FIRST STREET ��.
CERT.# 475-97
3 FEE $25.00
DATE: 07/21/97
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET
HEALTH AGENT Tel: (508)741-1800
Fax: (508)740-9705
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 2 First Street UNIT #: 15D
OWNER/AGENT: Quarry Square Realty Trust
ADDRESS: 290 Eliot Street
CITY/TOWN: Ashland, MA ZIP CODE: 01721 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 HEALTH DEPARTMENT AND THE UNIT MAY NOW BE RENTED AND/OR OCCUPIED.
MAXIMUM NUMBER OF OCCUPANTS, BASED ON 105 CMR 410 .000 : MASSACHUSETTS STATE
SANITARY CODE, CHAPTER II, "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" .
SECTION 410.400 (B) : DWELLING UNIT (X) AND 410 .400 (C) : ROOMING UNIT
MINIMUM SQUARE FOOTAGE FOR SLEEPING PURPOSES: .
NOTE: THIS APPROVAL DOES NOT CERTIFY COMPLIANCE WITH THE STATE LEAD LAW FOR
OCCUPANTS UNDER 6 YEARS OF AGE.
FOR THE BOARD OF HEALTH
qlly-p lx- `"/
JOANNE SCOTT, MPH, RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH,RS,CH6 NINE NORTH STREET
HEALTH AGENT Tei:(508)741-1800
APPLICATION FOR CERTIFICTE OF FITNESS Fax:(508)740-9705
IN ACCORDANCE WITH STATE SANITARY' CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM
STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT UNIT I
701 R/LESSER7�i�� MANACERIAGENT
ADDRESS / � s / S/� f S� ADDRESSS/ �//�} /o 5t
CITY �� / [(il / ( '� a CITY
'RESIDENCE, PHONE BUSINESS PHONE (24 HRS.) e)r '7c;L
BUSINESS PHONE —
TOTAL NUMBER OF ROOMS
ROOM USE: 1. 2. 3. 4 .
5.
THERE IS A TWENTY-FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK OR I40HEY ORDER TO THE
CITY OF SALEM HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TINE OF INSPECTION
APPLICANTS SIGNATURE___ DATE^?
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION: �jJ —� DA'L'E OF REINSPECTION __
DATE OF ISSUANCE OF CERTIFICATE: ,,)L DATE FEE PA ID:
TYPE OF UNIT: DWELLING OTHER
NOTES:
CODE ENFORCEMENT INSPECTOR
9 4'
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
"0A� laubflcHealth
120 WASHINGTON STREET,4"'FLOOR vrcvcm.vromole.r,mzci.
TEL. (978) 741-1800 F.ax(978) 745-0343
PINfBERLEY DRISCOLL 1lamdin e,saleln.com
LARRY R\NIDIN,RS/RP',I-IS,CHO,CY—FS
MAYOR H FAL:H I AC[NT
CERTIFICATE OF FITNESS
CERTIFICATE#421-12
DATE ISSUED: 10/18/2012
Property Located at: 4 First Street UNIT#6004
Owner/Agent: Hawthorne Commons/MIREF Hawthorne LLC
Address: 205 Highland Avenue
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-825-0030
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 RY RAMDIN !
HEALTH AGENT IT
(^may 1 v
GL
CITY OF SALEM, NLIASSACHUSE-ITS
IStzARDt,, IhA11I1
120 W:1SuiNGTory bTRI'_'GT' +t l'Ltx ill
Tubi- O-,8)741-ISO()
KIMBElull-:Y DRISC:OLL F-kx(971;) '745-034:7
MAYOR �a,t fitly u�_i.t u r' ut
LARRY It ANIDIN,12ti f RiSi IS,CI K),U'—PS
FIR;AI:rII Ac;I<"N1'
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 1'1, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION"
FEE: $50.00
1}ROPL•RTYLOCA'CEDArVS� �LIGHT-1
{ ���}��� UNITSI,.�
��lST�Ii-1(5^UN!"1'ITISIGNA`I'$LtBPt+CtUN 4C(t1ACK MASEGfkCLIEON
QWrER Ll S��slgqth��lw�,,,�t MANAG R/AG T,
0BOX
ADNO DRESS._ 1? V Ol�
\ —Ne—,—_AODR1"sS' \
CITY, STATE,ZIP _CITY, STAZE,2IP 1 t tt s ` 1 Q
RESIDENCE P1-IONE- BUSINESS PHONE(24HRS).�
BUSINESS PHONE_,,,, —
TOTAL NUMBER OF ROOMS:._„�_,_
ROOM USE: 1. 2. 3. 4 9,
b 7. _ 8.
THERE IS A FIFTY($50)DOLLAR FEL,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE . FAY LF.AT'IHE J[EFION �{ 1
APPLICAINT'S SIGNATURE DATE_
inspeetarS use only
Date on initial inspection:— /I���_ Data of reinspection:
Date or issuance of curdficate:--, _ pate fee paid:
Type of Unit: DU ell n _ Other _ Chcxk 4 Check date::
Notes:
Code Enforcement Inspector
.... , . ., ,,,. ,r•.,, rr:„.,,_ ,ten
C11YOF SALE'N' t, MASSACHUSE"ITS
B0\R17(ti'HEuU-T)1
120 WAS1(INCTON 4"1 ()(A
Tfl- (918)741-1800
fit t131:ftLLY t)R15Cc:ILI. FAX (9 i A)745-0143
NLAYOI
LARRY RAMNN,16jAW I"',CT 10,(T-VS
HEM!]I J A(;1;N I
Release
In accordance with Massachusetts General Laws Chapter 111;Code of Massachusetts Regulations 410-000 et. SQq, :,
State Sanitary Code Chapter 11 and Article XIfl 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 Ow e•/Lessor
HAwrHORNE COMMONS
205 HIGHLAND AVE.
SALEM,MA 01970
Address Address
Address on urn�to be inspected'
Date
1,P(Lidd
f
uu CITY OF SALEM, MASSACHUS ITS
BOARD OF He-YLTii
120 WASHINGTON STREET,41T[1=1.0OR
TEL. (978) 741-1800
1QMI3I RLLY DRISCOLL FAX (978) 745-0343
MAYOR lramdin(@salcin.com
LARRY R-ANIDIN,RS/RF14S,cno,cr-r•S
HRAI XIl AGIiNT
CERTIFICATE OF FITNESS
CERTIFICATE #407-11
DATE ISSUED: 9/26/2011
Property Located at: 4 First Street UNIT#6008
Owner/Agent: Hawthorne Commons
Address: 205 Highland Avenue
City/Town: Salem Zip Code: 01970 MA 24 Hour Phone: 978-825-0030
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.
FOR THE BOARD OF HEALTH
LARR IN \v`
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEi'vf, NNIASSAUT 5E ITS
�.
120W\SIITJC'lOh 4°i11'.O()lt
-1'F,2:..O78)741-1S(10
KIiSi1iL1UJl ..Y DRISCOLL l;�x(97S) 745-1)343
I,?.R1Y1'1trAMi?:N,ittiJi:I SI-IS,C:1I(7,(,:P-I.W
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR RLMANT HAM'I"A-PION"
LEE$:Q.00
PROPERTY LOCATED AI'--I �J i�..f—'�
ISTDISUNt'1-llMS1GNd'1'S;D d521t:k3,t ja :R'f li}:tON` flit$ACii"MASECIRCLLL)€ E -
UWNERlLrSSI R*I 4TMMX—W) S--_)'IANAGERf AGEi\' '_ LK/
NO P.O. BOX
CITY, STATE,Gil' _.._ CI lY, STATE,
RESIDENCE PTIONF _ BC.s1N1 sS PHONE(2.4MSs _ r�z)J030
BUSINESS.PHONE_ __
TOTAL NUMBER OF ROOMS:_ �L.—
ROOM USL j.3 T.L� 2. 'BPM 3. RCD _ , .,_5:_�I.�t2 C7
THERE IS.A FIFTY(M)DOLLAR fBE,PAYABLE 13Y CHECK OR MONEY ORDER TO THE C11Y OF SALEM
BOARD OF ETFAI- H THIS FEE I: AYABLZ AT T'tiE TINIE OF . SI C'TION (� 1
APPLICANT'S SIUNATURL ,f'-;�<
inspectors use—only
Date on initial inspection:_ ll Unto of r6aspi fction: __
Dain b1'issualrca crf curt'ifiexte::_, _ Datc Eire patd:
Type of unit: DWolling, Other.—______Check;4_a_I _Cheek Jarc:_
Code nfarcet Mill
i Peetur
quo--n TT�1 -'C ;oa
" C1'1Y OF SALEM, MASSACHUSETTS
BOARD OF HE\LI'H
120 WASHINGTON STREliT,4"'FLO()R
I IMBERLEY DRISCOIJ, Tt�L. (978) 741-1840
FAX (978) 745-0343
MAYOR tram n salem com
L AIM)'ILANII)IN,RS/liF1IS,CI 10,(T—FS
HEeAF,1'l I AGI;NT
CERTIFICATE OF FITNESS
CERTIFICATE#409-11
DATE ISSUED: 9/26/2011
Property Located at: 4 First Street. UNIT#6101
Owner/Agent: Hawthorne Commons
Address: 205 Highland Avenue
City/Town: Salem Zip Code: 01970 MA 24 Hour Phone: 978-825-0030
An inspection of your vacant Dwelling/Rooming Unit at the above address has been approved
and is in compliance with 105 CMR 410.000: Massachusetts State Sanitary Code, Chapter II"
Minimum Standards of Fitness for Human Habitation".
Therefore, this Certificate is issued by the Code Enforcement Division of the Salem Board of
Health and the unit may now be rented and/or occupied.
Maximum Number of occupants, must comply with 105 CMR 410.000.
Certificate valid for one year from date of issuance or until the current tenant vacates, whichever
is later.
This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy.
FOR THE BOARD OF HEALTH
I _
LARR
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
l -
j' CITY OF SALEM, MASSACHU'SE TS
�'" ISC1.iRD C.'d'1`G's�f:T'6Y
120 Wji sf IImGTbN STREF,-f,4"`F3.0OR
Tiu-.0)78)741-1,1,00
KIMBI:IUJ'.Y DRLSt OLL FAQ (975) -45-0343
LARRY R,;1NIDt v,R.J/TZ H Is,(]]u'1•€T-I`S
flecervt°
Application for ('ertificate of Fitness
( LTti����,CCORDANCE WITH STATE SANITARY CODE, CHAPTER I1, 105 CMR 4141.000
OF SH�,L�SM "MINIMUM STANDARDS Or FITNESS FOR HUMAN HABITATION"
G1T1' OS 54.00
aaaaa .�.�.
PROPERTY LOCATED AT UNI7'f� /o I
SS T.
UISIGNA'1'<rD Gtl'f �R HACK,Pt,lJASECIRCLR, E
z.
OWNER!LESSER __V& )j _ AANAGERr AGENT
NO P.O. Bolt
ADDRESS ADDRESS �� .
CITY, STATE zIP_. - - _CITY, sTArE,ZIP-Q1m4w&
��t��per/ D
RESILIENCE PHONE---' BUSINESS PHONE(24HRS&0�_t✓l1_�.,.
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:___,_-___
ROOM USE:
1. 2 i r, 3. 4�lud�IM
6.46. 17. &. 9. 10.
THERE IS A FIFTY($50) DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CI'T'Y OF SALEM
BOARD OF HEALTH THIS FEE IS PAYABLE AT Tlgl TIME OF INSPECTION
APPLICAN'T'S SIGNATURE _ DArE_ JI
Irks ect rs use only
Date on initial inspection:_•,_ / 1 _ Datc of reinspection:
Date of issuance of ct»xfifiemte:� ( / Dare fee paid:
Type of unit: Dwelling Other_�Chcwk _ J Check"c: L���__
Noies:
Col Eliorce entlnspecior�
• Y' m k �
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4."FLOORPI1b11CHC81tb 1
v.a.um.v«mo,o.v.mem. i
TEL. (978) 741-1800&�Z(978) 745-0343 i
KIMBERLEY DRISCOLL kamdinnsalem.com
LmtlRY RANNDIN,RS/RE.HS,CHO,CI'-I:TS
MAYOR
HP?A1:1'I-i AG ENT 't
r
i
4
l
CERTIFICATE OF FITNESS
i
CERTIFICATE#470-12
DATE ISSUED: 12/5/2012 i
I
I
Property Located at: 4 First Street UNIT#6102
Owner/Agent: MIREF Hawthorne LLC
Address: 205 Highland Avenue
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-825-0030 I
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
LATZFt'P RAMDIN
HEALTH AGENT SANITARIAN
TRANSMISSION VERIFICATION REPORT
TIME 01/03/2013 02: 55
NAME
FAX 9787450343
TEL 9787411800
SER. # 000BON341991
DATEJIME 01/03 02: 55
FAX NO. /NAME 919784539150
DURATION 00: 00: 36
PAGE(S) 02
RESULT OK
MODE STANDARD
ECM
4 I
r ` CIT'Y OF SALEM, MASSACHUSETTS
B ):\RI>of Huu;rii
120 WASHINGTON STRFFT,4"' FLOOK
117,1'. (978) 741-1800
K1MB1 RI,L:Y Dlt[SCOLL F,\x�)78)745-0343
MAYOR Iramdin@salem.com
1_,Ali.lil'IL,\pIDIN, Its/lwl is,CI It),o -I1
HH•.AM I i AcPNT
Facsimile
Transmittal
To: ..'-& . C 0,
Fax #
RE: Ll �
Date : 1 A 1413 r1
Page(s): including this cover# o�--
Message:
� e
Board of Health News ------------------ ------ ------------ — ---For Your Information
OFFICE HOURS:
Monday, Tuesday, Wednesday 8:00 AM to 4:00 PM
Thursday 8:00 AM to .7:00 PM
Friday 8:00 AM to 12:00 NOON
CITY OF SALEM, LvLNSSACt USff 1S
BOARD 0141•If,:ALill
120 W:+af iiNGTON STRrKf 4"`Fr.c x',t2
Tti.(478)741-180It
I-MMBMUJ. YDRLSCOLL Fz1 ()75)745-0..34:
lw%yoR gptitt7a (v.,f.E? i.c:<rtia
LARRY RAIMIAN,RS f Ri hlti,to tf),(T-!•S
FIVA):rki A(;1',NT
Application for(certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR I70-IMAN HABITATION"
gg
FEE: $50.00
PROPERTY LOCATED AT `i 6i 7�_ S}} ✓i UNIT#
tSTHISIJNt'rOtSIGNATFOASRIGHTI.,Err FRONT 4R CK ^ EASE CIRCLE ONE
OWNER L>ssrizR `� �fl(`{�Q vtANAGERtAGENT 1 �
NO P.O.BOX
CkM ADDRESS_�� _ADDRESS a 4..
CITY,STATE,ZIP Y t� .�� U _CITY,STATE,ZIP ����
RESIDENCE PRONE BT7SJNE55 PHONE(24HRS)�,_r
BUSINESS PHONE ��C-�_00
TOTAL NI.IMBER OF ROOMS:_&,_
ROOM USE: 1•— 2, 3. 4. 5.
6. 7. 8. 4. 10•
THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEAL114 THIS FEE ISP ABLE rl T T t OF LNS ECTION r }
APPLICANT'S SIGNATU DATE I Of
Inspectors use only
Date on initial iuspeetion: _ Date of reinspection:
Date of issuance of certificate: Date fee paid: }
Type of unit: Dwelling Other Check-_ Cheek date: ) 117
Nates: _
Code 7
eme t Inspector
RPS
s ,
CM OP SALEM, I1I SSACHUSET TS
y DoAw or FTr'Jwrl r
I2Ct�iJjs1 tt�c:2rry St'�zre;t'.�4"'t�r.<x�x
Trr- (978)741-1800
KIMWIRLEY DRISCOLL FAX(r,,9)7-t5-0343
''LWOR t R�"•i rn>t
LARRY RA NTI NN',RS/RN IN,C!Jo,CR-JN
HIiA1:111 AGINT
;titelease
In accordance with Massachusetts General Laws Chapter I 1 i; Code of Massachusetts Regulations 410.000 et. Seq.
State Sanitary Code Chapter 11 and Article 70111 of the City of Salem Ordinance, undersigned owner/lessor and
temmt/lessce 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.
I
hi the event it is necessary that said inspection be done in myloat absence. 1/we expressly authorized the same and for
my/our successors and assigns hereby release and dischat ge the City of Salem, Salem Hoard 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.
P 4
TenanftLssee Ownar,'Lessor
k::�Y� eeA�,
S� � C�1� Z �h
Address Address
L4 Opt-. (W)a
__r► WO -70
Address on unit to be inspected
a,.
Date
Glxtukd 323N t
. l
CITY OF SALEM, MASSACHCiSE"ITS
BOARD ou He:Alxl I
120 WAST iiNGTON S'rREF%T,4"' Fl,,UOR
T'ca,. ()78) 741-1840
IQMBERLL:Y DRISCOLL FAX (978) 745-4343
MAYOR Lramdin sglem.com
LARRY RAVOIN,RSJ11.I1-IS,0 10,(.P-FS
HllAI A'j,i AC.IiN'I'
CERTIFICATE OF FITNESS
CERTIFICATE#415-11
DATE ISSUED: 9126/2011
Property Located at: 4 First Street UNIT#6108
Owner/Agent: Hawthorne Commons
Address: 205 Highland Avenue
City/Town: Salem Zip Code: 01970 MA 24 Hour Phone: 978-825-0030
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
LARRY RAMDIN
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
F7:f' x (
m
CITY OF SAJ11,Nf, ,LNYL�,SSAG�I(�'SE'S"J:S
13it-hw(t )1 Flu k 111
120 Wil ';)ITNO1'ON STREC1,4`1:1,001t
TH .(9'f3)741-'IS 00
KINfI3MUJ;-.Y DRIS(I-01.1 FAX(97S) 745-0343
MAYOR
LA RAY RAN11)4N,RS/RFlIS,CI 107 r;P-1.5
fIkG1CCl I AGI>dV['
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, I05 CMR 4M000
"MINIMUM STANDARDS OF F11NESS FOR HUMAN HABITATION"
�/ ( FLE: -50.00
PROPERTY LOCATED AT � J� ru 4�fr UNIT#
IS THIS UNIT BISIGNA rFl)A W F gL0N R iSACK,FL,AsK ewci.L O�E�
OWNERILESSER YHA N --MANAGER AGENT"LOW)
NO P.O. BOX
ADDRESS _ADDRES L
CITY, STATE,ZIP --CITY, STATE,ZIP 6aLLff-i-``" b —9—
RESIDENCE PHONE,., �— Bi7SINESS PHONE(24HRS)C"pl—l3
—11
BUS7NESSPHONE
TOTAL INI MBER OF ROOiu1S: S
ROOM USE: I.b�d, . 2.b fin_ 311�11r1�/YL()I�.
6. 7.
TliERE IS A FIFTY($50)DOLLAR FEE,PAYABLE I3Y CBECK OR MONEY ORDER TO TIME CITY OF SALEiv1
BOARD OF HEAL;1`14 THIS FEL ISP YABLAT T'HE TIPv INSPECTION
APPhICAN'f'S SIGNATURE DATE
Inspectors use only
Date on initial inspection:-- _ Date of reinspection: �_
Date of issuance of certificate: � II _ Date fee paid; 1
Type of unit: Dwelling--�� C3ther� Ch wk ' � __Cheek date:
Notes: { I /( U r II l ,t Ldp tL1 cL�1
ale ni'ar ementlnspector
• CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4".FLOOR
TEL. (978) 741-1800
ICMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR ucnerNBnuu(�su cm.coM
DAVID Gityi.-NBAUM
ACTING Hi;JA :PH A(;uN ,
CERTIFICATE OF FITNESS
CERTIFICATE#655-09
DATE ISSUED: 12/30/2009
Property Located at: 4 First Street UNIT#6106
Owner/Agent: Hawthorne Commons
Address: 205 Highland Avenue
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-825-0030
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
DAVIDUGR
ACTING HEALTH AGENT CODE EN R EMENT INSPECTOR
HP Fax Series 900 Fax History Report for
Plain Paper Fax/Copier Ioanne Scott Salem BOH
978 745 0343
Jan 07 2010 4:OOpm
Last Fax
- Date Time Twe Identification. Duration-- Page&-Result
Tan 7 4:OOpm Sent 919788250097 0:24 1 OK
I
Result:
OK - black and white fax -
CITY OF SALEM, MASSACHUSETTS
a
y, BOARD OF HEALTH
120 WASHINGPON STREET,4 FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR D(;eei�N13AL)M(@SALEN1 COM
DAVID GREENBAUM,
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."
FEE: $50.00 /)
PROPERTY LOCATED AT f S�-P���� UNIT# �y
I)S THIS UNIT DISIGNATED S RIGHT LEFT FRSMT-OR BACK SE CIRCLE ONE
OWNER/LESSER W � ANAGE NT / D
NO P.O. BOX / e DDRESS S l C �- -�. C (✓L
ADDRESS
CITY, STATE,ZIP / �/ ���CITY, STATE,ZIP C� �
RESIDENCE PHONE BUSINESS PHONE(24HRS) ( 7 F—F,�-f " O O 3 G
BUSINESS PHONE
TOTAL NUMBER/ OF ROOMS:
y �
ROOM USE: 1` �'�11-ptn�2.J AL^ 3. erJ 4. 5.
6 8. 9. 10.
THERE IS A FIFTY OLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEAL H THI F E IS PAY LEA THE TIME OF INSPECTION
APPLICANT'S SI A DATE —
Inspectors use only
Date on initial inspection: .6 G Date of reinspection:
Date of issuance of certificate: Ia f Q G 1 Date fee paid: Q G
Type of unit: Dwelling �' Other Check#,s S- O oI VOCheck date: k9 13419 S
Notes: Wf(dity) bp f0 Qy-k 1 (JDA /15/ above 5-ymve—
bU f W J() yvor k -
Code rcement Inspector
CITY OF SALEM, MASSACHUSETTS
• ' • BOARD OF HEALTH
120 WASHINGTON STREET,4"'FLOOR
TFL. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR DG1WkNHAUM@Sn1,Hv1 COM
DAVID GREENBAUM,
ACTING HEALTH AGENT
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 0 ne�r/Lue-ssor
Address Address /�&-- ( 7 U
Address on unit to be inspected
/� - 3b v�
Date
IMPORTANT MESSAGE
• FOR 40's-s
DATE �� TIME .j.��,LP.1Vl.
M
OFW �,6( YlQ �1MYVLJYIS
PHONE
AREA CODE NUMBER EXTENSION
U FAX
U MOBILE
AREA CODE NUMBER TIME TO CALL
TELEPHONED PLEASE CALL
CAME TO SEE YOU WILL CALL AGAIN
WANTS TO SEE YOU RUSH'
RETURNED YOUR CALL WILL FAX TO YOU
MESSAGE
�-�nC.FS ? —'�q�8 gaS �OCF17
SIGNED
FORM 4009
��■YYY���f���� MARE IN U.S.A.
VCITY OF SALEM, MASSACHUSETI'S
BOARD OF HEALTH
120 W ISHINGTON STREET,4°1 FLOOR PublicHeaIth
TEL. (978) 741-1800 FAA.(978) 745-0343
KIMBERL.EY DRISCOLL lramdin@salein.com
L,.v(Rr RAnIDIN,WS/RN is,CI K),cr-rs
MAYOR Hi ALI'IIA(a:N. .
CERTIFICATE OF FITNESS
CERTIFICATE#550-11
DATE ISSUED: 10/3/2011
Property Located at: 4 First Street UNIT#6107
Owner/Agent: Hawthorne Commons
Address: 205 Highland Avenue
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-825-0030
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 `DA
LAR
HEALTH AGENT CODE ENP6RCEMENT INSPECTOR
CITY OF SALENI, MASSACHUSE17S
BOMW H r.!AJ-111
120 W;vsi w,,vGt'o.N,,STRm-.-f',4"'Fix)(At
T[a-(978)741-'k n00
V-1\(9?S) 7/45-0343
MAYOR
I'Almy RA.NII)IN,lks/ftw is,(:I)(),
Application for Certificate of Fitness
IN, ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, LOS CMR 41 0.000
"MINIMUM STANDARDS OF FITNESS FOR HG-,*v]AN HABITATION"
FEE $50.00
PROPERTY LOCATED AT
—6J5� 5�fee.� --UNIT#UWq
IS TOO UNIT DISIGNXI'rD Tsit—Gwr if.Vr FRONT OR BACK PLEASE CIRCLE ONE
OWNER/LESSEKAA(3 1 X `� , Y\� U&ANAGFFJ AGENT UWRQPk�d
NO 11.0, BOX —ADDRESS
ADDREZ )E��Mc—
CITY, STATE, STk,rz Zip
RESIDENCE pi-IONS_ BUSJNESS PHONE
BUSINESS PHONE-9rjt--
TOTAL NUMBER OF ROOMS:
ROOM USE. 1. 2, 3 4. 5.
6. 7. 8.
THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FE� IS PAY, LE TTHE TINIF-OFINSPECTION
APPLICANT'S SIGNATUR
AA�
Inspectors use only
Date an initial inspection:-- bate of reinspection:
_
Dat(�e),fissu�inceofc;ertificstte:--- 10 ,ILUIIl
1 3311 - Date fee paid:
Type ofunit. (.late:
Notes:
cl,
Code -nibro neat Inspector t Inspector
,^.rnrHrn is 11-71, IT117 ;1 '111
Cr-n' Or SALE-M. MASS ACRUS E-rfS
BOARD OF FILLU-SII
120 WA�f(ING"i ON S'f RFE.T,zV"FLOOR
TFoi- (976) 741-1800
Ki1%r15F02LLY FA,x(97fi1 745-0143
M'%yoR LL2N I—1)w
.Iftase
In accordance with Massachusetts General Laws Chapter 111;Code of Massachusetts Regulations 410.000 et. Seq.
State Sanitary Code Chapter 11 and Article Xlli of the City of Sale Ordinance,undersigned owner/lessor and
tenant/lessee oFa.unit of residential property, hereby autliorize the Salem Board ofHealth 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. 1/we expressly authorized the same and for
my/our successors and assigns hereby release and discharge the City of Salern, 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 n r/Les or
/Le
HORNE COMMONS
205 HIGHLAND AVE
SALEM, MA 01970
Address Address
ko -U-1
Address on unit to be inspected
Date
UpLttd5;23111
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH IV
-
120 WASHINGTON STREET 4"i FLOOR pllt►�1CHCAlIth
STREET, Prevent.Promote,Protect.
TEL. (978) 741-1800 FAx(978) 745-0343
KIM 3ERLEY DRISCOLL Iramdin@salei-n.com
_ - LARRI'ILAMDIN,RS/1tEHS,C,HO,CP-FS
MAYOR Hi-AL;rH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#25-13
DATE ISSUED: 1/16/2013
Property Located at: 4 First Street UNIT#6108
Owner/Agent: MIREF Hawthorne LLC
Address: 205 Highland Avenue
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-825-0030
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 B RD OF EALTH
(L.�
LARRY RAMDIN 4i
HEALTH AGENT -SANITARIA
T
s CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 Wd�HINGTC)N STREET,43"FLOOR
TEL.(978)745-1800
KTMBERL FjY DRISCOLL FAx(978)745-034.3
MAYOR ii�i)iNC7a ni i �t i E:t�
L,hkRS'R,\HIM,RS/R.It1 IS,Ci IO,CI'-15
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 �� iJNii# � 1 �
IS THIS UNIT DISIGNt4TED AS RIGHT LEFT FRONT OR BACK PLEAM CMCLE ONB rr
OWNERlLESSER_ O
� ��� L(�i_14fANAGER/AGENTI�0(>�i eA
IVO P.O.BOX
ADDRESS O �. r� ADL)RESS�
CITY, STATE,ZIP Piu p N Ma mp ]b CITY, STATE,ZIP
RESIDENCEPHONE BUSINESS PHONE(24HRS)
BUSINESS PHONE___ `^
TOTAL NUMBER OF ROOMS:
ROOMUSE: I. 'ky L. W40)5, _
6. 7. 8. 9. 10. _
THERE IS A FIF"IY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE IS PAYABLE AT TIME OF INSPECTION p
APPLICANT'S SIGNATURE - DATE1�I 3
Inspectors use onI
Date on initial inspection: -) Date of reinspection:
Date of issuance of cerGifrcate: 1 b- 1 s2 Date fee paid:
Type of unit: Dwelling ,.Othez-_^ _Check# ��- Check date.
Notes:
Code Enforcement Inspector
Y �
CITY OF SALEM, MASSACHUSETTS
Y BOARD OP HEALTH
120 WASHINGTON STREET,4".FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR DGREENBAUNIQSALF.M COM
DAVID GREISN BA UM
ACTING HUAL'ri-I AGI3NT
CERTIFICATE OF FITNESS
CERTIFICATE# 102-10
DATE ISSUED: 3/5/2010
Property Located at: 4 First Street UNIT#6201
Owner/Agent: Hawthorne Commons
Address: 205 Highland Avenue
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-825-0030
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 130A51) OF HEALTH /n
DAVID GREENBAUM
ACTING HEALTH AGENT CODE ENFORtEMENT INSPECTOR
• + CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4..FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR DGRrr_NBAUM@SA7, M.COM
DAVID GF=NBAUM,
ACTING HF-\LTH 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 UNI DISIGNATED S RIGD&T OR BACK,PLtqE CIRCLE ONE
OWNER/LESSER(1�61j)])Q /K�"�6GER/AGENT
NO P.O. BOX
ADDRESS ADDRESS
CITY, STATE, ZIP k2.D CITY, STATE, ZIP y�-Lt !) ICI 2 6
RESIDENCE PHONE / BUSINESS PHONE(24HRS) qY fd-F— d U
BUSINESS PHONE U �3 U
TOTAL NUMBER OF ROOMS: /
ROOM USE:
6. 7. 8. 9. 10.
THERE IS A FIFTY($50) OLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS E I P YABLE A THE TIME OF INFECTION
APPLICANT'S SIG�Nr� DATE
Inspectors use only
Date on initial inspection: lG Date of reinspection:
Date of issuance of certificate: L-3/9//6) yDate fee paid: 0
Type of unit: Dwelling V Other Check# g. 7d�Check date: LII D
Notes: j U f n down 6k W g kc .
ode nforcement Inspector
e
L
e
CITY OF SALEM, MASSACHUSETTS
BOARD OF HE:,AjTH
120 WASHINGTON STREF�'r,4.,i FLOOR
TEL. (978) 741-1800
IQMBEI2I EY DRISCOL I. FAX (978) 745-0343
MAYOR Iram(ingsalem com
L uR N'RANIDIN,RS/RISI[S,cI1O,CN-FS
I- FALI I I AGHNI'
CERTIFICATE OF FITNESS
CERTIFICATE#410-11
DATE ISSUED: 9/26/2011
Property Located at: 4 First Street UNIT#6208
Owner/Agent: Hawthorne Commons
Address: 205 Highland Avenue
City/Town: Salem Zip Code: 01970 MA 24 Hour Phone: 978-825-0030
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.
FO THE E BOARD OF HEALTH
LARRY RAMDIN
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
r CITE' OF SAS .N.1, ANSSACHFUSE17S
L9Ct,�W OF 1`1k.AI.P11
'ITS. (=r1f3}?=i1-I;�ail
KRABLItLI'''.Y DISC OLL I'dti(978) 745-0343
Mr1YtiR i:,iatt ivt;4 t.it.tccr t
L;tarwRn tt3t ,RS/RW Is,Ca R),ta'-rs
Piti:v:n i A<ut.N'r
!RCov
1�1 'L 2 IV �{ Application for Certificate of Fitness
CITE Op HZ�"MINIMUM STANDARDS Of 1JI'CNESSITH STATE SANITARY OFgRH 9AN H.4�I'CAT 0 .DE, CHAPTER 11. 105 CMR 41Q.UUU
50AF1O FEE: 50,OCt
PROPERTY LOCATED AT `-t fi&JJyt0 _ _ UNIT# �8
isuii5UNt'i•wsiGNATEi)A
Gtr {,!<_ %RQNP R gACh,YLG.A5);;GtkCi.L ONE
OWNER LESSER
V r I{/ftii\!�C _ _?t ANAGEERt A£ ENT r'!a(0 ✓CG
NO i'.O. BOX
ADDRESS —ADDRESS
nEZIP
CITY, STATE,ZIP 1� ` _CITY, STA ,
RESIDENCE PHONE_ �^ _ Bt}SINESS PHONE(24HRS( "_a_w
BUSINESS PHONE-_
TOTAL NUMBER OF ROOMS:_L_
ROOM USE: L 2. 3. bd 4. hod 5��(rWf!
6.
THERE IS A FIFTY($50)'DOL , FEE,,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE IS PAYABLE
,gAT THE TB OF;WSPECTION
APPI.ICAVT'S SIGIvATL RE4 �<
Ins ect rs use only
Date an initial inspection:_ _ Dau;of relaspection:
➢ate of"issuance of crlificnte:^ C/ _ Date fee paid:
Type of unit Dwelling_ l/OtherCheck �� _Check date: I(1 0 _ _.
Notes:
Cuda lforeement htspector
" CITY OF SALEM, IVLASSAC.HUSETTS
120 WASFTINGTON STREI-T,4'' I'1:,OOR
KINT 1} RLEY DRISCOLL TY.'L. (978)741-1800
PAX (978) 745-0343
MAYOR Ir�md ��salem coin
LARRY IYANIDIN,RS/m,"11 is,CtiO,c]'-FS
CERTIFICATE OF FITNESS
CERTIFICATE#412-11
DATE ISSUED: 9/28/2011
Property Located at: 4 First Street UNIT#7002
Owner/Agent: Hawthorne Commons
Address: 205 Highland Avenue
City/Town: Salem Zip Code:01970 MA 24 Hour Phone: 978-825-0030
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 it"
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
JRRY RAMIDIN
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEIM, NLIASSAUTUSEFFS
111
120 Wjusi HNICYONSTREET,4"FI00R
F, x(97,S) 745-0343
MAYOR -w_nl 1)1�--a-&LL-ku
Iax1myR,1xII)IrN,litifit 1;1 I's,cI lo"
1R
Application for Certificate of Fitness
JW ORDANkCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410MO
OIF
"MINIMUM STANDARDS OF FITNESS FOR ff(;MAN1 HABITATION"
0
PROPERTY LOCATE-DAT -
OCATED - lWo
IST619 NITUNIT#P41 r L)I SIG-
" DINATEDA IGH' I
j,rf RON OR 9ACK PLrASF.CIRCU ONE
OWNER LGSSh1� __"NIANAGF- AGENT I -1y)(01r)
NO 11.0. BOX
ADDRESS —ADDRESS
CITY, STATE,ZfP .---�Cr1-y, STATE,ZIP 01q1 D
RESIDENCE PILO IE -)3,Q ,
PHONE(24HRS(alo�– OL
BUSINESS
TOTAL NUMBER OF ROOMS:--Jt--
ROOM USE: 1� 2.. bWA 3.. � 4. be
7.
4 -- ;
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
FE,ZIP
_ffj4ffiA
APPLICANT'S SIGNAT URE L)A:f E
-7kviL
Inspectors use only
Date on initial inspection::-- U1 Date of reinspection;
Date of issuance of"rrificate:—�— Date fee paid:
Type of unit: Dwelling____--Other ChvckA_
as-1-- check date:
Notes:
Code n&i4 E�Jxctor
CITY OF SALEM, MASSACHUSETTS
BOARD()F HEALTH
120 WASHINGTON STREET,4"F=LOOR
TEL. (978)741-1800
KFMBERL EY DRISCOL.L FAX(978)745-0343
MAYOR 1X;R1,,F;NBAUM 'A1A M('.QM
DAVID GREENBAUM
ACnNG HEAL`nI AGF,N7'
CERTIFICATE OF FITNESS
CERTIFICATE#27"
DATE ISSUED:6/22/2009
Property Located at: 4 First Street UNIT#7105
Owner/Agent: Hawthorne Commons
Address: 205 Highland Avenue
City/Town: Salem,MA Zip Code: 01970 24 Hour Phone: 978.825-0830
I
i
An inspection of you vacant DwsllingtRooming 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 BOAR9 OF HEALTH
DAVID G E BAUM
ACTING HEALTH AGENT CODE NF CEMENT INSPECTOR
7 sa �"'' s
• CITY OF SALEM, MASSACHUSETTS
BOARD OF HEAT TH /�
120 WASHINGTON Sl'REET,4"' �.{ I.FLOOR -0 I
TEL. (978) 741-1800 v
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR WANCINI(C7�4ALEM.COM
JANET MANCINI,
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."
FEE: $50.00
S ( Q S
PROPERTY LOCATED AT ✓'5 I /ko— o ( 9 7a UNIT#
E
IS THIS UNIT DISIGNATED/AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE
OWNER/LESSERI,OYwrn�v sMANAGER/ GEN 0 N�"et
NO P.O. BOX
ADDRESS D-U S� 4J+ k LC, _ek k., ADDRESS r'} O S� Lko� _
CITY, STATE,ZIP CITY, STATE,ZIP Sa_e ,. E /k 6� a t -1-t - u
RESIDENCE PHONE q-7�" 3 3 I - <-7S BUSINESS PHONE(24HRS) a S a 36
BUSINESS PHONE 'q -77IF— a S — 6 O 3 b
TOTAL NUMBER OF ROOMS: 3
ROOM USE: L K( �-z "^--2. L%✓ 2I n�^3. JON 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 HEALT EE IS PAYABLE AT THE TIME OF INSPECTION /
L APPLICANT'S SI A DATE �✓ ��
/ _ ] Inspectors use only
Date on initial inspection: U! �� Q Date of reinspection:
Date of issuance of certificate: �9��a Date fee paid: LoAo
Type of unit: Dwelling Other Check# S a y Check date: 19 U
(Votes: cod -( P 1 _ �-W 1
�7 a
9CA e g79 - W6-d 7,V AP & ' e GVcbu
N plSf�a�
_ n ao h.
ode Enforcement Insp or
CI"I'Y OF SALEM, MASSACHUSF:ITS
BOARD OF HHALTrH
120 WASHINGTON STREET,4"" 1 J OOR
TEL. (978) 741-1800
IQ�II3ERLLY llRISCOLL Fax (978) 745-0343
MAYOR Iramdin@salem.com
salem.com
LARRY RAM1fI>IN Rti I
,
.�21 JiS,(:11(),li(l,(,I -I,5
HF IAII A(;i N'I
CERTIFICATE OF FITNESS
CERTIFICATE#411-11
DATE ISSUED: 9/26/2011
Property Located at: 4 First Street UNIT#7107
Owner/Agent: Hawthorne Commons
Address: 205 Highland Avenue
City/Town: Salem Zip Code: 01970 MA 24 Hour Phone: 978-825-0030
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 /o
LARRY RAMDIN
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
,/< 9 CITY ()F SAI.EN1, MASSACHUSE["1S
1SC t.i w(w I I r'Al !iI
120WnsiJINGTONSTRI`F ,4 F1.00tt
L
•i'Ia.. �r,13)'+1-is(iir
KD4BL U,F,.Y DRtSC OU, FAX(979) 745-0343
MAYOR �atto>�° ;t u.citat
LARRY 12AINwIN,Rs/11EI is,01c>,(T-t',
� I`Ir•:nC1 isrvr
Application for Certificate of Fitness
a
gpA pO � CODE, 414.�OG
MI1�IMUM STA DARDS Of F I"fNESSFOR ITU MAN HABITATION"
O
FEE: $50.00
PROPERTY LOCATED AT L4 ff�si- L
Sf 73 UNIT# T1
1ST1i1SIJNvrD1SIGNA'rrDA ICW J,EF'r(I�RaACCK,PLEASECIACUONE ✓�e�'
OwNLIULrSSEK I L�NMC _viANAGER/AfsEVT IADDRESS _ADDRESnl=CITY, STATE,ZIP _CF Y,STAJ�
RESIDENCE PHONE, PUSINESS PHONE(24HRS�. 6 �RJ
BUSINESS PHONI7_
TOTAL NTrMBER OF ROOMS:__,,.IQ_�}_
ROOM USE: T. 2_ U Y1 3. �(/it 4. YJ(d— 5.
66 7. S. 9. 10.
THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR:VIOKEY ORDER TO THE CITY OF SALEM
BOARD OF HEAL11 S THIS FEE IS PAYAB E AT'THE TIE OF INSPECTION
APPLICANT'S SIGNATURE— -U�
iv -
Insmeetois use ons
Date on initial inspection: _ Date of reinspection:
Date of issuance of eeriificate:_ /_ _ Date fee paid, „_
Type of unit: D'wvllin ✓'Othet_, _Ch xk# C'Iteck date: ,
Notes:
iColl n.forcen t Inspector—
s-,.. pCFln if !i. . I'll- 1/,C h71'S
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTI-I
120 WASHINGTON STREET,4""FLOOR PI1bi1CHC81�1
PrtvcN.Premorc.Prelett.
TEL. (978) 741-1800 FAx(978) 745-0343
KIMBERLEY DRISCOLL lramdinoa salem.com
LARRY RANIDIN,RS/211-IS,C[-Ip,.C1' IS
MAYOR H1 At:fNAGIaNT
CERTIFICATE OF FITNESS
CERTIFICATE#469-12
DATE ISSUED: 12/5/2012
Property Located at: 4 First Street UNIT#7201
Owner/Agent: MIREF Hawthorne LLC
Address: 205 Highland Avenue
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-825-0030
An inspection of your vacant Dwelling/Rooming Unit at the above address has been approved
and is in compliance with 105 CMR 410.000: Massachusetts State Sanitary Code, Chapter ll"
Minimum Standards of Fitness for Human Habitation'.
Therefore, this Certificate is issued by the Code Enforcement Division of the Salem Board of
Health and the unit may now be rented and/or occupied.
Maximum Number of occupants, must comply with 105 CMR 410.000.
Certificate valid for one year from date of issuance or until the current tenant vacates, whichever
is later.
This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy.
FOR THE BOARD OF HEALTH ?
LA RAMDIN
HEALTH AGENT ANITARIAN
r
q6q-4
t• '` o CITE' OF SALEM, .KNSSACHUSE` TS
_ y B0.\RD(m I-11z.ALf'11
120W;I,,'IiflVC1Y)NSTRECr 4."F1.001Z
-ILL.({)7$)741-1504
KM1BMU.NY DR'NCOLL F:vX()78) 745-11343
�I:lYt7R r;,infnt tr :o 1
.LARRY RANIDIN,RSf111i1 IS,(:11('1,(T-I'S
HVAIAII A01:NT
Application for(certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 1'1, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR If(,'.,IAN HABITATION"
C FE so,OO
PROPERTY LOCATED AT , l 1( S PP UNIT# ' U
��I�S-THIS)JNVr'D`IISIGI%WrEDA5RIGHT1,E,ffFRONTORSACK.PLEASECIRCLEONE -� n`,�,�1
O W NER/LESSER t y '� E -- �t 1�MANAGFR/AGENT �,— t �l1 '3' YJ�I
A D0, BOX S 2 ' , ��1
ADDRESS `:�'.. ADDRESS � ...� 1 {'��
CITY,STATE ZIP . _113 _CI'iY, STATE.ZTP (�.��`y1�_� )
RESIDENCE PHONE � BUSINESS PHONE(24HRS)
BUSINESS PHON-R {)t` 1 -�C?�J—W
I
TOTAL NUMBER OF ROOMS: c2,,
ROOM USE: L 2. 1 4. S.
6 7. 8. 4. 10
d THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE IS PA LE AT'THE tE F LNSPEGTION
APPLICANT'S SIGNATURE '
InsIectors use on
Date on initial inspection: _ Date of reinspection:
Date of issuance of ccnificate: _ Date fee paid: j
Type of unit Dlvelling Other _Cheek t4 Cheek date:
Notes:
Code fo l' pector
�. CITY OF SALEM, AI,NSSACHUSE7:I'S
i y BOARD OV l-1FillEfl 1
120 WAST FINGMN Sear M 4"'Ft OOR
TF.,L.(979)742-18OU
Kh%mF,RLEY DRISCOLL 1^hX(91-8)1,45-0.141
7Vl-wojz 1,it n�intu!�5„�I a!al rxml
LARRY RA:ti'DIN,2tijAfil 1S,C111,cl' S
l-tV�.?.f:ltt i1UliN'f
Release
In accordance with Massachusetts General Laws Chapter 11 l; Code of Massachusetts Regulations 410.000 et, Seq. ;
State Sanitary Code Chapter 11 and Article 70111 of the City of Salem Ordinance,undersigned ownerllassor 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. Uwe 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
ao5 WfW6
r` cLO 4 'lYV` ���
Address Address
Address on unit to be inspected
II
AaC1Cj
Date
Updated$23111
1
TRANSMISSION VERIFICATION REPORT
TIME 01/22/2013 22:36
NAME
FAX 9787450343
TEL 9787411800
SER. # 000BON341991
DATEJIME 01122 22:36
FAX NO. /NAME 919788250097
DURATION 00:00: 26
PAGE(S) 02
RESULT OK
MODE STANDARD
ECM
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4... FLOOR
TFL. (978) 741-1800
Ki�I13LItLLY DRISCOLL FAX(978) 745-0343
NL\YOR lramdin e salem.com
LARRY RAMDIN,RS/RFI IS,C110,C11-1,S
HI?A1:I1I A(il'.N'r
CERTIFICATE OF FITNESS
CERTIFICATE #413-11
DATE ISSUED: 9/26/2011
Property Located at: 4 First Street UNIT#7207
Owner/Agent: Hawthorne Commons
Address: 205 Highland Aveneue
City/Town: Salem Zip Code: 01970 MA 24 Hour Phone: 978-825-0030
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
LATY RAMDIN
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
J
m CITY OF SALEM, 1LLkSSACFT( SE-1`` S
B(ti o IIr a3 I11 '
'ITni). ('(Y78)741-4Si)ir
QM[iL1t1,I C1' llItlSt:(.N..L
FAX(978) 745-0343
LARRY kA\it):N,tiff/iti:1l ,G It 7,CM`,
Br
Z IV
1U� 6M Application for Certificate of Fitness
G�RCtO4F aftORDANCE WITH STATE SANITARY CODE, CHAPTER It. 145 CMR 410.000
gOP "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION"
FSE: So.Ofl
PROPERTY LOCA"1"Ct) AT t { _ UNIT#_�r�__9
IS THIS UNIT DISIGNATM A IGH' t�E 7RON" ORBACK PLEASECI LEONE
OWNER LESSEN
Y �C Fl�V� _ NSAIdAGFRI AGEN=T��QI,i� ��
NO N.O. BOX
ADDRESS _ _ADDRESS
MY, STATE,My � _CITY,STATE,ZIP M 1�`q 01g10
RESIDENCE PHONE- BUUSINESS PHONE(24HRS)�"
BUSINESS PHONE,
TOTAL NUMBER OF ROOMS:__-,..u_ __
ROOM USE: 1._ka4\/�,\ 2 �X" J. �lt� 4 s, lU+-C, 5
THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALT14 THIS FEE I: PAYABLE AT THE TIME OF INSPECTION
APPLICANTS SIGNATURE D
ATE-_L r7
bP
Inspectors use onlX
--
Date on initial inspection:— � I _ Datc of reinspection:
Date or issuance of certificate:_ �� _ Date fee paid:
Type of unit: Dw4inf;_ Lf Cher_ _Chwk k C-heck date: I 0 ,
Notes: , rrnr , cS_fd117 � cj 1ALd bah
i
Code -nforcei ent Inspector
.�+ T7.17 ;0c .0
• � �'�� CITY OF SALEM, MASSACHUSETTS 10
BOARD OF HEALTH
120 WASHINGTON STREET 4."FLOOR Pllb)I1CHP.81t1
TFL. (978) 741-1800 FAX (978) 745-0343
KIMBERLEY DRISCOLL Itamdin@salet-n.com
L:ARItY R:A,1tDIN,RS/RF H
IIS,CO,CI'-I rg
b4AYOR I-Iit,u:['H A(;FNI'
CERTIFICATE OF FITNESS
CERTIFICATE#548-11
DATE ISSUED: 10/6/2011
Property Located at: 4 First Street UNIT#8002
Owner/Agent: Hawthorne Commons
Address: 205 Highland Avenue
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-825-0030 .
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
L 1
LARRY RAMDIN
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
T
F�
CITY OF SALETM, MASS NCHUS>-✓TfS
Bk)'mw ov Fn3.+ti't�l
\ � f 20 U'i��si itw'c'tcir.S'�"IY13E`P,+I°`ITr.t x 7R
i �I't=�.. {478)?41-t8tiix
K114BUtIJ W DICIS( QLL I'aX(9'S) ;4j-11343
LARRY RAiMI)tN,Ws/tams,ca in,cr-rs
Hml:r11 !Vwl "JT
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 1 I, 105 CMR 410.000
"MrNIMUNI STANDARDS OF FITNESS FOR HUMAN HABITATION"
�
11
FEF.-L50.00
PROPERTY LOCATED AT_`k T1 S 1 ONIT{#
IS�Tti�hs�UNIT DIS1GN/A�XED AS R GGT t.,&P'r RONT aRBAM PLEZECIRCLF ONE
OWNER/LESSEV,na!E 1 C �\11`11C X12 k) Y � (S&ANAGLRf A�`GEE,\-f'NO VO. BOX
��� \��Y�� �Y1{U IQ�/
QDRESS_(- .�,1_��___—ADDRESS`!} ty�CtY,.dl�{M� )!No-.
CITY, STATE,Z'IP �1 P _y O 1 O _C17Y, STATE,ZIP i (� . } ��
RESIDENCE P7iON3E_ c� Bi15INESS PHONE
BUSINESS PHONI?�
TOTAL NUMBER OF ROOMS:-4'—
ROOM
OOM.S:___4 __ROOM USE! 1. Z. 3. 4, 5,
6. 7.
T14ERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEL' IS PAYAB - A' THE TIME OF M. PECTION
APPLICANT'S SIGNATUREL ` \`Q _
Inspectors use only
Date on ini#ial inspection:— � /! _ Date of reinspection:_ -
Date of issuance of cur#ificate:_- // ,�qq Dace fee paid:
Other Chcck---J�—_Clieckdate: EA-Typeo#`unit: D'Wallin� _,,.
Notes:
C e En#' rce nenl Inspector
..^fi'1.'•^.11- rr ^f'r tTlT ii'a.-' /q(]
CF-n' OF SALE-M, NIASS)ACHUSE-ITS
bt 7ARI)(W'1414-ALVJ I
120 WASI(INM ONSTIVU-7,� 9'1'1,00,
TO—(978)7,41-1800
Kh%WFQ�LLY DRISCOU FAN' (97 A) 7454143
MAYOR "uLwi
J!-A1?RYR'\M])]N'
in accordance with Massachusetts General Laws Chapter 111; Code of Massachusetts Regulations 410,000 a. Seq. ;
State Sanitary Code Chapter 11 and Article 70111 of the City of Salcra Ordinance, undersigned owner/lessor and
tenant/lesseeol'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 OwAsor la� �
HAWTHORNE COMMONS
205 HIGHLAND AVE
SALEM, MA 01970
Address Address
—S-Ma—
Address on unit to be inspecte(.
Date
Updut d4 3 ll
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4."FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAx(978) 745-0343
MAYOR DGRPENI3AUM([75ALEM.COM
DAVID GREI:'',NBAUM
AC'T'ING HI ALiH.AGENT
CERTIFICATE OF FITNESS
CERTIFICATE # 17-10
DATE ISSUED: 1/22/2010
Property Located at: 4 First Street UNIT#8102
Owner/Agent: Hawthorne Commons
Address: 205 Highland Avenue
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-825-0030
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
D GaI
RE AUM
ACTING HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
• J s BOARD OF HEALTH
120 WASHINGTON STREL T,4"'FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR DGRI ..NBAUM&ALEM.COM
DAVID GREENBAUM,
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."
/- FEE: $50.00
PROPERTY LOCATED AT rS T ��Z,6J- P1 D l 70 UNIT#-SOOE�
I,STHIS UNIT DISIGNATED AS RIGHT LEFT F ONT OR BAC ,P E CIRCLE ONE
OWNER/LESSER t`�/(�Nl C�MANAGER) AGENT' -, -A
BOX
ADDRESS
CITY, STATE,ZIP �0-7 L CITY, STATE, ZIP
RES CE PHONE / ��' 4p� r��y��� (BUSINESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:: °
ROOM USE: 1ljdL� (�� 3� 4. 5.
6. 7. 8. 9. 10.
THERE IS AeFY $50) OLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF THI FEE IS AYAB ATTHET E OF INSPECTIONAPPLICANTAT v DATE4`
I spectors use only
Date on initial inspection: I r)J� I I U Date of reinspection:
Date of issuance of certificate: ]A'A' l Date fee paid: I j `� TIL)
of unit: Dwelling Other Check# S�j�����r y�Check date: I
Notes: l I11i-' in .( ctnn hodl/v M cU)-
J J
v
Code EnforAjat Inspector
o CITY OF SALEM, MASSACHUSETTS
�. BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA O 1970
TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
7/26/05
Ridgeside Realty LLC
100 Grandview Road Suite 207
Braintree, MA 02184
PROPERTY LOCATED AT 4 First Street Unit 8105
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 r the Board of Hea Reply to
anne Scott MPH, RS, CHO Pablo Valdez
Health Agent Code Enforcement Inspector
.�o CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
a SALEM, MA O 1970
.� TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
7/26/05
Ridgeside Realty LLC
100 Grandview Road Suite 207
Braintree, MA 02184
PROPERTY LOCATED AT 4 First Street Unit 8106
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 Healt Reply to
J nne Scott MPH, RS, CHO Pablo Valdez
Health Agent Cade Enforcement Inspector
C1-1Y OF SALEM, MASSACHUSETTS
120 WASHINGTON S REEeT 4"' FLOOR
T111.. (978) 741-1800
IQMBERL;EY DRISCOLI. FAX(978) 745-0343
MAYOR DGRI NBAUM@SALLM.COM
Dnvtu GtsEFNIMum,RS
Ac CING FIRM;fH AGI'N*f
CERTIFICATE OF FITNESS
CERTIFICATE#527-10
DATE ISSUED: 11/12/2010
Property Located at: 4 First Street UNIT#8107
Owner/Agent: Hawthorne Commons
Address: 205 Highland Aveneu
City/Town: Salem Zip Code: MA 24 Hour Phone: 978-825-0030
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
D VIA D GRREEENBA , RS
ACTING HEALTH AGENT CODE ORCEMENT INSPECTOR
4 a� /0
.` CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4°1 FLOOR
TEL. (978) 741-1800
KIMI3ERLEY DRISCOLL FAX(978) 745-0343
MAYOR DGRIIeNIIAUNI@Smx. m.CONI
DAVID GRrENBAUM,RS
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."
J (� + �e FEE: $50.00 I
PROPERTY LOCATED AT L( �'I C�1 C* UNIT#�1
IS THIS UNIT DISIGNATTEED AS RIGHT LEFT FRONT OR B�PLEASE CIRCLE ONE
OWNER/LESSER *JV71/ /Grn( , (_�/YI')Yl�(GVJ'MANAGER/AGENT 7V ] VYJ 6(YL(j((
NO P.O. BOX')(I'-
i+ i h „_ )(10 I ft
ADDRESS //�1�'1��J'�—/.V—�"ry�F L//`A��] (�U�a ADDRESS
CITY, STATE,ZIP �� m fl Q vl q 0 CITY, STATE,ZIP
RESIDENCE PHON(E� 2 BUSINESS PHONE (24HRS)
BUSINESS PHONE"1' I (l U�� OC�v
TOTAL NUMBER OF ROOMS:— � I/
ROOMUSE: 1.(�jl.VM 2.b I(M 3. 6Cel) 4.hffM. • 5.
6. 7. 8. 9. 10.
THERE IS A FIFTY($50)DOLLAR FEE, PAY Y CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FE ISP YAAT7THT E OF INSPECTIONAPPLICANT'S SIGNATURE BDATE
Ins ectol use nl
Date on initial inspection: (d I/U Date of reinspection: �—
Date of issuance of certificate: I I W I ) JJ p yDaate fee paid: l. /a /o
Type of unit: Dwelling ✓ Other Check# q MPI V Check
Notes:
C e,Enforc ent Inspector
F
Y
CITY OF SALEM, MASSACHUSETTS
_ l BOARD OF HEALTH _
120 WASHINGTON STREET,4`"FLOOR
TEL. (978) 741-1800
KIMIiERLEY DRISCOLL FAX(978) 745-0343
MAYOR DGRIIiENBALHN4 SALEM.COM
DAVID GREENBAUM,RS
ACTING HEALTH AGENT
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
P P Y> Y g
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
Address Address
Address on unit to be inspected
Date
CITY OF SALEM, MASSACHUSETTS
,j BOARD OF HEALTH
C
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
7/26/05
Ridgeside Realty LLC
100 Grandview Road Suite 207
Braintree, MA 02184
PROPERTY LOCATED AT 4 First Street Unit 8108
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 Health Reply to
xr�
Jo ne Scott MPH, RS, CHO Pablo Valdez
Health Agent Code Enforcement Inspector
3
CITY OF SALEM, MASSACHUSETTS 10
BOARD OF HBALTH
120 WASHINGTON STREET,4"'FLOOR PublicHealth
Prevent.Vromme.Pmtecr.
TEL. (978) 741-1800 Fax (978) 745-0343
KIMBERL Y DRISCOLL Iramdin@salem.com
LARRY ILrANfDIN,RS/RF(I IS,CI 10,CP-I;S
MAYOR II�3.V:nI A(;F;Nr
CERTIFICATE OF FITNESS
CERTIFICATE#549-11
DATE ISSUED: 10/6/2011
Property Located at: 4 First Street UNIT#8201
Owner/Agent: Hawthorne Commons
Address: 205 Highland Avenue
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-825-0030
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 CODE ENFORCEMENT INSPECTOR
ix
t+
CITY OF SAf EM, MASSAUTUSE-ITS
BOARD OF iRtA II't
-fEL. (J'.8)741-1 S00
tiIiABIL lJ W DRISCOtd. F.ca(178) ?45-()343
NIAYf)R
L,vzl(v I?AMI)IN,WfzwIs,cmrz,c m.";
HFMAII A(WNi
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11. 105 CMR 410,000
"MINIMUM STANDARDS OF FITNESS FOR ff(JIMMN HABITATION"
FEF.x,00
PROPERTY LOCATED AT & S�_ UNIT 2
IS THIS U�N`rrIMSIGNA/'f�U)AS RIGHT t.F.FT MONT OR.BACK PLEASF CIRCLE ONE
OWNER/LrssERi& 1�D�v1Y1Q(Y1,QI,� �14 ) ANAGLR/AGE,,,,TNO 11.0BOX
ADDRESSL-� �'Y
ADDRESS
CffY, STATE,ZfP� R � �CI'lY, STATE,ZIP t(��,t�c� c�
RESIDENCE PRONE_ BtfSINESS PHONE(24HRS), 9A tYY
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:_02
ROOM USE: 1. 2. 3. 4. 5.
6 7
THERE IS A FIFTY($50)DOLLAR FEL,,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
A`I'"HE TIME F LYSPECTION {�
BOARD ANTHS SIG\ A`I fit FE' IS PAY�BL. .. _ v DA'1'6_'�.S
InTeetols use only
Date an initial inspection:-- /� _ Date ofrain3pection:_
�--- —
Date of issuance of certificate:__ _ / _ Date Fee paid: _
Type of unit Dtvclling L Other .Chet k kg Check date.:
Notes:
Code -nfo mens Inspector
Cl'-n' OF SALEM, TVIASSACHUSE-J-fS
EWARD OF HE.Af-TI i
I20W% si ri\jmot, SI'RFF7,10 '1
Tr'f-(IM)741-1801)
Kh%WERLEY DIUSCOLL Fz�"'(978) 741-0-143
Pvfal�olz LLt,\—'])I N-f)sti.J .—Com
LA RRY RAPAIUN!,RS/lk];I is,(.[Io,
I IvAl:m 'WtSN'f
f"Oease
In accordance with Massachusetts General Laws Chapter 111; Code of Massachusetts Regulations 410.000 et. Seq.
State Sanitary Code Chapter 11 and Article X111 of the City of Salem Ordinance,undersigned owner/lessor and
tonant/tessce 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,
"S 06 P
Tenant/Lessee 0 w?�/VLS's 1X)r
WTHORNE COMMONS
205 HIGHLAND AVE
SALEM, MA 01970
Address Address
Address on unit to be inspected
Date
Updated 523111
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREr'T',4"'FLOOR
TEL. (978)741-1800
1-jNIBFRLEY DRISCOLL F.A�, (978) 745-0343
MAYOR IramcL❑ salem.coin
LAIMY RANIDIN,RS/1WI-IS,CI-I,O,CP-I'S
H ttrV l�t'hl�flriNT
CERTIFICATE OF FITNESS
CERTIFICATE#414-11
DATE ISSUED: 9/26/2011
Property Located at: 4 First Street UNIT#8205
Owner/Agent: Hawthorne Commons
Address: 205 Highland Avenue
City/Town: Salem Zip Code: 01970 MA 24 Hour Phone: 978-825-0030
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 RY RAMDIN
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
i
a CITY OF S1 LEN-f, 11 kSSACHUSEI S
I �
13O.AIU)(.iP Ilr�.a1:3'P1
����"`•� f 20\Xin�i IrrJc i'oN STRrr"i' 4"'I=r,vt alt
�.
KRAIMLY..Y DRISC(A,L FAX(9i 9) 745-0343
\ r1Yt)TR ui N )i rtzjksu.-w
LARRY RAMIAN,RS/Riitlti,CI ICI,Ci'-15
FIN.Al lI f A(.I>N"I'
Application for Certificate of Fitness
G( �ORDNCE WITH STATE SANITARYf l�pF kA `MINIMUMS STANDARDS OF FI'[NESSODEFOR IfU MAN HABITATION", CPTER 11. 105 410.UU
30P Fm 50.00
PROPERTY LOCATED AT_q-6 —Is-frua, UNIT'#
ISTliISUNi,rD1SIGNA'!'EDA9 ,F,VfIYIt NTOR ACK LEASECIRCUONE
(y r
OWNERfLESSER---_�/_flAZ_ _MANAGERf AGENT
NO 11.0. BOX ,q
ADDRESS —ADDRESS � � Win j i , //��
CITY, STATE,GIF ,JM� _CRTY, STA'!"E,ZIP f� j)}C!j 6
RESIDENCE PITONE_ BUSINESS PHONE(24IiRSJ.,.9-70 _'W.30
BUSINESSPHONF
TOTAL NUMBER OF ROOMS:
ROOM USE: t•bt(-. 2bk1L11 1614. ►M '! 5: lawhdni
5. 7. 8. .__ �j ---LQ--
THERE
0THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CI'T'Y OF SALEM
BOARD OF HEALT14 THIS FEE IS AAYABLAT THE TININSPECTION
APPLICANT'S SIGNATURE _ � ,_
laVeetors use only
Date on initial inspection:-- I I _ Date of reinspection:
Date of issuance of cortificate: Date£ee paid:
Type of unit: D'tveiling ( then Check r , _.,Check date:_
Nates:
de -nf emcntlnspeetot�
�,..nfM1r 6ll' !C 11-71, 1TIl9 iii_ %.]P
CITY OF SALEM, MASSACHUSETTS
+ ` BOARD OF HEALTH
120 WASHINGTON STREET,4°i FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX (978) 745-0343
MAYOR DGRP:ENBAUMna,SALEM.COM
DAVID Gm-'.i3NBAUM
ACTING HEAI.;PI-I AGUNP
CERTIFICATE OF FITNESS
CERTIFICATE# 18-10
DATE ISSUED: 1/22/2010
Property Located at: 4 First Street UNIT#8206
Owner/Agent: Hawthorne Commons
Address: 205 Highland Avenue
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-825-0030
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 BOARF HEALTH
1/�w 1
DAVID GREENBAUM
ACTING HEALTH AGENT COD E FORCEMENT INSPECTOR
• > CITY OF SALEM, MASSACHUSETTS
J BOARD OF HEALTH - iJ
y 120 WASHINGTON STREET,4"'FLOOR
TEL. (978) 741-1800
KIM ERLEY DRISCOLL FAX(978) 745-0343
MAYOR llGR1`.EN13AUM@SA1 EM.COM
DAVID GREENBAUM,
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."
FEE: $50.00
PROPERTY LOCATED AT �S I/�i(� 4 M d ) '170 UNIT#
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PL"S CIRCLE QNE_-- � Gc/
OWNER/LESSER /" MANAGER/AGENT_
NO P.O. BOX
ADDRESS o<�� ADDRESS
CITY_, STAR,ZIP G/1 / �� �l 7 CITY, STATE,ZIP 7 v
RESIDENCE PHONE / ���C ���U D� � BUSINESS PHONE (24HRS)
BUSINESS PHONE �'7
TOTAL NUMBER OF ROOMS:
ROOM USE: 101 1/ 't '� 0� 34 V74-(- 4. 5.
6. ° 7. 8. 9. 10.
THERE IS A FIFTY OLLAR F E,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HE) H THIS FEE I AYABLE T THE TIME OF INSPECTION
APPLICANT'S SIGNA DATE/
Inspectors use only
Date on initial inspection: � 'a: 'IV I Date of reinspection:
Date of issuance of certificate: 1 /J)� (/U Date fee paid: 1 ah D
Type of unit: Dwelling 1/6ther Check# •S Ay J00�/��Check date:
Notes:
Code Enfolq6ent Inspector
,- HP Fax Series 900 Fax History Report for
Plain Paper Fax/Copier Joanne Scott Salem BOH
978 745 0343
Jan 26 2010 3:42pm
Last Fax
Date Time T= Identification Duration Paees. X11
Jan 26 3:42pm Sent 919788250097 0:37 2 OK
Result:
OK - black and white fax -
y CITY OF SALEM, MASSACHUSETTS
BOARD OF Hr�t:rFi
120 WAtiH7NGTON STREET,4'"FI..()OR
'TEL. (978) 741-1800
KIMIiEIiLEY DRISCOLL FAX (978) 745-0343
MAYOR Iramdin@salem.cOm
L,uw),RANK UIN,RS/RF11 TS,CI10,CP-PS
HEM:rn Ac r,N'r
CERTIFICATE OF FITNESS
CERTIFICATE #406-11
DATE ISSUED: 9/26/2011
Property Located at: 4 First Street UNIT#8304
Owner/Agent: Hawthorne Commons
Address: 205 Highland Avenue
City/Town: Salem Zip Code: 01970 MA 24 Hour Phone: 978-825-0030
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.
FOR THE BOARD OF HEALTH
LAR
HEALTH AGENT CODE ENFiTRCEMENT INSPECTOR
w
�• CITY j, O1
B(( }J ).al.At)OV HL
��„ f2(}�YJ VAI 11�1C4U� Yl l.i!Lfl,�n f'1.Ot�12
tSlibIBLIi ..l':1'DRIS(IXA L F.1x(978) 743-03$3
LARW RAMO N,U.S/Tom.)is,Ca I(1,cr-PS
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER I'1, 105 CIVR 41 OMO
"MLINIMUM STANDARDS OF FITNESS FOR HUMAIN HABITATION"
�r� }, PEE': S�O.00
PROPf RTY LOCATED AT—!�!��_t 31C..��t ? �
IS THIS UNi"I'pES1f;NA"1'F,R AS ARI 1'r LC+�B'r IrkON"r R t1ACit,PLliASr:GTRC'LL<tRE
OWNLRiLrSSEKJRJ S MANACER/AGENTLPC;
L_
ADDRESS__— _ _ Ai?DRL•"SS__ --
CITY, STATE,ZIP_ _Cl`I1, STATE,ZIP __ —
RESIDENCE PHONE _. BUSJN"ESS PHONE(2,3HRS)_ qja ._ 2 OOOiJ
BUSINESS PHONT -
TOTAL NUMBER OF ROOMS:— " — —
r.00NI USE: i_Wt4 z-Re- D 33-L1M/"�L
THERE IS A FIFTY($50) DOLLAR PEE,PAYABLE BY CBECK OR MONEY O'MER TO THE CITY OF SALEM(
BOARD OF FIEAL,TH THIS FEE IS RAYABLE AT IHE Tiltit --SPECTIOiN 1 1
APPLICANT'S SIGNATURE
G i /�/ lnsI ecto rs tlse�nlv
Date on initial inspection:_, Data of reinspection:
Da%;ofissunceof'Gur6ficat�e: r fZ �� DateCee t»id- _
Typeofunit: Dwel1mg_1/ Other____Chuck.-__. Chm
?Notes:_
U(',iG E'11trCL•tYie`nt h7sI7e4[oL
• CITY OF SALEM, MASSACHUSETTS
r� BOARD OF HEALTH
a 120 WASHINGTON STREET,4,"FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAx(978) 745-0343
MAYOR DOR1`TNBAUNf@SA1,EM.00Da
DAVID GREENIMUM
Ac'I'INCi Ha.AIA'f-1.AC3 ENT
CERTIFICATE OF FITNESS
CERTIFICATE#337-09
DATE ISSUED: 7/24/2009
Property Located at: 4 First Street UNIT#8306
Owner/Agent: Hawthorne Commons
Address: 205 Highland Avenue
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-825-0030
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 HE BOA F HEALTH
Al
DAVID G E BAU
ACTING HEALTH AG NT CO �N ORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHI:NGPON STREET,4'°'FLOOR
TEL. (978) 741-1800 Fk CTr
KIMBERLEY DRISCOLL FAX (978) 745-0343 q-nr q63-q,60
MAYOR' uG1ZH`,NBAUN1@SA1.ET1.COM
DAVID G'REENBAUM,
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."
FEE: $50.00
PROPERTY LOCATED AT S�5 f S'-1&t.t -�ZCt 4 M /j'1_4 tL UNIT# r3 6 4
IS THIS UNIT DISIGNAn'MIRA�ANAGER/
AS RIGHT LEFT FRONT OR BACK,P ASE CIRCLE ONE
OWNER/LESSER-f.LJ�? er1-> t- AGENT
NO P.O. BOX
ADDRESS CC �� ADDRESS ,)-U
CITY, STATE,ZIP `17�ITY, STATE,ZIP JC� rvI
RESIDENCE PHONE BUSINESS PHONE(24HRS) -( 31 - G G 3 G
BUSINESS PHONE 7 IF S 0 63 0
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. GL 2. et'
34- "" 4./;v, Sm
6. 7. 8. 9. 10.
THERE IS A FIFTY($56}DC1 LAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS F IS Py LE AT THTIME OF INSPECTION
APPLICANT'S SIQNAT.IIRV-'/ DATE 'n
f�
Insyectors use o y
Date on initial inspection: /a3 O I Date of reinspection:
Date of issuance of certificate: 7/d Date fee paid: :71a y/G 5
Type of unit: Dwelling Other Check# y#S30YCheckdate: "7�J)a /0 1
Notes:
c IVA(GYM /Paj'�
Code Enforcement Inspecto
HP Fax Series 900 Fax History Report for
Plain Paper Fax/Copier JoanneScottSalem BOH
978 745 0343
Jul-29L 2009 10:02am
Last Fax
Date Time Tvne Identification Duration--Pages_-. esult
Jul 29 10:02am Sent 919788250&7 0:25 1 OK
Result:
OK - black and white fax
1
• + CITY OF SALEM MASSACHUSETTS
BOARD or HFal.rr I
120 WASHINGTON STREET,4 FLOOR
TEL. (978) 741-1800
KIMIiERLEY DRISCOLL FAQ:(978) 745-0343
MAYOR D(3RI?F_N11AUNI @ SALf?M.COM
Dywn)Giu';FNBiW,vI
ACI'ING Hj.?A n-I A(;vN'r
Facsimile
Transmittal
Fax # 453 J/ U
RE:
Date : �,�9,�`�
Page(s): including this cover#
Message:
Board of Health News --------------------------------------------------------------For Your Information
OFFICE HOURS:
Monday, Tuesday, Wednesday 8:00 AM to 4:00 PM
Thursday 8:00 AM to 7:00 PM
Friday 8:00 AM to 12:00 NOON
HP Fax Series 900 Fax History Report for
Plain Paper Fax/Copier Joanne Scott Salem BOH
978 745 0343
Jul 29 2009 10:04am
Last Fax
Date Time Twe Identification Duration Pages--- esult
Jul 29 10:03am Sent 919784539150 0:35 2 OK
Result:
OK - black and white fax
CITY OF SALEM, MASSACHUSETTS
• • BOARD OF HEALTH
120 WASHINGTON STREET,4f0'FLOOR
TEL. (978) 741-1800
ICIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR 1MANCINI&AILM COM
JANE I'MANCINI
AC"LING HFAL'111 Ac;i;N'r
CERTIFICATE OF FITNESS
CERTIFICATE # 130-09
DATE ISSUED: 3/10/2009
Property Located at: 4 First Street UNIT#9103
Owner/Agent: Hawthorne Commons
Address: 205 Highland Avenue
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-825-0030
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.�ccc�cc
NET MANCINI
ACTING HEALTH AGENT CODE E OR EMENT1jNSPECTOR
#50 q
0
• CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4""FLOOR
TEL. (978) 741-1800
KIM13ERLEY DRISCOLL FAX(978)745-0343
MAYOR 1D1oNNe e S1I.EM.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."
FE/E: $50.00 ,/�
PROPERTY LOCATED AT 61 1Y S>< �></�e r �o Ili/ /'�V �/ 7y UNIT# /03
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE
OWNER/LESSER &aw J/9UYHe C011�r�o�/ MANAGER/AGENT Sc ClXrF(xlTi S
NO P.O. BOX J p ,/
ADDRESS �(]S y.crd��p�a� />v i9fiP ADDRESS �b
CITY, STATE,ZIPSa le 0/9 70 CITY, STATE,ZIP c�
RESIDENCE PHONE // 7 &„1S 3 BUSINESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. Be��Iom 2. L 4. 5
6. 7. V 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 OP INSPECTION
APPLICANT'S SIGNATURE � DAT91
Inspectors use only
Date on initial inspection:_ Date of reinspection:
Date of issuance of certificate: 3 ' p d S Date fee paid: lo-oq
Type of unit: Dwelling � Other Check# 255\,15i Check date:
Notes:
f
Code Enforcement lnspel,or
� n
CITY OF SALEM, MASSACHUSETTS
BOARD OF FIE'U TII
120 WASHINGTON STREET,4"'FLOOR
Tr.L. (978) 741-1800
KIMBERLEY DRISC01:.1:. FAX(978) 745-0343
MAYOR DGIWIsNBAUMns,y,�'.n4.a)i�4
DAVID GRI'.IiNH AUN1,RS
AcTIN(; HP;AI:I'Ii AGISN'I'
CERTIFICATE OF FITNESS
CERTIFICATE#540-10
DATE ISSUED: 11/22/2010
Property Located at: 4 First Street UNIT#9107
Owner/Agent: Hawthorne Commons
Address: 205 Highland Avenue
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-825-0030
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.
FOL�"__ 'BO F HEALTH
DAVID GREENBAUM, RS
ACTING HEALTH AGENT CODE EN CEMENT INSPECTOR
µ- y
CITY OF SALEM, MASSACHUSETTS �9
BOARD OF HEALTH
120 WASHINGTON STREET,4°i FLOOR
TEL. (978) 741-1800
KINIl3EKLEY DRISCOLL FAX(978) 745-0343
MAYOR uciuENKAoM@SAccM.COM
DAVID GREENBAum,RS
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."
FEE: $50.00
PROPERTY LOCATED AT C rce t ED UNIT
IS THIS UNI DISI TA RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER_4mL( (ff ne,
NO P.OBOX m MANAGER/AGENT
ADDRESS. (q 0':) �h rlt Qv �P ADDRESS___
CITY, STATE,ZIP c l�i�� I ' I l n Q CITY, STATE,ZIP
RESIDENCE PHONE BUSINESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:— 1/ 1
ROOMUSE: l hV f-M 2. 1Y1�(t p. lU `,S1 9 , ° 1
THERE IS A FIFTY($50)DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH TH ESP YAB E TIME OF INSPECTION
APPLICANT'S SIGNAT E DATE ldaalto
Ins ec u onl
Date on initial inspection: 1 G /U Date of reinspection:
Date of issuance of certificate: / o Date fee paid: i o
Type of unit: Dwelling VOther Check# 33d3(o�� Check date: ////.3//0
Notes:
C nfor went Inspector
TRANSMISSION VERIFICATION REPORT
TIME : 11/23/2010 03: 13
NAME :
FAX : 9787450343
TEL : 9787411800
SER.# : 000BON341991
DATEJIME 11/23 03: 12
FAX N0. /NAME 919784539150
PAGE(S)
DURATION 0:00:27
RESULT OK
MODE STANDARD
ECM
CITY OF SALEM, MASSACHUSETTS
BOARD OF HFALTH
120 WASHINGTON STREET,4°1 FLOOR
TEL. (978) 741-1800
IQMBERLEY DRISCOLL. FAX(978) 745-0343
MAYOR DGRMNBAUMnn SAHN.COM
DAVID GRFI NBAUNI
ACTING HrACn-I AGI;N'I'
Facsimile
Transmittal
ff ��
To: Gvl. t4 A �—
Fax # 4q 7) �J�3 -
RE: 7 T rS� ni &2e 9y C� /7
Date : /'1 j o2 3 2/ D
/ �i Page(s): including this cover#
/ i
Message: ,eAZ-'A b 1 a (17C 42AA-
Board of Health News ----------------------------------------------------------------For Your Information
OFFICE HOURS:
Monday, Tuesday, Wednesday 8:00 AM to 4:00 PM
Thursday 8:00 AM to 7:00 PM
Friday 8:00 AM to 12:00 NOON
CITY OF SALEM, MASSACHUSETTS
so
BOARD OF HEALTPI
120 WASHINGTON STREET,4"'FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAx(978) 745-0343
MAYOR DGiL'ENBAUM@SA1.BM.COM
DAVID GRFLNBAUM
ACTING HEAD1I-1 A(&N'r
CERTIFICATE OF FITNESS
CERTIFICATE#73-10
DATE ISSUED: 2/19/2010
Property Located at: 4 First Street UNIT#9307
Owner/Agent: Hawthorne Commons
Address: 205 Highland Avenue
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-825-0030
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
OF HEALTH
/
1
DAVID GREENBAUM
ACTING HEALTH AGENT CODE ENFORqEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS ) )�
BOARD OF HEALTH
120 WASHINGTON STREET',4`"FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR DG EINBAUhi(a ALEN.COM
DAVID GREENBAUM,
ACTING HEALTH AGENT
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."
FEE: $500.00
PROPERTY LOCATED AT L rS+ '!S V\"- � UNIT4 3 4 -1
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK.P ASE CIRCLE ONE
OWI 'NER/LESSER �L C,(?-dYWYvl--tM S MANAGER/AGENT
NO P.O. BOX
ADDRESS ADDRESS ��S �� �( � �-C,
CITY, STATE,ZIP � �� 611-16 CITY, STATE,ZIP
RESIDENCE PHONE 15 G� a U U 30 BUSINESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:_
ROOM USE: 1 I J�� ✓bDv� '�fir( �1 Z k4 LIZ k�
6. '7. 8. 9. fo.
THERE IS A FIFTY($5 LLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH'THIS IS PAYABLE THE TIM OAF )INSPECTION q /t
APPLICANT'S SIG T /v DATE
Inspectors use only
Date on initial inspection: y ��U Date of reinspection:
Date of issuance of certificate: q 1 el I() Date fee paid: lU
Type of unit: Dwelling_v—Other Check# •S� �s /� Check date: I/D
Notes:
Code Enforeaijnt Inspector
CITY OF SALEM, MASSACHUSETTS
• BOARD OF HEALTH
120 WASHINGTON STREET,4"FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR - UGRIiP,N13AUM[�!SALL:M.COM
DAVID GREENBAUM,
ACTING HEALTH AGENT
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.
r
1,
r
Tenant/Lessee &or
Address Address
All
Address on unit to be in petted
Date
SND City of Salem, Massachusetts {
Board of Health
120 Washington Street, 4th Floor, Salem, Pub11CHBellth
MA 01970 Prevent. Promote. Protect.
Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, RENS,CHO
Mayor health@salem.com Health Agent
CERTIFICATE OF FITNESS
CERTIFICATE#: GHL-16.504
DATE ISSUED: 12/29/2016
Property Located at: 9FIRST STREET UNIT#S113
Owner/Agent: Pequot Highlands
Address: 12 First Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(978) 745-4884
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.
Larry Ramdin, MPH, RENS, CHO
HEALTH AGENT SANITARIAN
r CITY OF SALEM, 1'L�SS ACHUSETTS IV
BOARD OF HEALTH
120 WASHINGTON STREET 4"'FLOOR Promo...ublic.. th
r Preama.Pu.Pmma.
TEL. (978) 741-1800 FAX(978)745-0343
Iii IBERLEY DRISCOLL Iramdin@salem.com
NL�YOR LARIiI' .�AbN
RID ,RS/REI-I5,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: $$550.00 1
PROPERTY LOCATED
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE
OWNER/LESSER O kW\_kCLVAAS MANAGER/AGENT 30ar\
NO P.O.BOX
ADDRESS —EIM—L S� A p^ I ADDRESS S��e
CITY,STATE,ZIP , IPJYn I /t/V''I1 O�pl� �D CITY, STATE,ZIP s �
RESIDENCE PHONE q 1 '9' �45 ' 4 f a L� BUS NESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:_
ROOM USE: 1. 2. LIZ 3. (: JJ W 4. 5. SAV V'^
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:1 /}� C� ��/I,1 Q Date of reinspection:
Date of issuance of certificate:�yV L� Date fee paid:
Type of unit: Dwelling Other Check# Check date:
Notes: p
OP
Site# y 0137
Date Received
Purchase Order# 1 '7AQk001UH
Code nforceme t pector Batch*
GL Code — lJ1S1TD
Amount to be Paid
Approved By
I rpND ` City of Salem, Massachusetts
Board of Health 4
120 Washington Street, 4th Floor, Salem, P evPublPcmate. Protect.
Healt]i
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-17-3
DATE ISSUED: 1/5/2017
Property Located at: 10 2 FIRST STREET UNIT#5302
Owner/Agent: Pequot Highlands
Address: 12 First Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(978)745-4884
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.
e124L/1 - --
Larry Ramdin, MPH, REHS, CHO 14
HEALTH AGENT SANT ARIAN
CITY OF SALEM NLASSACHUSETTS
a� BOARD OF HEALTH
120 WASHINGTON STREET 4� FLOOR Public Health
STREET, Prevent.Promote,Protect.
TEL. (978) 741-1800 FAs(978)745-0343
Iii IBERLEY DRISCOLL lramdin a„salem.com
MAYOR LAR1Ll'RA;�IDI�i,Rs/R1J ts,cttq Cl'-[:S
HEALTH AGENT
Application for Certificate of Fitness
N ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION"
,¢ L
FEE: $50.00
Q
PROPERTY LOCATED AT L O l ��1 f 'CXR UNIT#
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BAM PLEASE CIRCLE ONE
OWNER/LESSER 7".W� \�k6-AAS MANAGER/AGENT OCLn 'ASSe, (
NO P.O.BOX
ADDRESS—1.2-RyLtzk S-� ADDRESS Su.Vr 2
CITY,STATE, ZIP SWM ) MA/ 1 Q 19 7o CITY, STATE,ZIP s �
RESIDENCEPHONE 01-7Z, 745 ' 4A a0A BUSINESS PHONE(24HRS) Sa L
BUSENESS PHONE
TOTAL NUMBER OF ROOMS: �tIJ
ROOM USE: 1. �� 2. LR- 3. IYiL✓nti4. 'iL 5. V���w�
6. 7. 8. 9. 10.
THERE IS A FIFTY(S50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE IS PAYABLE AT THE TIME OF Iii ISPECTION
APPLICANT'S SIGNATURE DATE
InI . 20
�1 Inspectors use only
Date on initial inspection? NA f I ro w a Date of reinspection:
Date of issuance of certificate:/ an F 2--(nDate fee paid:
Type of unit: Dwelling Other Check# Check date:
Notes:
Site Name Pe not Highlands
-� Site# 0137
Date Received
Purchase Order# 2 (n(O
Batch#
Code E orcemen Insp GL Coded
Amount to be Paid
��Ap�ed By --
�.
City of Salem, Massachusetts
Board of Health
120 Washington Street, 4th Floor, Salem, PlublfCHeatth
�N " h
MA 01970 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-16-506
DATE ISSUED: 12/29/2016
Property Located at: 10 12 IRST STREET UNIT#N203
Owner/Agent: Pequot Highlands
Address: 12 First Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(978) 745-4884
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.
a-�& -
Larry Ramdin, MPH, REHS, CHO
HEALTH AGENT SANITARIAN
y
CITY OF SALEM 1l'LASSACHUSETTS
BO:\RD OF HEALTH
120 WASHINGTON STREET 4'"FLOOR PublicHealth
Prevent.Promo[e.P'aw.
TEL. (978)741-1800 F.m1(978)745-0343
I<L'yIBERLEYDRISCOLL Iramdin salem.com
Lr
1VLIYOR \12121'R;\DIDN,R,ti/REI I5,CHO,CI'-PS
HEALTH AGENT
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"NIINEMUM STANDARDS OF FITNESS FOR HUMAN HABITATION"
FEE: $50.000
PROPERTY LOCATED AT I ) _ �- S'�QJI, UNIT#
IS THIS UMT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE
OWNER/LESSER 7e-q,W� kWV\CLAAS MANAGER/AGENT 30ar\
NO P.O.BOX
ADDRESS 12_ '�,I_s 1 ADDRESS S� e
CITY, STATE,ZIP �ICJY► 1 1 )VA/ '0 tot 7D CITY, STATE,ZIP
RESIDENCE PHONE q-] Z, �4S ' 4A b0L� BUSI1i LESS PHONE (24HRS)
BUSNESS PHONE C--O-'Yh
TOTAL NUMBER OF ROOMS:_ r� 'I
ROOM USE: 1. 2. U V— 3. f J_U(—PV\ 4. 5.
6. 7. 8. 9. 10.
THERE IS A FIFTY(S50)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: r()L '.(�� 4 ex' J
A _ Date of reinspection:
Date of issuance of certificate:' 2q gm(_�_ _ Date fee paid.-
Type
aid:Type of unit: Dwelling Other Check# Check date:
Notes:
Site Name Pequot Highlands
Site# 0137
Date Received ( L_ -((0
Purchase Order# �( (1010-9
Batch#
Co e E o emeAt Inspec r GL Code —(n O Q- 770
Amount to be Paid
Approved By
N " City of Salem, Massachusetts
k
r . ,
Sm Board of Health
120 Washington Street, 4th Floor, Salem, Pub1iCHEalth
MA 01970 Prevent. Promote. Proved,
Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, RENS, CHo
Mayor health@salem.com Health Agent
CERTIFICATE OF FITNESS
CERTIFICATE#: GHL-16-507
DATE ISSUED: 12/29/2016
Property Located at: 10-@1FIRST STREET UNIT#N301
Owner/Agent: Pequot Highlands
Address: 12 First Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(978) 745-4884
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. —
Larry Ramdin, MPH, REHS, CHO
HEALTH AGENT SANITARIAN
CITY OF SALEM, l'LASSACHUSETTS lu
• ��� BO:\RD OF HEALTH
120W.\.SIHVGTONSTREET 4F"FLOOR PRb1iCHCait11
STREET, Prevent.Promote.Protea.
TEL. (978) 741-1800 FAA(978)745-0343
ISL IBERLEY DRISCOLL lramdin a,salem.com
MAYOR Lr\Rltl'It\ilIDIDJ,R.S/REF[S,CFiO,CP-['S
HFALTH AGFNT
Application for Certificate of Fitness
N ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"MIlVIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION"
FEEL: $,,50..0, _0,
PROPERTY LOCATED AT Z �� S+)n(� UNIT#
IS THIS UNIT DISIGN1ATED AS RIGHT LEFT FRONT OR BA PLEASE CIRCLE ONE
OWNER/LESSER W 1��C111G�S MANAGER/AGENT 36a r\
NO P.O.BOX
ADDRESS_ ` 2_ SAAA
^V'n _ADDRESS
CITY, STATE,Zzipa I ew I I /i/ /I, D
0197o CITY, STATE,ZIP
RESIDENCE PHONE q-] Z, 7` 5 ' L LBUS NESS PHONE (24HRS) Sa ✓r`'L
BUSININESS PHONE
TOTAL NUMBER OF ROOMS:
I n _ nn ff
ROOM USE: 1. 2. 1�- 3. V�1,W4. 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 TWE OF INSPECTION
APPLICANT'S SIGNATURE DATE
Inspectors use only
Date on initial inspection: A V V Date of reinspection:
Date of issuance of certificate 120 Date fee paid:
Type of unit: Dwelling Other Check# Check date:
Notes:
84e Nalne Site# equot Highlands
0— 13—7
Date Received Z_ b
ro Purchase Order# Z 0
e E orceent Inspector Batch;
m
Gt. Code
Amount to be Paid
Approved By
i
6
��OONU7
CERT.# 34-99
FEE $25.00
DATE: 01/27/99
���MINB7'A
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT,MPH, RS,CHO NINE NORTH STREET
HEALTH AGENT Tel: (978)741-1800
Fav(978)740-9705
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 12 First Street UNIT #: 701
OWNER/AGENT: Pe4uot Highlands
ADDRESS: 12 First Street
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-4884
AN INSPECTION OF YOUR VACANT DWELLING/ROOMING UNIT AT THE ABOVE ADDRESS HAS
BEEN APPROVED AND IS IN COMPLIANCE WITH 105 CMR 410 .000: MASSACHUSETTS STATE
SANITARY CODE, CHAPTER II, "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" .
THEREFORE, THIS CERTIFICATE IS ISSUED BY THE CODE ENFORCEMENT DIVISION OF THE
SALEM HEALTH DEPARTMENT AND THE UNIT MAY NOW BE RENTED AND/OR OCCUPIED.
MAXIMUM NUMBER OF OCCUPANTS, BASED ON 105 CMR 410 .000: MASSACHUSETTS STATE
SANITARY CODE, CHAPTER II, "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" .
SECTION 410 .400 (B) : DWELLING UNIT (X) AND 410 .400 (C) : ROOMING UNIT
MINIMUM SQUARE FOOTAGE FOR SLEEPING PURPOSES: .
NOTE: THIS APPROVAL DOES NOT CERTIFY COMPLIANCE WITH THE STATE LEAD LAW FOR
OCCUPANTS UNDER 6 YEARS OF AGE.
OR THE BOARD OF HEALTH
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
s
��MIN6�
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 / /r �YA UNIT#_�7d `
IS THIS UNIT DESIGNATED AS�RIGHT LEFT
FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER /' j0YIL�%`E*` �ANAGER/AGENT //- a
No P.O. Box No P.O. Box
ADDRESS IZ P ADDRESS / ��r
CITY CITY
CITY
RESIDENCE PHONE BUSINESS PHONE (24 HRS.) 7LI _y
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. 2._ 3.
5. 6. 7. 8.
THERE IS A TWENTY-FIVE($25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY
ORDER TO THE CITY OF SALEM HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE
TIME OF INSPECTION.
3
APPLICANTS SIGNATURE DATE
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION /,r}? - ?f DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE:/-,? � - If DATE FEE PAID:_ 1-d-7 y Y
TYPE OF UNIT: DWELLIN' OTHER_ CHECK# /5-8'40 CHECK DATE
NOTES:
CODE ENFORCEMENT INSPECTOR 9/28/98
JAN 29 '99 09:49 AM SALEM HEALTH +5007409705 Page 2
A
a i
114 .� 4t
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT,MPH,RS,CHO NINE.NORTH STREET
HEALTH AGENT Tel:(508)741-1000
Fax:(508)740-9705
RF1-EASF
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
riic City of. Salem Ordinance, undersigned owner/lessor and tenant./lessee of a unit
of resideotinl property, hereby authorize the Salem Hoard of Health or its author-
ized agent:9 to inspect the residence identified below in accordance with tile.
aforementioned statutes, reFulaLious and ordinances.
L1 the event iL is neteSsarV LhaL said inspection be done in my/our absence, ;/We
expressly authorize the same and for lily/our successors and assi.gus hereby rebase
and discharge the CiLy of Salem, Salem board of Health snd its authorized egen�a
mora any loss or injury s_sLained Of whatever nater(• and dascripLi-,n occasivaefI
by my/our abserct during said inspecti.ur.
,•=.NA\T'/ S'SEb: OWNER/�.FSSCC
ouRrss nF UNl"I- "P11 i5)•: INSPECTI'D
0.Cfh;
i
J �NDtz City of Salem, Massachusetts
n
Board of Health
120 Washington Street, 4th Floor, Salem, PabliCHeaith
MA 01970 Prevent. Promote. Protein.
Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, RENS, CHO
Mayor health@salem.com Health Agent
CERTIFICATE OF FITNESS
CERTIFICATE #: GHL-16-503
DATE ISSUED: 12/29/2016
Property Located at: 10-12 FIRST STREET UNIT#N702
Owner/Agent: Pequot Highlands
Address: 12 First Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(978)745-4884
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.
Larry Ramdin, MPH, REHS, CHO
HEALTH AGENT SANITARIAN
Q..
y
c CITY OF SALEM, N'LASSACHUSETTS
BOARD OF HEALTH PublicHealth
120 WASHINGTON STREET,4"`FLOOR prcreoG promme.Protect.
TEL. (978)741-1800 FAZ(978)745-0343
Iii IBERLEY DRISCOLL lramdin@saletn.com
MAYOR LARRY x.�� RS/RM,,RS/RM,cHo,cr-Fs
HEALTH AGENT
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"MI NLVIUM STANDARDS OF FITNESS FOR HUMAN HABITATION"
FEE: $50.00
PROPERTY LOCATED AT UNIT#��UZ
IS THIS1N[T]D�I,S,I�GNA TED AS RIGHT LEFT FRONT OR BAPLEASE CIRCLE ONE
�Wi
OER/LESSER x'1 lA` \\ \' 1CLR S MANAGER/AGENT 30a P\ '� �SseA(
ADDRESS :R][ S-�
I�,,_,� �p� I —7 ADDRESS Sa- -nP
CITY,STATE,ZIP �1CJI ► 1 t /�V'T1 Q I� /0 CITY, STATE,ZIP s �
RESIDENCE PHONE CI 7 9, �45 ' y ALA BUSINESS PHONE(24HRS)
BUSINESS PHONE C�
TOTAL NUbIBER OF ROOMS: 4p pp/��
ROOM USE: 1 � 2. Lf, 3. Y7Q OA- 4. VV r�to 5.
6. 7. 8. 9. 10.
THERE IS A FIFTY(S50)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
nInspectors use only
Date on initial inspection: l p( 0 �I-C J it 1��/ ' Date of reinspection:
Date of issuance of certificate:—Ue� � Q Date fee paid:
Type of unit: Dwelling Other Check# Check date:
Notes:
Puquot man s
Site# 0137
Date Received
Purchase Order#
E orcement Ins ector Batch
GL Code V��
Amount to be Paid
Approved By
w
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
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#653-05
DATE ISSUED: 10/28/05
Property Located at: 12 First Street UNIT#708
Owner/Agent: Pequot Highlands
Address: 12 First Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-4884
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 HT E BOAR�D OF HEALTH
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
Oct 04 05 10: 44a Joanne Scott Salem BOH 978 745 0343 P. 1
CITY OF SALEM, MASSACHUSETTS
ca,
BOARD OF HEALTH120 WASHINGTON STREET, 4TH ELOOR
SALtM, MA 01970
TEL 978-741-1900 .
FAX 978-745-0343
y STANLCY USOVIC2, JR. JOANNC SCOT 1. MPH, RS, CIAO .a.
MAYVR HEALTH AGFNT
APPLICATION FOR CERTIFICATE OF FITNESS
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000
"MINIMUM STANDARDS OP FITNESS FOR
1HUMAN HABITATION" �/ q� '
PROPERTY LOCATED AT 1Z._ ���T 54r� ._. UNIT#... / O O
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNEFULESSER ....-i IDS_MANAGEPJAGENT
No P.O.Box No P.O.Box
ADDRESS I Z F I rs+ S+�ee,Q ADDRESS
CITY O, CITY..... ---
RESIDENCE PHONE_ __- BUSINESS PHONE (24 HRS.) _.
BUSINESSPHONE_ 7b'"�NS" yg
TOTAL 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 HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE
TIME OF INSPECTION.
APPLICANTS SIGNATURE _. . ......- _ DATE_., _..
INSPECTORS_,USE ONLY
DATF OF INITIAI INSPECTION /J_. > 0 DATE OF REINSPECTION_-_—__ -.
DATE OF ISSUANCE OF CERTIFICATE:I.4 46 —or DATE FEE PAID:_.�a=�
TYPE OF UNIT: DWELLING OTHER__ CHECK# -:P DATE -:P
�\
NOTES: _
CODE ENFORCEMENT INSPECTOR q'28/98
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
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#654-05
DATE ISSUED: 10/28/05
Property Located at: 12 First Street UNIT#908
Owner/Agent: Pequot Highland
Address: 12 First Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-745-4884
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
q�� -
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
Ocb 04 '05 10: 44a Joanne Scott Salem BOH 878 745 0343 P. 1
CITY OF SALEM, MASSACHUSETTS
.�
BOARD OF HEALTH
04D
120 WASHINGTON STREET, 4TH FLOORSALE.M, MA OI&70
TEL. 978-741-1800
FAX 978-745-0343
STANLEY USOVICZ, JR. ,JOANNE SCOTT, MPH, RS,, CHO
MAYOH HEALIH AGFNT "
1
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 ! Z FI f,5+ 5 ev,+ QQ UNIT# . De
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER Pe Ofi J IAAD.S_MANAGER/AGENT
No P.O. Box 1 No P.O. Box
ADDRESS Iz f.11'ST S�Yp�� ___ADDRESS
CITY 541,edi ��._ CITY..._ - -
RESIDENCE PHONF— BUSSIINESS PHONE (24I-IRS.) _.
BUSINESS PHONE_
TOTAL NUMBER OF ROOMS:
ROOM USE: 1.__ 9 3. . ....
4.—_-. .
THERE IS A TWENTY-FIVE($25.00)DOLLAR FEE,PAYABLE BY CHECK OR MONEY
ORDER TO THE CITY OF SALEM HEALTH DEPARTMENT THIS FEE 15 PAYABLE AT THE
TIME OF INSPECTION.
APPLICANTS SIGNATURE
INSPECTOR USE ONLY
OATF OF INITIALIN4PFy _CTI�6 fjd DATE OF REINSPECTION,..---
DATE
EINSPECTION..- _DATE OF ISSUANCE OF CERTIFICATE:/�-?_-PJ DATE FEE PAID:/a.
i
TYPE OF UNIT: DWELLINqC OTHERCHECK#- V t 7 CHECK DATE_Z S
NOTES: /�
CODE ENFORCEMENT INSPECTOR 9%2Sf9S
0.
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
z 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#614-5
DATE ISSUED: 10/3/05
Property Located at: 12 First Street UNIT# 1101
Owner/Agent: Pequot Highland
Address: 12 First Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-745-8166
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 IN4ESCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
Sep 27 05 09: 36a Joanne Scott Salem HUH 978 745 0343 P.2
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH fJ 4 Is
SILO WASHINGTON UTREFT,41 H FLOOR
SALEM, MA 01970
TEL. 978-741.,SOOI&
FAX 978.740-Q444:j 0 1
STANLEY USOVIC2, .JR, ,JOANNC SCOTT, MPH, RS. CHO '
MAYOR HEALTH AGENT
I
APPLICATION FOR CERTIFICATE OF FITNESS
IN ACCORDANCE WITH STATE SANITARY CODE.CHAPTER 11, 1 M CMR 410.000
'MINIMUM STANDARDS OF FITNESS FOR HUMAN1HABITATION".S-!
PROPERTY LOCATED AT_j 7 7( _,.. ret+ _UNIT# „11 0 !
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT$AC.K PLEASE CIRCLE ONE Lt
OWNER/LESSER_40PT i d np5 MANAGER/AGENT,...
No P.O.Bax 1 �LL No P.O.Bax Y
ADDRESS. - I FI/ � _ f I�ADDRESS_
uw_.. .. `J fl L 2A_._01970 CITY_..-... .... _.
RESIDENCE PHONE_. .,-BUSINESS BUSINESS PHONE(24 HRS.)
BUSINESS PHONE!
TOTAL NUMBER OF ROOMS:_-- _
ROOM USE: I. __2. __3 ..--.. 4 ..-_.._.:._
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
jNSPECTORS USE ONLY,
r
DATE OF 1 TI ..INSPECTION f 3� 0 U' DATE OF REINSPECTION
i
DATE OF ISSUANCE OF CERTIFICATE. i,5.0. "_b✓DATE FEE PAID: ..,. 3 0,
TYPE OF UNIT: DWELLTHER, CHECK# jo/Z .._CHECK DATE. v Jam.
NOTES,
CODE ENFORCEMENT INSPECTOR 9128/98
Y
City of Salem, Massachusetts
Board of Health
120 Washington Street, 4th Floor, Salem, P�oPubliCmHealth
f,ONDT 0MA 01970
Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, RENS, CHO
Mayor health@salem.com Health Agent
CERTIFICATE OF FITNESS
CERTIFICATE#: GHL-16.505
DATE ISSUED: 12/29/2016
Property Located at: 10*IRST STREET UNIT#N1212
Owner/Agent: Pequot Highlands
Address: 12 First Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(978)745-4884
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.
P—--4*� 1 i/D/L�l 4
Larry Ramdin, MPH, REHS, CHO
HEALTH AGENT SANITARIAN
N
CITY OF SALEM NLASSACHUSETTS
BO:aRD OF HEALTH
120 WASHNGTON STREETf 4� FLOOR PablicHealth
Prvm(.Promote.Pmt¢t.
TEL. (978) 741-1800 F.As(978)745-0343
I vBERLEYDRISCOLL Iramdin2salem.com
MAYORLr\R1tY R\MIDIN,RS/REI I5,CHq C]'-FS
HEALTii AGUANT
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CNIR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION"
FEE: $50.00
PROPERTY LOCATED AT �L UNIT# Nil�l Z
IS THIS U1NIT]D�I.S�I�GNATED AS RIGHT LEFT FRONT OR B�PLEASE CIRCLE ONE
OWNER/LESSER 7�W` \\�"1M IAA S MANIAGER/AGETNT
ADDRESS—J. I�,,—S� q �7 ADDRESS Salmi e
CITY,STATE,ZIP J(�.ICJY► ' /�V'�I1 O9D� /o CITY, STATE,ZIP SdAn%k
RESIDENCE PHONE 01 7 9, �45 ' 4 L0 BUSINESS PHONE(24HRS) SSQ r0—j-
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: nn ��QQ, �Q,��
ROOM USE: 1��2. 3. I d OV 4. I.�lil 01A 53. 1 d OV 4. 1..(il 01A 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 IS PAYABLE AT THE TINIE OF INSPECTION
APPLICANT'S SIGNATURE DATE
Inspectors use only
Date on initial inspection: Date of reinspection:
Date of issuance of certificate: Date fee paid:
Type of unit: Dwelling Other Check# Check date:
Notes:
Site Name Pequot Highlands
Sae
Date Received
Purchase Order# n�seko E2!4
Batch 9
od E nYorc en Inspector GL Code
Amount to be Paid
Approved By