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FAIRMOUNT STREET CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH a 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#244-06 DATE ISSUED: 5/16/06 Property Located at: 3 Fairmount Street UNIT# House Owner/Agent: Bruce & SallyJo Cody Address: 21 Hemenway Road 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 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 '6 C r/tom JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS 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 II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED ATZi2IylO Q/ STi�EG T UNIT 11 wig IST IS UNIT DESIGNATED AS RIGH,T/ LEFT FRONT BACK PLEASE CIRCLE ONE O EWLES ERLL1cA0 ed�7Y MANAGER/AGENT Box No P.O. Box ADDRESS E/VLt//�E/ /C06JA__7ADDRESS CITY � ��rr, OXOM713 CITY RESIDENCE PHONE.97.Y�y// BUSINESS PHONE (24 HRS.) BUSINESS PHONE�L?1?7� TOTAL NUMBER OF ROOMS: " </v/"l� l7ip/i ,77H• FAhi�G ROOM USE: 1. —�2. 3. 4. 67fi , a�7?y J THERE IS A TWENTY-FIVE($25.00) DOLLAR FEE, PAYABLE BY CHE R-MONEY ORDER TO THE CITY OF SALEM HEjkLTH DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. APPLICANTS SIGNATUE DAT /�'� INSPECTORS USE OIZY DATE OF INITIAL INSPECTIONDATE OF REINSPECTION -0/, DATE OF ISSUANCE OF CERTIFICATES-1 G DATE FEE PAID: TYPE OF UNIT: DWELLIN OTHER_ CHECK# a rS— CHECK DATE- -i d-6 boort. NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 CITY OF SALEM, MASSACHUSETTS a 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# 198-06 DATE ISSUED: 4/20/06 Property Located at: 31-33 Fairmount Street UNIT#2 Owner/Agent: Joseph L'Heureux Address: 11 Intervale Road City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 744-6751 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 i9 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR SlILE7. NI;: ;CHUSLOM HOARD OF HEALTH 120 WASHINGTON STREET,4TH FLOOR SAL£M.MA 01970 TCL. 970-741-1800 �(/"� j FAX 97874S-0343 STANLEY USO"CZ,JR. ,JOANNE SCOTT, MPH, RS, CHO - MAYOR HEALTH AGENT i APPLICATION FOR CERTIFICATE OF FITNESS IN ACCORDANCE WITH STATE SANITARY CODE,CHAPTER It, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FO HUMAN HABITATION'. '} PROPERTY LOCATED AT1c #C � i IS THIS UNIT DESIGNATED AS RIGHT LEFT E-RONT BACK PLEASE CIRCLE ONE OWNERlLESSE �(2t3 �1ANAGERIAGENT No P.O. Bax No P.O.Box ADDRESS �n /� icy { --ADDRESS CITY 1 y 1 t ) t {� CITY RESIDENCE PHONaap uls3 ISINESS PHONE (24 HRS.)i_. BUSINESS PHONE TOTAL NUMBER OF ROOMS:_V ROOM USE: S. THERE IS A TWENTY-FIVE($25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF S HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. APPLICANTS SIGNATURE INSPECTORS USF ONLY DATE OF INITIAL INSPECTION �f�a A ` a DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATF Y-d"O DATL FFF PAID '7' TYPE OF UNITDWLLHNGX o l H[_:R CHECK t CI-i[CK DATE —0-0 NO1ES, 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 3/6/06 Joseph P. L'Heureux 16 Mason Street Salem, MA 01970 PROPERTY LOCATED AT 31 Fairmont 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. 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. ,Fqr the Board of HeajifiI Reply to oanne Scott MPH, RS, CHO Pablo Valdez Health Agent Code Enforcement Inspector 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 6/15/05 Joseph L'Heureux 16 Mason Street Salem, MA 01970 PROPERTY LOCATED AT 31 Fairmount 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 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. For the Board of HH alg th Reply to Joanne Scott MPH, RS, CHO Pablo Valdez Health Agent Code Enforcement Inspector I � 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 2/8/06 Suchand Pingli 26 Borroughs Street#1 Danvers, MA 01923 PROPERTY LOCATED AT 34 Fairmount 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. 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 I inspection. A property owner is required to pay gas and electricity for residential tenants if there is not a written letting j 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 r the Board of He h Reply to LYoanne Scott MPH, RS, CHO Pablo Valdez Health Agent Cade Enforcement Inspector r .. CITY OF SALEM, MASSACHUSETTS s]! BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR r 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#46-05 DATE ISSUED: 2/3/05 Property Located at: 34 Fairmount Street UNIT# 1 Owner/Agent: Suchand Pingli Address: 26 Borroughs Street#1 City/Town: Danvers, MA Zip Code: 01923 24 Hour Phone: 617-306-9180 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 s V -- JOANNE SCOTT, MPH, RS, CHO A f' arl HEALTH AGENT CODE ENFORCEMENT INSPECTOR k CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • • 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 - STANLEY LISOVICZ, JR. / JOANNE SCOTT, MPH. 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 J UNIT # IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER 6Cd/,r,/id pTjrQj7 MANAGER/AGENT_yy)_� D'V No P.O. Box / No P.O. Box I ADDRESS ADDRESS �L S S� • J ADDRESS CITY 'Q,,H/S Nl acio CITY \3 RESIDENCE PHONE_ BUSINESS PHONE (24 FIRS)���V BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1. \I---- 2.------3.-------- _4.------- THERE IS A TWENTY-FIVE (S25.00) 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 �AG�� _ _ DAT INSPECTORS USE ONLY DATE OF INITIAL INSPECTION DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATES DATE F/ESE PAID __ �_ 0- .-. D )/ TYPE OF UNIT: DWELLING-�OTHER CHECK +l S CHECK DATE NOTES /1\ ((( CODE ENFORCEMENT INSPECTOR 9/213/98 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 CERTIFICATE OF FITNESS CERTIFICATE#45-05 DATE ISSUED: 2/3/05 Property Located at: 34 Fairmount Street UNIT#2 Owner/Agent: Suchand Pingli Address: 26 Borroughs Street#1 City/Town: Danvers, MA Zip Code: 01923 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 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 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT COD EAORCEMENT INSPECTOIT 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 i APPLICATION FOR CERTIFICATE OF FITNESS IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITA '.. PROPERTY LOCATED AT 3 (�I R M /1 ( UNIT#6� IS THIS UNIT DESIGNATED ASRIGHTLEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER g ✓IL C9Wa MANAGER/AGENT dNWA) No P.O. Box No P.O. Box ADDRESS o2� 0.xJ �t"v�, ��/ ADDRESS 17 Lj l Q E� CITY AA-3 CITY 26�A , RESIDENCE PHONE 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 H7R;— EN7—DATE FEE IS PAYABLE AT THE TIME OF INSPECTION. fi APPLICANTS SIGNATURE v V INSPECTORS USE ONLY DATE OF INITIAL INSPECTION / -/-S -U S ___DATE OF REINSPECTION__ DATE OF ISSUANCE OF CERTIFICATE: -P-)___DATE FEE PAID:_ - C> TYPE OF UNIT: DWELLING -((OTHER__- CHECK #_S 0 __.CHECK DA_ � NOTES:— /� - - - — CODE ENFORCEMENT INSPECTOR 9/28/98 CERT.# 384-99 gr e, FEE $25.00 f DATE: 07/26/99 ����nverP 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: 41 Fairmount Street UNIT #: 1 Rear OWNER/AGENT: Rena E. Wilkins ADDRESS: 41 Fairmount Street #1 CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-4736 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 _ ode XOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR R 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)Tai-iaoo 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 LII tta y`mnana _ UNIT#-1 s IS THIS UNIT DESIGNATED AS RIGHT T RON AC PLEASE CIRCLE ONE OWNER/LESSER ° MANAGER/AGENT No P.O. Box P.O. Box ADDRESS DDRESS CITY CITY, , RESIDENCE PHONE L `SINESS PHONE (24 HRS.) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1. IL 2. 3. 1' 4. � T 5. 6. 7. 8. THERE IS A TWENTY-FIVE($25.00)DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM H ALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. APPLICANTS SIGNATURE ��. C&A, DATE�_�g INSPECTORS USE ONLY DATE OF INITIAL INSPECTION '—tet l( DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: 74 6 -fj DATE FEE PAID: 7–.), 6 --�' F C TYPE OF UNIT: DWELLING OTHER_ CHECK#� !CHECK DATE-�b ' / NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 1 i i 6 3 tjrp 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 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 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 identified 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, i_/we expressly authorize 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 loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. ?f'YgA T/ ESS E UWfIE_ /LESSOR ADDRESS ADDRESS ADD ES. OF UNIT IO BE INSPECTED DATE' DATE gCo� CERT.# 385-99 n FEE $25.00 DATE: 07/26/99 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: 41 Fairmount Street UNIT #: 2 OWNER/AGENT: Rena E. Wilkins ADDRESS: 41 Fairmount Street #1 CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-4736 AN INSPECTION OFIYOUR 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 -�J�OTT, 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 APPLICATION FOR CERTIFICATE OF FITNESS Tee(978)741-1800 Fax: (978)740-9705 IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT 4LI � D(,�j -�1 UNIT# a IS THIS UNIT DESIGNA AS RI HT LEFT FRONT BACK PLEASE CIRCLE ONE r OWNER/LESSER - R/AGENT No P.O. Box [z �� f10 P.O. Box ADDRESS _��y�ry�q�oN1 ADDRESS CITY CITY � RESIDENCE PHONE? ' BUSINESS PHONE (24 HRS.) BUSINESS PHONE • TOTAL NUMBER OF ROOMS: ROOM USE: 1. Itl__ 5. 6.-7.-8. THERE IS A TWENTY-FIVE($25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM IjkALTH DEPARTMENT THIS FEE IS PAYABLE AT THE ` TIME OF INSPECTION. ,1 gip APPLICANTS SIGNATURE c DATE / CJ INSPECTORS USE ONLY DATE OF INITIAL INSPECTION? a-6 —4F DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE:? b ft DATE FEE PAID:�� ¢ TYPE OF UNIT: DWELLINGOTHER_ CHECK# a VCHECK DATE —Q-6 1r f NOTES: / CODE ENFORCEMENT INSPECTOR 9/28/98 a 1j�lp 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 RELEASE In accordance with Massachusetts General Laws Chapter III ; Code of Massachusetts Regulations 410.000 et. seq. ; State Sanitary Code Chapter II 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 identified 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 and discharge the City of Salem, Salem Board of Health and its authorized agents from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. TENANT/LESSEE W R/LESSOR ADDRESS ADDRESS ADDRESS OF UNIT TO BE INSPECIED DA3E /