l n4LO1.f Notes: Ei orcement pector F CITY OF SALEM, MASSACHUSETTS BOARD OP Hr-.u,*Lii 120 WASHINGTON STRE6:T,4...hL,OOit KIMBIi!RIMY DRISC.;OL L 11'a- ()78) 741-1800 F<�x {978) 745-0343 MAYOR Iramdin0salein coin I'mm),R MI)IN,KS/RVI fS,(A10,CP-PS RFAJA I l i\(;ENT CERTIFICATE OF FITNESS CERTIFICATE #005-12 DATE ISSUED: 1!3/2012 Property Located at: 409 Essex Street UNIT#3 Owner/Agent: Henry Kantorosinski Address: 84 Linden 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 11" 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. FOF HEALTH LARRY RAMDIN l HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS BOARD OF HF-uxi-i- 00 120W_\S1f1NG'r0N STRF-F-i,4... ,*rL-,.i,. (978) 741-1800 KIMBE'RLEY DRISCOLL FAX (978) 745-0343 MAYOR JA AM DI N@SA 1.1RI.CQNI 1,,\1WY1UMDfN,16/iml Is,(if lo,(T-IFS Hrmxii M;v,M 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 fSex S - UNIT# IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE owNER/LFssER_dE/vAy KRro7oRas�NSK, MANAGER/AGENT NO P.O. BOX ADDRESS eY 1,jvDe1v# ADDRESS CITY, STATE, ZIP ITY, STATE,ZIP RESIDENCE PHONE q)d- 70- 0.2 if —BUSINESS PHONE (241IRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1, 2. L-9 3. 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 DATE PJ- jZ Inspectors use only Date on initial inspection: Date of reinspection:_ Date of issuance of certificate: Date fee paid: Type of unit: Dwelling_! Other Check#_f 3S_Check date: )*111 Notes: 'Code Enforce4ent Inspector CITY OF SALEM, MASSACHUSETTS o ; 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#41-06 DATE ISSUED: 2/1/06 Property Located at: 412 Essex Street UNIT#5 Owner/Agent: Amtrical Realty Trust Address: 7 Churchill Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-6848 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 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR 4 CITY OF SALEM, MASSACHUSETTS 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 It, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION' PROPERTY LOCATED AT A�-2- UNIT IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNERILESSER&d��IC A-L--4)L-A�V5rANAG ER/AG ENT-FZ-tD aRlt No P.O. Boxes No P.O. Box ADDRESS�2-c ADDRESS J&I't CH IL---5 cITy-,SAhcill, ..--CITY-kV RESIDENCE PHONqA�74T61q7BU91NESS PHONE (24 HRS.) 7, -�w BUSINESS PHONE VT 4�1 TOTAL NUMBER OF ROOMS:—6/ ROOM USE 1 2.DJJV 3-0t-- 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 TIME OF INSPECTION. APPLICANTS SIGNATURE DATE IT It A 0(0 INSPECTORS-USE ONLY DATE OF INITIAL INSPECTION4,.-. I - 0 & DATE OF REINSPCCTION.. DATE OF ISSUANCE OF CERTIFICATET) 0 6 DATL FEE PAID 0.0 6 . TYPE OF UNH OWELLIN<OTHER CHECK 41 D (,,'HFC -,�K DATE' - (,Ut)i--- l7NFOIiGLMIZN I* INSPEC I-OH 9128/98 CITY OF SALEM, MASSACHUSETTS BOARD OP'FILALTF[ 120 WASTT HNGTON S'I'RE}3"1' 4".FLOOR PI1b OHCRIth TEL. (978) 741-1800 FAX (978) 745-0343 KIMBERLEY DRISCOLL Iramdin@salem.com LdKRY R.-AIvNIN,RS/RF,FtS,Cf 10,CP-I'S MAYOR CERTIFICATE OF FITNESS CERTIFICATE#271-14 DATE ISSUED: 8/11/2014 Property Located at: 414 Essex Street UNIT# 1 Owner/Agent: Juana Inoa Address: 414 Essex 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 LA 9LARRY MDIN HEALTH AGENT SANITARIAN �f CITY OF SALEM, n1kSSACHUSETTS V BOARD OF H&kLTH 120 WASHINGTON S'T'REET,4".FLOOR ptlb]ICxCAIt3t r,evm.rrmo«,n.mo ,. TEL.(978)741-1800 FAx(978)745-0343 KIMBERLEY DRISCOLL Iramdm a.sale c.com MAYOR LaltRl`1LNff>IN,RS/1111 IS,CHO,C:1'-FS Hr.,. Lv i AC;EN7' 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 � ESWX Sr t� I UNIT#_L _ IS THIS UNIT D`IISII,G�NNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE OWNER/LESSER U l MANAGER/AGENT NO P.O. BOX F ADDRESS q �* e'�l S ADDRESS CITY, STATE,ZIP ! '� +� 1 CITY, STATE,ZIP p (� RESIDENCE PHONE BUSINESS PHONE(24HRSti 1 I BUSINESS PHONE TOTAL NUMBER OF ROOMS:__....,_ ROOM USE: 1 3. 4. 5. 6. 7. S. 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 ISi PAYABLE AT THE TIME OF INSPECTION r{ 1 APPLICANT'S SIGNATURE +EIWAV6-- �� /�� DATE t} i Inspectors use only Date on initial inspection: 'Ott 111,4 Date of reinspection: �— Date of issuance of certificate: /�f f Date fee paid:_ Type of unit: Dwelling Other Check#. zzq( Check date: a P t f j Notes:LqI�f--t" �VliVle IonYY1 l.J�hS�ou.T -So_.,()rr4j N kir- er� t ea(yn—�1 �� Y�-IVISbQ,G(iD71 `alb ViO�C2fi'� Y �X?�Cn CAiY�CP, Code n ement Inspector 1 � l CITY 0F SALE M, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"`FL(X)R PubI1CHPa1C]1 - e, uent.rmmnec.n:omu�. TEL(978)741-1800 Fax(978) 745-0343 KIMBERLEY DRISCOLL lramdin0salemxom LARRY ItrA MDIN,RS/RFI IS,CI 10,Cl 15 MAYOR HFF,xa:n i AGFN'r CERTIFICATE OF FITNESS POLICY I. A Certificate of Fitness inspection is required for all rental units older than 5 years, per City of Salem ordinance; 2. A Certificate of Fitness is good for 1 year or the life of the tenant, whichever is longer; 3. A Certificate of Fitness inspection may be obtained by calling or coming into the Health Department and requesting an appointment; 4. Appointments must be requested at least 24 hours in advance pending an open j appointment; 5. No "same day' appointments will be granted; 6. All appointments are subject to the schedule of the inspector; 7. A rental unit will be considered occupied when either the previous tenant or the current tenant has belongings in the unit. In the case of an occupied unit, either the tenant whose belongings are in the unit must be present at the time of inspection, OR have signed a release statement allowing the Board of Health to inspect the unit. 8. Please allow at least one week turnaround time for the Certificate to be issued, especially at the end of the month; 9, A Certificate of Fitness will be granted when: a. An inspection has been conducted by a Health Department employee b. An application has been filled out and a check or money order has been received 10. If you have any questions, please contact the Health Department r �t CITY OF SALEM, MASSACHUSETTS BOARD Or HEALTH 120 WASHINGTON S"rRm-n 4°'FLOOR P th er:cane�'ramo«.vmme�. - TEL. (978) 741-1800 FAX(978) 745-0343 KIMMKLEYDRISCOLL Iramdin@salern.com MAYOR L,�1usv xAn11a1N,1is/xt�,[rs,r:r+o,cr-ins H[,u:1t t t1t,rN t Release In accordance with Massachusetts General Laws Chapter 111; Code of Massachusetts Regulations 410.000 et. Seq. ; State Sanitary Code Chapter II and Article XIII of the City of Salem Ordinance, undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health or its authorized agents to inspect the residence identified below in accordance with the aforementioned statutes, regulations and ordinances. In the event it is necessary that said inspection be done in my/out absence. Ilwe expressly authorized the same and for my/our successors and assigns hereby release and discharge the City of Salem Salem Board of Health and its authorized agents from any lose or injury sustained of whatever nature and description occasioned by my/out absence during said inspection. �l/�/�V�C. Vi�t�tJ✓ Tenant/Lessee Owner/Lessor Address Address 1AIq_ C2� S Address on unit to be inspected Date Updated 5/23111 CERT.# 728-00 FEE $25.00 DATE: 11/17/2000 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: 416 Essex Street UNIT #: 1 OWNER/AGENT: Laverne Saunders ADDRESS: 416 Essex Street #2 CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 740-2462 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 JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR ,��ownrry 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 Fax: (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 414. E ss tx S t7eet _-UNIT#— IS THIS UNIT DESIGNATED AS RIGHT LEFT FRON BACK PLEASE CIRCLE ONE OWNER/LESSER Lavcrnk S2ua j_e MANAGER/AGENT ._ No P.O. Box No P.O.Box ADDRESS.iErb Esscx S{- & 2- ADDRESS_ CITY Saler AA oto? v CITY RESIDENCEPHONE Q78- '!'+v-9,+(,zBUSINESSPHONE (24HRS.) BUSINESS PHONE `t t S 5 Y 2 - toz3 7 TOTAL NUMBER OF ROOMS: 5 ROOM USE: 1. 2._3.__4. i 5._6._T_ 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 00 � i1. dtA. j DATE /Ih7loy INSPECTORS USE ONLY DATE OF INITIAL INSPECTION DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE:// --I `fir DATE FEE PAID: ,� l - -L) ' TYPE OF UNIT: DWELLING j,LOTHER— CHECK#_ 3! CHECK DATE�Zt�' NOTES: /� CODE ENFORCEMENT INSPECTOR 9/28/98 f � City of Salem, Massachusetts Board of Health 120 Washington Street, 4th Floor, Salem, PablicHealth MA01970 Prevent.Promote. Protect. Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, REHS,CHO Mayor health@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE#: GHL-16.323 DATE ISSUED: 8/26/2016 Property Located at: 418 ESSEX STREET UNIT#1 Owner/Agent: Sao Wal Lao Address: 418 Essex Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(978) 876-4020 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. Note: This approval does not certify compliance with the state lead law for occupants under 6 years of age. JAJr Larry Ramdin, MPH, REHS, CHO HEALTH AGENT SANITARIAN . r o CITY OF SALEM, MASSACHUSETTS BOARD OF HE--),LTH "—� 120 WASHINGTON STREF_T,4`.. FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOL L FAX (978) 745-0343 MAYOR LRA 1DLNrS-V,EM.00M LARRY RANIDIN,RS/REFIS,C:HO,CP-FS _ HF.,Aun--I AG FNT - 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 7! ST UNIT#_�— IS THIS UNIT DISIGNATED AS RIGHT LEFT' RONT OR BACK,PLEASE CIRCLE ONE OWNER/LESSERSho W41 /--0 MANAGER/AGENT S'7EFAAJL6 SET ADDRESS y/� SSex ST ADDRESS �2 CHuRC �1 CITY, STATE,ZIP :-S"1Z . Mff 019 R) CITY, STATE,ZIP <SM6&P7, RESIDENCE PHONE !2R,? -V 4 �Q, BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: s ROOMUSE: 1 I-IWN/T 2 61AIIP& 3 KIrfFIGN 4 nM&Mt`,RYABt Z 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 �� WR l J'�r� DATE Inspectors use only Date on initial inspection: S'/)-016 Date of reinspection: Date of issuance of certificate Date fee paidQ �&V _ Type of unit: Dwellin Other Check#_Check date: 01V-2. ee.019 Notes: 4d1A.1,11Axez"/ C d n rcement Spector CITY OF SALEM MASSACHUSETTS eta BOARD OF HEALTH 120 WASHINGTON STREET,4." FI,O(.)R TEL. (978) 741-1800 KIMBERLEY DRISCOI,L FAX (978) 745-0343 MAYOR 1 AN1D1N&ALEM.CO LARRY RA IDIN,RS/RP:HS,CHO,CP-FS I-IEAlxvi AGli:NT Release In accordance with Massachusetts General Laws Chapter 111; Code of Massachusetts Regulations 410.000 et. Seq. ; State Sanitary Code Chapter II and Article XIII of the City of Salem Ordinance, undersigned owner/lessor and tenant/lessee of a unit of residential property,hereby authorize the Salem Board of Health or its authorized agents to inspect the residence identified below in accordance with the aforementioned statutes, regulations and ordinances. In the event it is necessary that said inspection be done in my/out absence. I/we expressly authorized the same and for my/our successors and assigns hereby release and discharge the City of Salem, Salem Board of Health and its authorized agents from any lose or injury sustained of whatever nature and description occasioned by my/out absence during said inspection. Tenant/Lessee Owner/Lessor !9/R Essex ST, - Address Address yi g E�ss�x ST sy9ffJ)9, M,* Address on unit to be inspected Date Updated 5/23/11 r oND>s" City of Salem, Massachusetts r. ; y9 Board of Health 120 Washington Street, 4th Floor, Salem, PublicHealth M ,D Prevent Promote. Protect. MA 01970 Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 7451-0343 1 Larry Ramdin, MPH, REHS, CHO Mayor Iramdin@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE#: GHL-15-158 DATE ISSUED: 7/6/2015 Property Located at: 420 ESSEX STREET UNIT#3 Owner/Agent: John Hickey Address: 104 Simpson Drive City/Town: Framingham, MA Zip Code: 01701 24 Hour Phone:(757) 685-9094 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 Larry Ramdin, MPH, REHS, CHO HEALTH AGENT SANIT AN V • CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH ' 120 WASHINGTON STREET,4"'FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR LRAMDINQa SALEM.COM LARRY RAMEIN,RS/RENS,CHO,CP-FS HEALTH AGENT Application for Certificate of Fitness IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" FEE: $50.00 PROPERTY LOCATED AT `T �fi UNIT#� IS THIS UMT DLSIGNATED AS RIGHT LEFT FRONT OR HACK PLEASEiCIRCLE ONE OWNER/LESSERI MANAGER/AGENT NO P.O.BOX r / �+ ADDREss�J -11-f/7S6//rl –Al( ADDRESS CITY,STATE,ZIP �l 'ps q( CITY,STATE,ZIP / 0l/ 701 RESIDENCE PHONE I/J p S • ' BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS:— ROOM OOMS:ROOM USE: 1. 2. 3. [1 t- Q, 4. 5. 6. 7. 8. 9. 10. THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE IS YABLE AT THE TIME OF INSPECTION APPLICANT'S SIGNATURE DATE 1 M Z Inspectors use only Date on initial inspection: CJWP2 .f�25- Date of reinspection: Date of issuance of certificate: o Zl022, 5- Date fee paid: 0 ZLQZV12Z Type of unit: Dwelling_Z—Other Check# 202 Check date: O7Z0 / r Notes: (,See-Affar.W,� Corcement Spector } Inspection of Date Time Name Address y'O Fa$ r-%, F t9r` Owner AmIn Hick�� ((�� Tel. No. ///111��r Type of Inspection lam` r jCvsl'L iii' i{-ne.SS Inspector is - -e, :jje ( ' ( Remarks and Violations are listed below: / Vy iN14AW IVl YZn✓l beIroowi 0.LVMS�tn llee-ds loc 0i4N L FfD-MC GCfavt�d oa��vh Wl�l w ( S �01��e_e�. m'f- re,�n,✓' POSa- (-nLr k;}c .i, .5Ink 1's! IP Livia, L l V f nq mom windowy1Q4swl_-�p0Q wav L$ et-Ln liar 15x1 MOA Ap- J,.6, o,r s l„rr r r, f - - c r Report Received by: CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4'FLOORp11t1�CHP.81th ple.,M.erumms.P, ,�a. TEL. (978) 741-1800 FAx(978) 745-0343 KIMBERLEY DRISCOLL lxamdin(,salem.com LkxRY IzAn[uIN,xs/x[�a-Is,cl Io,c:r_rs MAYOR H v.IT AGF,NT CERTIFICATE OF FITNESS CERTIFICATE#428-13 DATE ISSUED: 12/18/2013 Property Located at: 420 Essex Street UNIT#1 Owner/Agent: John Hickey Address: 1312 Hillside Avenue City/Town: Chesapeake, VA Zip Code: 23322 24 Hour Phone: 757-685-9094 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 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 LA* HEALTH AGENT ANITARIAN I P t' Crit'OF SALEM, MASSACHUSETTS BtI.=or•Hmumt 120 W.irl uNun-ox SI'Rrm,4"'RXXIR Ttl1_OM 741-1800 k1Aw I.h•Y mlct:Al.(. F.ix(979)745-043 1YOIt liA �'�ithau lEms-mu! ^�L�Illi 1:171 a1:1?V'1' II,VJ14 Irl � /l.� V \J Appliesdon for Certificate of Moen in I ACCORDANCE WITH STATE SANITARY CODE,CHAPTER 11, 105 CMR 416.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" FEE:S50.00 PROPERTY TED AT flab ALfrfes�4 s Open /77.1- UNfrn = -�IS THI$' YT O15=AT[D AS RIOIIT j U MOW OR7AG L6ASS CIRCLE ON6 OWNERILESS$R V��h /r ` '� �Y' MANAG ADDRESS f, Ion � GS%�� /7Kt/2 DRESS /'1/Y L ltiu �f S F •ate CITY,STAT / E.,W-c&;,$ ��c'� cnv.STAM 71P RESIDENCE P�ONp % ®`r 3y8p BUSINESS PHONE(24HRS BUSINESS PHbNE TOTAL"EK OF ROOMS- l ROOM USE: i y�/k 4 k THERE IS A FIFTY($50)D01yLAR PAY E BY CHECK OR MONEY OR DER TO HE CITY OF SALEM BOARD OF KtALTH THUS FEE A ?THE INSPECTION APPLICANT-0 SIONAT DATE ��/� Instlectora use only Date on initial i*pection, Pateof Ion Date of K%moO Of eeaifiwto: Date fee pi ' Type of unit: DvMfing,Othar Check N0001 data. I Notes I i I Code Hnfolcemont Inspects' i i i , CITY OF SALEM, MASSACHUSETTS BOARD a IFHr•..1LTFi 1�)W,i5lILVl7rl IK S1nra:r,a"�Flsn ut Mil.(978)741-1800 KIMARRLKY DRISCO L F.t%(978)745.0343 i.muty R.1\a)I\,m/RMI LC,1:l 1 IR.11 I l AL WN r �LhEl6e In accordance with Massachusetts General Laws Chapter 111;Cade of Massachusetts Regulations 410.000 el.Seq. ; State Sanitary Code Chapter 11 and Article XIII of the City of Salem Ordinanoe,undersigned owner/lessor and tenanthessee of a unit of residential property,hereby authorize the Salem Board of Health or its and orized agents to inspect the residence identified below in a000rdanoe with the aforementionod statutes,nutations and ordinances. In the everit it is necessary that said inspection be done in my/out abmcc.Uwe expressly authorized die some and for my/our successors and assigns hereby release end discharge the City of Salem,Salam hoard of}health and its authorized agents&nm any laze or itqury sustained of whatever nature and description occasioned by mylout absence during said inspection. '% /fin /`te t✓ Tenanva essa Owrox/Lessor A Wass Address U + � I out to be mpoetcd to cnsrbnl ',i CITY OF SALEM9 MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA O 1970 9q TEL. 978-741-1800 p FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#: 451-03 DATE ISSUED: 8/28/2003 Property Located at:: 420 Essex Street UNIT#: 1 Right Owner/Agent: John Hickey Address: 1 Andrews Farm Road City/Town: Boxford, MA Zip Code: 01921 24 Hour Phone: 978-887-3505 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. 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. 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 9 6 lzdjv� Joanne Scott, MPH, RS, CHO Health Agent CODE ENFORCEMENT INSPECTOR 1{ CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR /C . SALEM, MA 01 970 TEL. 978-741-1800 l 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 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT %?D ZS�,PK Sf UNIT# IS THIS UNIT DESIGNATED /REFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER u k n !-/IGH lLkez MANAGER/AGENT No P.O. Box �f � r No P.O. Box �L ADDRESSr /�;I�^,er?ADDRESS CITY 6,0X rbrd i fW,44:S CITY RESIDENCE PHONE 976 987-?of BUSINESS PHONE (24 HRS.) BUSINESS PHONE_ 79/ Jit-d Y.9g TOTAL NUMBER OF ROOMS: r ROOM USE: 1.4�( 2, 10<kryrr 5Xt�C � 6. 7. 8. THERE IS A TWENTY-FIVE($25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF S EALT DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. APPLICANTS SIGNATU DATE P/-7/3 INSPECTORS USE ONLY DATE OF INITIAL INSPECTION r' -D & - 0 3 DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATEDATE FEE PAID: TYPE OF UNIT: DWELLINGS/OTHER_ CHECK# S-G CHECK DATE `43 NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 t CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH r 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 Illi ill RELEASE In accordance with Massachusetts General Laws Chapter III ; Code of Massachusetts Regulations 410.000 et. seq. ; State Sanitary Code Chapter It and Article XIII of the Cit; of Salem Ordinance, undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health or its author- ized agents to inspect the residence idents_vied below in accordance with the aforementioned statutes, regulations and ordinances. In the event it is necessary that said inspection be done in my/our absence, !/we expressly authorize the same and for my/our successors and assigns hereby release i and discharge the City of Salem, Salem Board of Health and its authorized age^.'ts from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. C' ';R/11,ESSOR4V1— ----- l t DRESS K—DDRESS I 5DRESS OTTKFIT TO BIs INSPECTED DAVE I I f CITY OF SALEM, MASSACHUSETTS * BOARD OF HEAi,TFI 120 WASHINGTON STREL-r,4"'F1:..00R TEL. (978)741-1800 KIMBERLE.Y DRISC:OLL FAx(978) 745-0343 MAYOR LMANCiNIC &U-M.CON1 JANE:I'MAN(W ACIING HFAmi i.AGI N'r CERTIFICATE OF FITNESS CERTIFICATE# 100-09 DATE ISSUED: 212412009 Properly Located at: 420 Essex Street UNIT#2 Owner/Agent: John Hickey Address: 1 Andrews Farm Road Cityt7own: Boxford, MA Zip Code: 01921 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 Cade Enforcement Division of the Salem Board of Health and the unit may now be rented and/or occupied. Maximum Number of occupants, must comply with 105 CMR 410.000. Certificate valid for one year from date of issuance or until the current tenant vacates, whichever is later. This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy. FOR THE BOARD OF HEALTH I NET MANCINI ACTING HEALTH AGENT CODE ENFORCEMENT IMPECTOR { ✓ CITY OF SALEM, MASSACHUSETTS + f ; BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FAx(978)745-0343 MAYOR I_DIQNNE&ALIsM COM JANET DIONNE, ACTING 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." ,/1 FEE: $50.00 PROPERTY LOCATED AT /ab 4ysex_ _S�7 UNPf# /LI__S THIS UNIT,,DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE OWNERILESSER MANAGER/AGENT_,... NO P.O. BOX ADDRESS ADDRESS --Z AE�er-�fi'f�ryt 2Q CITY, STATE,ZIP CITY, STATE,ZIP rf6K /E,-c/ /?71 Cil gdr RESIDENCE PHONE X749 ��6� DS ad BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: S_ ROOM USE: IA/411kf 2 /J/k.<kk^ 3. 1 f i�r/+ 4, 6. 7. 8. 9. 1.0. THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE IS'P AT THE TjA,4E OF INSPECTION APPLICANT'S SIGNATURE _ _ DATE a �� Iz _rs use only Date on initial inspection: Date of reinspection: Date of issuance of certificate: 2 -Li 'o Date fee paid: Z- Type of unit: Dwelling V�_ Other Check# I &b 3 Check date: Notes: Code Enforcement ctor CITY OF SALEM, MASSACHUSETTS ® BOARD OF HEALTH 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#528-06 DATE ISSUED: 10/30/2006 Property Located at: 420 Essex Street UNIT#3 Owner/Agent: John Hickey Address: 1 Andrews Farm Road City/Town: Boxford, MA Zip Code: 01921 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 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 � 1, JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CRY OF SALJZM, MASjAC>HUSE TS BOARD OF HEALTH 120 WASHINGTON STREET, ATH FLOOR 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 D SseyC S7UNIT # 3_- IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNERILESSER. Z-0k t,^j4fGkey _MANAGERIAGENT((4_�� No P,O. Box No P.O. BOX r ADDRESS ftr �`? __ADDRESSZ Gr/1CS FP�JG/�I 1.7 CITY � �/// o/gdt_CITY �bdG/'a'i1 /67 dl g RESIDENCE PHONE-?t4_887'2C�rBUSINESS PHONE (24 I BUSINESSPHONE /788�7'.3S�DS TOTAL NUMBER OF ROOM&__— _ JI ROOM USE: 1,."40W4-k A*+e c THERE IS A TWENTY-FIVE ($25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SAL EALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION, APPLICANTS SIGNATURt;WPEC "__ DATE SDA` _4 Y Qom; OF 1N1_T Af_IN1a_RECTION_fb `3p" F DATF OF RCINSPFCTION DATE OF ISSUANCE OF CERTiFiCATFIi/ -0"=t DATE FEE PAIL) . TYPE OF UNIT: DWEI.L11�1� OTHER. - CHE:CK I! p� CHLCK LAI C NOTES �' �� G,ODE FNFORGf_MFN1 IiJ;'.;I'LC;TOH III CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 WWW.SALEM.COM Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO Mayor HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#492-06 DATE ISSUED: 10/1312006 Property Located at: 434 Essex Street UNIT#2L Owner/Agent: Wayne J. Scott Address: 505 Paradise Road#14 CityTTown: Swampscott, MA Zip Code: 01907 24 Hour Phone: 617-413-1922 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. OOARD OF HEALTH HE JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR Crry OF SALEM, MASSACHUSETTS -0 ` BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR 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 it, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT_�Z IS THIS UNIT DESIGNATED AS RIGHT EFT FRONT BACK PLEASE CIRCLE ONE OWNERILESSERAgi"�MANAGER/AGENT No P.O. Box fOl No P.O.Box ADDRESS y—G. �.��ADDRESS —____ CITY RESIDENCE PHONEBUSINESS PHONE (24 HRS)4�-_�/J_7%1� BUSINESS PHONE _ TOTAL NUMBER OF ROOMS:__< u ROOM USE: 1. THERE IS A TWENTY-FIVE($25.o0) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. j� / APPLICAN 1-S SIGNATURE -� —= `- - - — DATE_LI� U -- INSPECTORS U ONLY DATE OF INITIAL INSPECTION/V-13_.:wi 0_,_ PATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE/p_-/1 _DATE FEE PAID `D ' TYPE OF UNIT: DWELLING OTHER, _ CHECK II CHECK DATE NOTES. CODE ENFORCEMENT INSPECTOR 9/28,198 i CITY OF SALEM, MASSACHUSETTS o ; 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 JOANNE SCOTT, MPH, RS, CHO Mayor HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#491-06 DATE ISSUED: 10/13/2006 Property Located at: 434 Essex Street UNIT#2R Owner/Agent: Wayne Scott Address: 505 Paradise Road #14 City/Town: Swampscott, MA Zip Code: 01907 24 Hour Phone: 617-413-1922 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. ORTHEBOARH / JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR t C!CY OF SALEM, MASSACtiUSE7"f S BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1 SOO FAX 979-745-0343 JOANNE SCOTT, MPH, R5, CHO Kimberley Driscoll HEALTH AGENT Mayor APPLICATION FOR CERTIFICATE OF FITNESS IN ACCORDANCE WITH STATE SANITARY CODE,CHAPTER If, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT ` UNIT #�4 IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER(LESSER� J! MANAGER/AGENT _ No P.O. Box No P.O.Box ADDRESS Yn A,2, io _�ADDRESS� CITY_ CITY RESIDENCE PHONE_ _—BUSINESS PHONE (24 HRS. ! 42, — BUSINESS PHONE TOTAL NUMBER OF ROOMS:_ iROOM USE: 1..-- — - 2.-_ ----5 -- ---- -4 - ---- 5.----6.----7. --6------- THERE IS A TWENTY-FIVE($25.40) OLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. APPLICANTS SIGNATUREr DATE lNSP CT�SE ONLY DATE OF INITIAL INSPECTION l 1 O _ ,DATE OF RE!NSPECTiON DATE OF ISSUANCE OF CERTIFICATE.f6.'� _ /' DATE FEE PAID.__f TYPE OF UNIT: DWELLIN OTHER, CHECK 0 j t CHECK DATE NOTES:__ .-.. ✓` CODE ENFORCEMENT INSPECT OR 912k119 wa' - Co CITY OF SALEM, MASSACHUSETTS 3v �! BOARD OF HEALTH s 120 WASHINGTON STREET, 4TH FLOOR ry^N o' SALEM, MA 01970 9g4hMB1' TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#421-05 DATE ISSUED: 7/8/05 Property Located at: 434 Essex Street UNIT#3L Owner/Agent: Wayne J. Scott Address: 505 Paradise Road City/Town: Swampscott, MA Zip Code: 01907 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 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 JO NE SCOTT, MPH, RS, CHO / HEALTH AGENT CODE ENFORCEMENT INSPECTOR { i qa CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH Tau 120 WASHINGTOFI STREET, ATH FLOOR SALEM, MA 01970 TEL. 978.741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO OL •✓ 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". 5lISPROPERTY LOCATED AT � ,6 'i' UNIT #5Z— IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER(� LtJ AMANAGER/AGENT� _ No P.O. Box No P.O. Bax ADDRES/Si�ADDRESS CITY_ t^ _ clTv RESIDENCE PHONE �Ag__6USINESS PHONE (24 HRS.)-- BUSINESS PHONE TOT AL NUMBER OF ROOMS_ ROOM USE: THERE IS A TWENTY-FIVE($25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM HEAI.TH DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. APPLICANTS SIGNATURE —_-DATE INSPEC ORS : ONLY DATE OF INITIAL INSPECTION_€ 't_ C� - DATE OF REINSPFCTION..__ DATE OF ISSUANCE OF CERTIFICATE _DATE FEE PAID: TYPE OF UNIT OWELLIN Ol"HER CHECK ✓< CHECK DATE NOTFS CODE ENFORCEMENT INSPFCTOR 9/21B/98 CITY OF SALEM, MASSACHUSETTS c fe BOARD OF HEALTH / 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 W W W.SALEM.COM Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO Mayor HEALTH AGENT — CERTIFICATE OF FITNESS CERTIFICATE#45-06 DATE ISSUED: 2/9/06 Property Located at: 434 Essex Street UNIT#3R Owner/Agent: Wayne J. Scott Address: 505 Paradise Road City/Town: Swampscott, MA Zip Code: 01907 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 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 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CPCY OF SALEM, MASSACHUSETTS • 60ARD OF HEALTH • i 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 976-741-1800 FAX 978-745-0343 �^ STANLEY USOVIC2, JR. 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 HA B ITATION" . PROPERTY LOCATED AT 7 3 lQ/ }/ _ UNIT H�� IS THIS UNIT DESIGNATED AS RIGHTLEFTFRONT BACK PLEASE CIRCLE ONE OWNERJLESSER_: 60 MANAGERIAGENT No P.O. Bax / /, No P.O.Box ADDRESS '�� .pav /iJe !/(.G _ADDRESS_, CITY_ ,✓ wG CITY_� rl RESIDENCE PHONED ! BUSINESS PHONE (24 HRS.)_._ BUSINESS PHONE TOTAL NUMBER OF ROOMS:_ ROOM USE: 1. 2. ._3L_4___ 5. 6... 7_ `a• THERE IS A TWENTY-FIVE($25,00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM HEALTH DEPAR NT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. , 19 APPLICANTS SIGNATURE — --DATE 1 ✓1 INSPECTORS USE .NLY DATE OF INITIAL INSPECTION o� _DATE OF REINSPECTION,______,__.. DATE OF ISSUANCE OF CERTIFICATE,_ . _ DATE FEE PAID TYPE OF UNIT DWELLIt�C�/- OTHER _ CHECK k_1. CHECK DATE NOTES I _ CODE ENFORCFMEN`I- INSPECTOR 9128/98