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CITY OF SALEM
HOARD OF HEALTH
120
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. ; SALEM, MASSACHUSETTS 01970-3523
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c CITY OF SALEM9 MASSACHUSETTS
efv� BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
Ahlne flp q SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
KIMBERLEY DRISCOLL JSCOTT@SALEM.COM
MAYOR
JOANNE SCOTT
HEALTH AGENT
3/7/08
Ronald Cimon
52 Flint St., Apt. 3R
Salem, MA 01970
PROPERTY LOCATED AT 52 Flint Street All Units
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.
Ar the Board of H th Reply to
Joanne Scott MPH, RS, CHO Pablo Valdez
Health Agent Code Enforcement Inspector
Sent Certified Mail: 7005 3110 0000 7160 3927
CITY OF SALEM, MASSACHUSETTS
`
BOARD OF HEALTH
120 WASHINGTON STREET,4`FLOOR
TEL. (978)741-1800
KIMBERLEY DRISCOI.L FAx(978)745-0343
MAYOR I'c_ort sn11sai.com
.JOANNE SCO1T,
HEALTH AGENT
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMA HABITATION."
PROPERTY LACATED AT UNIT#
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER MANAGERJ AGENT _
NO P.O. BOX
ADDRESS ADDRESS
CITY,STATE,ZIP CIT'Y,STATE,ZIP
RESIDENCE,PHONE _BUSINESS PHONE (24HRS)
BUSINESS PHONE_,
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. 2. 3. 4. 5.
6. 7, 8. 9, 10.
THERE IS A TWENTY-FIVE(125)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF
SALEM BOARD OF HEALTH THIS FEE IS PAYABLE AT THE TIMI:OF INSPECTION
APPLICANTS SIGNATUREDATE
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: _.
Code Enforcement Inspector
CITY OF SALEM, MASSACHUSETTS
.]L BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
_ FAX 978-745-0343
JOANNE SCOTT, MPH, RS, CHO
,Kimberley Driscoll HEALTH AGENT
Mayor
October 10, 2004
Dear Property Owner, Property Manager, or Real Estate Agents:
As you may know, landlords, sellers and agents are now required to disclose known
Information on lead-based paint and/or lead-based paint hazards in virtually all rent, lease, and sales
transactions in dwellings built before 1978 to enable parents to protect their children. The required
Tenant Notification Form is enclosed.
The United States Department of Housing and Urban Development along with the State of
Massachusetts Childhood Lead Poisoning Prevention Program has asked the City of
Salem Board of Health to help in ensuring the disclosure process is working.
The Federal Residential Lead-Base Paint Hazard Reduction Act, 42'U.S.C. 4852d, requires sellers and
landlords of most residential housing built before 1978 to disclose all available records and reports concerning
lead-based paint and/or lead-based paint hazards, including the test results contained in this notice to
purchases and tenants at the time of sale or lease or upon lease renewal. This disclosure must
occur even if hazard reduction or abatement has been completed. Failure to disclose these test
results is a violation of the U.S. Department of Housing and Urban Development and the U.S.
Environmental Protection Agency regulations at 24 CFR Part 35 and 40 CFR Part 745 and can
result in a fine of up to $11,000 per violation. To find out more information about your obligations
under federal lead-based paint requirements, call 1-800-424-LEAD.
Thank you in advance for your assistance. If we can be of any assistance, please call the Salem Board
of Health (978-741-1800) and ask for a Lead Paint Determinator.
For the Board of Health
...1'oanne Scott
Health Agent
Form 1 : Tenant Lead Law Notification
and Tenant Certification Form
Tenant Lead Law Notification
What lead paint forms must owners of rental homes give to new tenants?
Before renting a home built before 1978, the property owner and the new tenant must sign two copies of
this Tenant Lead Law Notification and Tenant Certification Form, and the property owner must give
the tenant one of the signed copies to keep. If any of the following forms exist for the unit, tenants must
also be given a copy of them: lead inspection or risk assessment report, Letter of Compliance, or Letter
of Interim Control.This form is for compliance with both Massachusetts and federal lead
notification requirements.
What is lead poisoning and who is at risk of becoming lead poisoned?
Lead poisoning is a disease. It is most dangerous for children under six years old. It can cause permanent
harm to young children's brain, kidneys, nervous system and red blood cells. Even at low levels, lead in
children's bodies can slow growth and cause learning and behavior problems. Young children are more
easily and more seriously poisoned than others, but older children and adults can become lead poisoned
too. Lead in the body of a pregnant woman can hurt her baby before birth and cause problems with the
pregnancy. Adults who become lead poisoned can have problems having children,and can have high
blood pressure, stomach problems, nerve problems,memory problems and muscle and joint pain.
How do children and adults become lead poisoned?
Lead is often found in paint on the inside and outside of homes built before 1978.The lead paint in these
homes causes almost all lead poisoning in young children. The main way children get lead poisoning is
from swallowing lead paint dust and chips. Lead is so harmful that even a small amount can poison a
child. Lead paint under layers of nonleaded paint can still poison children, especially when it is
disturbed, such as through normal wear and tear and home repair work.
Lead paint dust and chips in the home most often come from peeling or chipping lead painted surfaces;
lead paint on moving parts of windows or on window parts that are rubbed by moving parts; lead paint
on surfaces that get bumped or walked on, such as floors,porches, stairs, and woodwork; and lead paint
on surfaces that stick out which a child may be able to mouth such as window sills.
Most lead poisoning is caused by children's normal behavior of putting their hands or other things in
their mouths. If their hands or these objects have touched lead dust, this may add lead to their bodies. A
child can also get lead from other sources, such as soil and water, but these rarely cause lead poisoning
by themselves. Lead can be found in soil near old, lead-painted homes. If children play in bare, leaded
soil, or eat vegetables or fruits grown in such soil,or if leaded soil is tracked into the home from outside
and gets on children's hands or toys, lead may enter their bodies. Most adult lead poisoning is caused by
adults breathing in or swallowing lead dust at work, or, if they live in older homes with lead paint,
through home repairs.
Form 1 A 461
t
How can you find out if someone is lead poisoned?
Most people who are lead poisoned do not have any special symptoms.The only way to find out if a
child or adult is lead poisoned is to have his or her blood tested. Children in Massachusetts must be
tested at least once a year from the time they are between nine months and one year old until they are
four years old.Your doctor, other health care provider or Board of Health can do this. A lead poisoned
child will need medical care. A home with lead paint must be deleaded for a lead poisoned child to get
well.
What kind.of homes are more likely to have lead paint?
In 1978, the United States government banned lead from house paint. Lead paint can be found in all
types of homes_built,before 1978; single-family and multi-family;homesin cities, suburbs or the
countryside; private housing or state or federal public housing.The older the home,the'more likely'it is
to have lead paint.The older the paint,the higher its lead content is likely to be.
Can regular home repairs cause lead poisoning?
There is a danger of lead poisoning any time painted surfaces inside or outside the home are scraped for
repainting, or woodwork is stripped or removed, or windows or walls are removed. This is because lead
paint is found in almost all Massachusetts homes built before 1978, and so many of Massachusetts'
homes are old. Special care must be taken whenever home repair work is done. No one should use power
sanders, open flame torches, or heat guns to remove lead paint, since these methods create a lot of lead
dust and.fumes. Ask the owner of your home if a lead inspection has been done. The inspection report
will tell you which surfaces have lead paint and need extra care in setting up for repair work, doing the
repairs, and cleaning up afterwards.Temporarily move your family(especially children and pregnant
women)out of the home while home repair work is being done and cleaned up. If this is not possible,
tape up plastic sheets to completely seal off the area where the work is going on.No one should do repair
work in older homes without learning about safe ways to do the work to reduce the danger of lead dust.
Hundreds of cases of childhood and adult lead poisoning happen each year from home repair work.
What can you do to prevent lead poisoning?
• Talk to your child's doctor about lead.
• Have your child tested for lead at least once a year until he/she is four years old.
• Ask the owner if your home has been deleaded or call the state Childhood Lead Poisoning Prevention
Program (CLPPP) at 1-800-532-9571, or your local Board of Health.
• Tell the owner if you have a new baby,or if a new child under six years old lives with you.
• If your home was deleaded, but has peeling paint, tell and write the owner. If he/she does not respond,
call CLPPP or your local Board of Health.
• Make sure only safe methods are used to paint or make repairs to your home,ano,to clean up
afterwards.
• If your home has not been deleaded, you can do some things to temporarily reduce the chances of
your child becoming lead poisoned. You can clean your home regularly with paper towels and any
household detergent and warm water to wipe up dust and loose paint chips. Rub hard to get rid of
more lead. When you are done, put the dirty paper towels in a plastic bag and throw them out. The
areas to clean most often are window wells, sills, and floors. Wash your child's hands often
(especially before eating or sleeping) and wash your child's toys, bottles and pacifiers often. Make
462 A Form I
sure your child eats foods with lots of calcium and iron,and avoid foods and snacks that are high in
fat. If you think your soil may have lead in it, have it tested. Use a door mat to help prevent dirt from
getting into your home. Cover bare leaded dirt by planting grass or bushes, and use mats, bark mulch
or other ground covers under swings and slides. Plant gardens away from old homes, or in pots using
new soil. Remember, the only way to permanently lower the risk of your child getting lead poisoned
is to have your home deleaded if it contains lead paint.
How do you find out where lead paint hazards may be in a home?
The only way to know for sure is to have a lead inspection or risk assessment done. The lead inspector
will test the surfaces of your home and give the landlord and you a written report that tells you where
there is lead in amounts that are a hazard by state law. For interim control, a temporary way to have your
home made safe from lead hazards,a risk assessor does a lead inspection plus a risk assessment. During
a risk assessment, the home is checked for the most serious lead hazards, which must be fixed right"
away. The risk assessor would give the landlord-and you a written report of the areas with too much lead
and the serious lead hazards.Lead inspectors and risk assessors have been trained, licensed by the
Department of Public Health, and have experience using the state-approved methods for testing for lead
paint.These methods are use of a sodium sulfide solution, a portable x-ray fluorescence machine or lab
tests of paint samples.You can get a list of licensed lead inspectors and risk assessors from CLPPP.
In Massachusetts,what must the owner of a home built before 1978 do if a child under six years
old lives there?
An owner of a home in Massachusetts built before 1978 must have the home inspected for lead if a child
under six years old lives there. If lead hazards are found, the home must be deleaded or brought under
interim control. Only a licensed deleader may do high-risk deleading work, such as removing lead paint
or repairing chipping and peeling lead paint.You can get a list of licensed deleaders from the state
Department of Labor and Workforce Development. Deleaders are trained to use safe methods to prepare
to work,do the deleading,and clean up. Either a deleader,the owner or someone who works for the
owner who is not a licensed deleader can do certain other deleading and interim control work. Owners
and workers must have special training to perform the deleading tasks they may do. After the work is
done, the lead inspector or risk assessor checks the home. He or she may take dust samples to test for
lead, to make sure the home has been properly cleaned up. If everything is fine, he or she gives the
owner a Letter of Compliance or Letter of Interim Control.After getting one of these letters, the owner
must take care of the home and make sure there is no peeling paint.
What is a Letter of Compliance? '
It is a legal letter under state law that says either that there are no lead paint hazards or that the home has
been deleaded. The letter is signed and dated by a licensed lead inspector.
,z
What is a Letter of Interim Control?
It is a legal letter under state law that says work necessary to make the home temporarily safe from
serious lead hazards has been done. The letter is signed and dated by a licensed risk assessor. It is good
for one year, but can be renewed for another year. The owner must fully delead the home and get a Letter
of Compliance before the end of the second year.
Form 1 ♦ 463
Where can I learn more about lead poisoning?
Massachusetts Department of Public Health Your local lead poisoning prevention program or
Childhood Lead Poisoning Prevention Program (CLPPP) your local Board of Health
(For more copies of this form, as well as a full range of
information on lead poisoning prevention, tenants' rights U.S. Consumer Product Safety Commission ,
and responsibilities under the MA Lead Law, how to (Information about lead in consumer products)
clean lead dust and chips, healthy foods to protect your 1-800-638-2772
children, financial help for owners, safe deleading and
renovation work, and soil testing.) U.S. Environmental Protection Agency, Region I
617-753-8400, 1-800-532-9571 (Information about federal laws on lead)
617-565-3420
Massachusetts Department of Labor and Workforce
Development National Lead Information Center
(List of licensed deleaders) _ (General lead poisoning information)
617-969-7177, 1-800425-0004 1-800-LEAD-FYI
464 A Form 1
Tenant Certification Form
Required Federal Lead Warning Statement
Housing built before 1978 may contain lead-based paint. Lead from paint,paint chips,and dust can pose health
hazards if not managed properly. Lead exposure is especially harmful to young children and pregnant women.
Before renting pre-1978 housing, lessors must disclose the presence of known lead-based paint and/or lead-based
paint hazards in the dwelling. Lessees must also receive a federally approved pamphlet on lead poisoning
prevention. The Massachusetts Tenant Lead Law Notification and Certification Form is for compliance with
state and federal lead notification requirements. -
Owner's Disclosure
(a) Presence of lead-based paint and/or lead-based paint hazards(check(i)or(ii)below):
(i) _Known lead-based paint and/or lead-based paint hazards are present in the housing(explain).
(ii)_Owner/Lessor has no knowledge of lead-based paint and/or lead-based paint hazards in the housing.,
(b) Records and reports available to the owner/lessor(Check (i)or(ii)below):
(i) _ Owner/ Lessor has provided the tenant with all available records and reports pertaining to lead-based
paint and/or lead-based paint hazards in the housing(circle documents below).
Lead Inspection Report; Risk Assessment Report; Letter of Interim Control; Letter of Compliance
(ii) _ Owner/Lessor has no reports or records pertaining to lead-based paint and/or lead-based paint
hazards in the housing.
Tenant's Acknowledgment(initial)
(c) _ Tenant has received copies of all documents circled above.
(d)_ Tenant has received no documents listed above.
(e) _ Tenant has received the Massachusetts Tenant Lead Law Notification.
Agent's Acknowledgment(initial)
(f) _ Agent has informed the owner/lessor of the owner's/lessor's obligations under federal and state law for
lead-based paint disclosure and notification and is aware of his/her responsibility to ensure compliance.
Certification of Accuracy
The following parties have reviewed the information above and certify,to the best of their knowledge,that the
information they have provided is true and accurate.
Owner/Lessor Date Owner/Lessor Date
Tenant Date Tenant Date
vT
Agent Date Agent Date
Form 1 ♦ 465
1
Owner/Managing Agent Information for Tenant (Please Print):
Name Street Apt.
City/Town Zip Telephone
_1 (owner/managing agent)certify that I provided the Tenant Lead Law Notification/Tenant Certification Form
and any existing Lead Law documents to the tenant,but the tenant refused to sign this certification.
The tenant gave the following reason:
The Massachusetts lead law prohibits rental discrimination,including refusing to rent to families with children or
evicting families with children because of lead paint.
Contact the Childhood Lead Poisoning Prevention Program for information on the availability of this form in other
languages.
Tenant and owner must each keep a completed and signed copy of this form.
,z
466 ♦ Form 1
P qqy
..75
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH - -
120 WASHINGTON STREET 4`FLOOR PubliCHealth
STREET, Prevent.Promote.Protect.
TEL. (978)741-1800 FAX(978) 745-0343
KIMBERLEY DRISCOLL liai-ndin@salei-n.com
LARRY RAMDIN,Its/al.Hs,CH('),(;P-PS
MAYOR
CERTIFICATE OF FITNESS
CERTIFICATE #367-13
DATE ISSUED: 10/10/2013
Property Located at: 2 Flint Street UNIT# 1
Owner/Agent: Peter Hinchey
Address: 237 Locust Street
City/Town: Danvers, MA Zip Code: 01923 24 Hour Phone: 774-6839
Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division3, Section
705: Certificate of fitness of rented dwelling unit, apartment or tenement. An inspection of your
vacant Dwelling/Rooming Unit at the above address has been approved and is in compliance with
105 CMR 410.000: Massachusetts State Sanitary Code, Chapter ll"Minimum Standards of
Fitness for Human Habitation".
Therefore,this Certificate is issued by the Code Enforcement Division of the Salem Board of
Health and the unit may now be rented and/or occupied.
Maximum Number of occupants, must comply with 105 CMR 410.000.
Certificate valid for one year from date of issuance or until the current tenant vacates, whichever
is later.
This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy.
FOR THE BOARD OF HEALTH
LAR RAMDIN `-
HEALTH AGENT SANITARIAN
` CITY OF SALEM, MASSACHUSETTS
BOARD Or HEA1."rIr
v 1
120 WASHINGTON S1REE'1',4." FLOOR
TEL (978) 741-1800
KIt%113ERLEY DRISCOLL FAX ()78) 745-0343
YL�YOR LIZyNI D I NCa>s y1 XN1.f0%t
L:ARRF R;AJIDIN, RS/RHI IS,CI 10,CP-PS
HF:\ix IA(;FN'1'
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION"
FEE: $50.00
PROPERTY LOCATED AT 2 Flint St UNIT# 1
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK.PLEASE CIRCLE ONE
OWNER/LESSER Peter Hinchey MANAGER/AGENT
NO P.O.BOX
ADDRESS 237 Locust St. ADDRESS
CITY, STATE,ZIP Danvers CITY, STATE,ZIP Ma. 01923
RESIDENCE PHONE 978-774-6839 BUSINESS PHONE(24HRS) 978-618-6839
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: 6 1/2
ROOM USE: l.bdrm 2.bdrm 3.bdrm 4.kitchen 5.1vrm
6.dining 7.bathrm 8. 9. 10.
THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FE PAYABLE AT THE TIME OF INSPECTION
APPLICANT'S SIGNATU .li(t;V V ` DATE
Inspectors use y
Date on initial inspection: Date of reinspection:
Date of issuance of certificate: d -I a—\� Date fee paid:
Type of unit: Dwelling�f Other Check# V 'Vb Check date:
Notes:
r^(
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4O'FLOOR
TEL. (978)741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR 1)('RFI'NIiAUM R SAL P M.COM
DAVID GREENBAUM
Aci NG HF.ALIii AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#475-09
DATE ISSUED: 9/23/2009
Property Located at: 2 Flint Street UNIT#2
Owner/Agent: Peter Hinchey
Address: 237 Locust Street
City/Town: Danvers, MA Zip Code: 0192324 Hour Phone: 774-6839
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 BOARq OF HEALTH
DAVID GREENBAUM
ACTING HEALTH AGENT CODE ENFORCEMENT INSPECTOR
I
CITY OF SALEM, MASSACHUSETTS
• _ s BOARD OF HEALTH
120 WASHINGTON STREET,4'"FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978) 745-034.3
MAYOR DGIZEENBAllhlr[7� ALE..M.COM W j
� t
DAVID GREENBAUM, 6
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 IV�� C� UNIT#
IS THIS UNIT DISI' NII GATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER N i VkG- " MANAGER/AGENT j r. �
NO P.O. BOX f
ADDRESSQS L0 C-DADDRESS
f t
(�
CITY, STATE,ZIP D Ctj�5C-1-kf ��. '1 CITY, STATE,ZIP
RESIDENCE PHONE �} �( ? q C-/r�13 BUSINESS PHONE(24HRS)
BUSINESS PHONE-61)e
TOTAL NUMBER OF ROOMS:—1
ROOM USE: 1. 2. 3. 4. 5.
6. 7. 8. 9. 10.
THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEYABLE AT THE TIME OF INSPECTION
J
APPLICANT'S SIGNATURE &, DATE I DCl
Inspect se only
Date on initial inspection: 9//($/G01 Date of reinspection: a G
Date of issuance of certificate: alfa 3/01 Date fee paid:
Type of unit: Dwelling_zOther Check#Check date: q&P 61
Notes: FPP G� arr 04 - 5uhbs M , lyra cwbon , smog . -yy lrepl.4a cfaclod Piiv�311laCJ�U17
, F V1 & z w cl ups
-�rjQ�'�ff�-
C de E orcement Inspector
y CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH IV
120 WASHINGTON STREET 4`"FLOOR PublicHealth
> Prevent.Promote Protect.
TEL. (978) 741-1800 FAX(978)745-0343
KIMBERLEY DRISCOLL Iramdin@salem.com
LARRY RAMDIN,RS/REI S;CHO,CP-PS
MAYOR Hi;AJ:rii AGENT
CERTIFICATE OF FITNESS
CERTIFICATE #37-14
DATE ISSUED: 2/12/2014
Property Located at: 7 Flint Street UNIT#2
Owner/Agent: Ilse Peirce
Address: 5 Flint Street
CitylTown: Salem, MA Zip Code: 01970 24 Hour Phone: 744-2778
Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division3, Section
705: Certificate of fitness of rented dwelling unit, apartment or tenement. An inspection of your
vacant Dwelling/Rooming Unit at the above address has been approved and is in compliance with
105 CMR 410.000: Massachusetts State Sanitary Code, Chapter II" Minimum Standards of
Fitness for Human Habitation".
Therefore, this Certificate is issued by the Code Enforcement Division of the Salem Board of
Health and the unit may now be rented and/or occupied.
Maximum Number of occupants, must comply with 105 CMR 410.000.
Certificate valid for one year from date of issuance or until the current tenant vacates, whichever
is later.
This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy.
FOR THE BOARD OFHEALTH
LARRY RAMDIN
HEALTH AGENT SANITARIAN
CITY OF SALEM, MASSACHUSETTS
BOARD OF HE1�LTH
120 WASHINGTON STREF.r,4"'FLOOR
TEL. (978) 741-1800
KIMBERLEY DKISCOLL FAX(978) 745-0343
KWOR LRANIDIN2SALFALCONI
LARRY RAbffJTN,RS/REHS,CHO,CP-FS
HI.A1XH AGCi:NT
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 h V\ IV& UNIT#—_
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER MANAGER/AGENT
NO P.O. BOX
ADDRESS ADDRESS
CITY, STATE,ZIP CITY, STATE,ZIP \JAA U\'I
RESIDENCE PHONE SIc6 _ ` 1-! -'��V BUSINESS PHONE(24HRS)
BUSINESS PHONE _* Qwvl
TOTAL NUMBER OF ROOMS:—
ROOM
OOMS:ROOM USE: 1. 2. 3. 4. 5. c1do
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 TIM �j F INSPECTION
APPLICANT'S SIGNATURE DATE_Z1 Z tCt�
,Lectors use only
Date on initial inspection:T (1 Date of reinspection:
Date of issuance of certificate: Date fee paid:
Type of unit: Dwelling Other Check# /Check date:
Notes:
Code f r mentInspector
1LCITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
! SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
2/22/05
Flint Street Trust c/o Jerome Riordan
20 Anderws Road
Topsfield, MA 01983
PROPERTY LOCATED AT 10 Flint Street Unit 2
Dear Sir/Madam:
It has come to our attention, that you may be considering renting a dwelling unit at the above address.
In accordance with Chapter 11, Article XIII of the City of Salem Code of Ordinances, Section 2-
334, titled "Certificate of Fitness," each dwelling unit must be inspected and certified prior to
allowing occupancy. The inspection will be conducted in accordance with 105 CMR 410.000; State
Sanitary Code, Chapter 11: Minimum Standards of Fitness for Human Habitation.
Please notify us if you do not intend to rent the unit.
Please contact this department within 24 hours of receipt of this notice at 978-741-1800, to schedule an
appointment for an inspection. Our office hours are Monday thru Wednesday from 8:00 a.m. —4:00 p.m.
Thursday 8:00 a.m. to 7:00 p.m. and Friday 8:00 a.m. — 12:00 p.m.
Failure to comply with this procedure, may result in a fine of Twenty ($20.00) dollars per day for every
day that the dwelling unit is occupied without a Certificate of fitness.
A$25.00 check payable to the City of Salem is required for each unit inspected at the time of
inspection.
A property owner is required to pay gas and electricity for residential tenants if there is not a written letting
agreement stating the tenant is responsible for those utilities and if the meter(s) records electricity and
gas use which is not used exclusively by that tenant. The Department of Public Utilities has billed
property owners for their tenant's entire utility bills retroactive to the date of initial occupancy in cases in
which cross-metering has been proven to exist.
For the Board of Health Reply to
drdanne Scott MPH, RS, CHO Pablo Valdez
Health Agent Code Enforcement Inspector
4A.p^r.i ,. •'^ice Tn.h. app.. , . M'. '. n�M^, LL..r��� .. - � .:
yt`a..., }r
a CITY,OFI SALF-M; M_A_SSACHUSET•mTS'
S BOARD OF:HEALTH
,, -
'. 120 WASHINGTON STREET '4TH FLOOR `' }� ,��°��� T '�- v i
4,S4LEM, MA 01970
TEL, 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR - HEALTH AGENT
211105
Flint Street Trust/C/O Jerome Riordon
20 Andrew Road
Topsfield, MA 01983
PROPERTY LOCATED AT 10 Flint Street Unit 3
Dear SidMadam:
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 It: 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.
ForBoard of Health Reply to
Joa neScottMP
, RS, CHO Pablo Valdez
Health Agent Code Enforcement Inspector
3y 1n CERT.# 190-98
FEE $25.00
3 5t
1�� F= DATE: 04/06/98
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET
HEALTH AGENT T01:(978)741-1800
Fan:(978)740-9705
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 33 Flint Street UNIT #: 2nd Floor
OWNER/AGENT: Malcolm F- MacLean
ADDRESS: 41 Puritan Road
CITY/TOWN: Swamosoctt. MA ZIP CODE: 01907 24 HOUR PHONE: 595-7600
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
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
L WHI E YOU WERE OUT
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CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT Tel:(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 j 't� � fUNIT
OWNER/LESSERU-a-a /— &-o MANAGER/AGENT
ADDRESS &�-`N {-� ADDRESS q`` ��
CITY /lam Q 707 CITY
RESIDENCE PHO - BUSINESS PHONE (24 HRS�)`J7� 77 yo
BUSINESS PHO
TOTAL NUMBER OF ROOMS: `
ROOM USE: I . �jp,Q t� 2. e.� 3. Z -�4 .
5. 6. 7. 8.
THERE IS A TWENTY-FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE
CITY OF SALEM HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION
APPLICANTS SIGMA INSPECTORS
--
INSPECTORS USE ONLY .
DATE OF INITIAL INSPECTION: - DATE OF REINSPECTION J _
DATE OF ISSUANCE OF CERTiFICATE:Y i -I- DATE FEE PAID: D .
TYPE OF UNIT: DWELLING (/ OTHER
NOTES: 7� --
CODE ENFORCEMENT INSPECTOR
a�7MINE
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH,RS,CHO 06/24/99 NINE NORTH STREET
HEALTH AGENT Tel:(978)741-1800
Evelyn & David Schwartz Fax:(978)740-9705
22-6 Weatherly Drive
Salem, MA 01970
PROPERTY LOCATED AT 35 Flint Street UNIT # 103
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 the State Sanitary Code, Chapter II: Minimum Standards of Fitness
for Human Habitation.
Please notify us if you do not intend to rent the unit.
Please contact this department within One Week of receipt of this notice at:
978-741-1800, to schedule an appointment for an inspection. Our office hours are Monday
thru Wednesday from 8:00 a.m. - 4:00 p.m. Thursday 8:00 a.m. - 7:00 p.m. and Friday 8:00
a.m.- 4 :00 p.m.
A $25.00 check payable to the City of Salem is required for each unit inspected at the
time of inspection.
A property owner is required to pay gas and electricity for residential tenants if there
is not a written letting agreement stating the tenant is responsible for those utilities
and if the meter(s) records electricity and gas use which is not used exclusively by
that tenant. The Department of Public Utilities has billed property owners for their
tenants' entire utility bills retroactive to the date of initial occupancy in cases in
which cross-metering has been proven eo exist.
OR THE BOARD HEALTH REPLY TO
/7]77/Joanne Scott, MPH,RS,CHO PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
1
ZLJ (/Yi o e- /L-r C �J_ t AJ So A/
9z- G:lk dd�Z 3� �/, - � o
a ` ry
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT Tel:(978)741-1800
02/04/2000
Fax:(978)740-9705
Duane & Frank Carbone
550 Cabot Street
Beverly, MA 01915
PROPERTY LOCATED AT 35 Flint Stret Q4
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 %III 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 CMR1 State Sanitary Code, Chapter I: General Administrative
Procedures and 105 CMR 410.0001 State Sanitary Code, Chapter II: Minimum Standards of
Fitness for Human Habitation.
Please notify us if you do not intend to rent the unit.
Please contact this department within 24 hours of receipt of this notice at
978-741-1800, to schedule an appointment for an inspection. Our office hours are Monday
thru Wednesday from 8:00 a.m. - 4:00 p.m. Thursday 8:00 a.m. - 7:00 p.m. and Friday 8:00
a.m. - 4:00 p.m.
Failure to comply with this procedure, may result in a fine of Twenty (20) 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
j utilities and if the meter(s) records electricity and gas use which is not used
exclusively by that tenant. The Department of Public Utilities has billed property
owners for their tenants' entire utility bills retroactive to the date of initial
occupancy in cases in which cross-metering has been proven to exist.
OR THE BOARD
REPLY TO
oanne CHOr�eO PABLO VALDEZ
Health Agent CODE ENFORCEMENT INSPECTOR
i
CERT.# 788-97
J�' R FEE $25.00
DATE: 12/01/97
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT Tel:(978)741-1800
Fax:(978)740.9705
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 35 Flint Street UNIT #: 202
OWNER/AGENT: James Wade
ADDRESS: One Devonshire Street
CITY/TOWN: Boston, MA ZIP CODE: 02109 24 HOUR PHONE: 345-7208
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: THISAPPROVAL DOES NOT CERTIFY COMPLIANCE WITH THE STATE LEAD LAW FOR
- OCCUPANTS UNDER 6 YEARS OF AGE.
FOR THE BOARD OF HEALTH IJ/
qo-o-lf-�Iex�7 /
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
G tr
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT,MPH,RS,CHO - NINE NORTH STREET
HEALTH AGENT Tel:(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 / Lam/ T �'% UNIT I
OWNER/LESSER �/ ( C, � MANAGER/AGE-NT
ADDRESS 0 /1P._ C fl £ �}l ADDRESS } d
CITY `Bo 1ST'Q CITY /`,)1
i
'RESIDENCE PHONE BUSINESS PHONE (24 HRS.)
susixsss raoNE /
TOTAL NUMBER OF ROOMS:
f
ROOM USE: 1. �P2 .-3. G i _4.iR C to�
7. - 8.
THERE IS A TWENTY-FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK OR HONEY ORDER TO THE
CITY OF SALEM HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSP'EECT/IOONc
APPLICANTS SIGHATW 2t!2 - o DATE
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION:_/ I (, '?DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: / — DATE FEE PAID: 1g `j 7_
TYPE OF UNIT: DWELLING OTHER
NOTES:
—
F ENFORCEMENT INSPECTOR
4
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT Tel:(978)741-1800
10/21/99 Fax:(978)740-9705
Jay & Karen Browne
19 Hills Road
Loudonville, NY 12211
PROPERTY LOCATED AT 35 Flint Street UNIT # 203
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; State Sanitary Code, Chapter I: General Administrative
Procedures and 105 CMR 410.000; State Sanitary Code, Chapter II: Minimum Standards of
Fitness for Human Habitation.
! Please notify us if you do not intend to rent the unit.
Please contact this department within 24 hours of receipt of this notice at
978-741-1800, to schedule an appointment for an inspection. Our office hours are Monday
thru Wednesday from 8:00 a.m. - 4:00 p.m. Thursday 8:00 a.m. - 7:00 p.m. and Friday 8:00
a.m. - 4:00 p.m.
Failure to comply with this procedure, may result in a fine of Twenty (20) dollars
per day for every day that the dwelling unit is occupied without a Certificate of
Fitness. s
0
A $25.00 check payable to the City of Salem is required for each unit inspected at the
time of inspection.
A property owner is required to pay gas and electricity for residential tenants if there
is not a written letting agreement stating the tenant is responsible for those
utilities and if the meter(s) records electricity and gas use which is not used .
exclusively by that tenant. The Department of Public Utilities has billed property
owners for their tenants' entire utility bills retroactive to the date of initial
occupancy in cases in which cross-metering has been proven to exist.
i
R THE BOARD O)t HEALTH REPLY TO
oanne ScottXMPrRRSCHO - PABLO VALDEZ
Health Agent CODE ENFORCEMENT INSPECTOR
' ��,CONOIT
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT 03/11/99 Tel:(978)741-1800
Duane & Frank Carbone Fax:(978)740-9705
550 Cabot Street
Beverly, MA 01915
PROPERTY LOCATED AT 35 Flint Street UNIT # 204
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; State Sanitary Code, Chapter I: General Administrative
Procedures and 105 CMR 410.000; State Sanitary Code, Chapter II: Minimum Standards of
Fitness for Human Habitation.
Please notify us if you do not intend to rent the unit.
Please contact this department within 24 hours of receipt of this notice at
978-741-1800, to schedule an appointment for an inspection. Our office hours are Monday
thru Wednesday from 8:00 a.m. - 4:00 p.m. Thursday 8:00 a.m. - 7:00 p.m. and Friday 8:00
a.m. - 4 :00 p.m.
Failure to comply with this procedure, may result in a fine of Twenty (20) dollars
per day for every day that the dwelling unit is occupied without a Certificate of
Fitness.
A $25.00 check payable to the City of Salem is required for each unit inspected at the
time of inspection.
A property owner is required to pay gas and electricity for residential tenants if there
is not a written letting agreement stating the tenant is responsible for those
utilities and if the meter(s) records electricity and gas use which is not used
exclusively by that tenant. The Department of Public Utilities has billed property
owners for their tenants' entire utility bills retroactive to the date of initial
occupancy in cases in which cross-metering has been proven to exist.
FPR THE BOARD OF HEALTH REPLY TO
oanne Scott, MPH,RS,CHO PABLO VALDEZ
Health Agent CODE ENFORCEMENT INSPECTOR
� A�l. CERT.# 399-97
FEE $25.00
DATE: 06/26/97
MIf�
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: 35 Flint Street UNIT #: 205
OWNER/AGENT: Robert Adams
ADDRESS: 66 Coolidge Avenue
^ITY/TOWN: Needham. MA ZIP CODE: 02192 24 HOUR PHONE: 449-2974
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 OF HEALTH
/�
,10ANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
't
I
3
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT Tel:(508)741-1600
APPLICATION FOR CERTIFICTE OF FITNESS Fax:(506)740-9705
IN ACCORDANCE WITH STATE S4NITARY' CODE„CHAPTER II, 105 CMR 410.000 "MINIMUM
STANDARDS OF FITNESS FOR HUMAN H"ITATION". y
PROPERTY LOCATED AT 3S- f / S r UNIT i ry d
OWNER/LESSER Roof f't? C API /ti'I J MANAGER/AGENT
ADDRESS l [ C,.f I Q C /} 1/� ADDRESS
CITY /-)i( CdIj o '"( aZ 16?. 2 CITY
RESIDENCE PHONE Z r V'1'9 Pf ,/ / BUSINESS PHONE (24 HRS.)
BUSINESS PHONE 0'9 3,2 - 6/,90 G -
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. 41V 2.i �c/L,3 _ 1�R� 4 .
5. 5. 7. 8.
THERE IS A TWENTY-FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE
CITY OF SALEM HEALTH DEPARTHM THIS FEE IS AYABLE AT THE TIME OF INSPECTION
APPLICANTS SIGHATURF.-/
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION: DATE OF REINSPECTION_
DATE OF ISSUANCE. OF CERTIFICATE: -'� _DATE FEE PACD:
TYPE OF UNIT: DWELLING y OTH£R
NOTES:--
CODE
OTES:CODE ENFORCEMENT INSPECTOR
r
3 �
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3626-Z---
JOANNE
703928 ---JOANNE SCOTT,MPH,RS,CHO _ _ . . _ " = NINE NORTH STREET
HEALTH AGENT - '- - TeC'(508)741-1800
Fax:(508)740-9705
RELEASE
In accordance with Massachusetts General -Laws Chapter III ; Code of Massachusetts
Regulations 410.000 et. seq. ; State Sanitary Code Chapter II and Article XIII of
the Citv of. Salem Ordinance, undersigned owner/lessor and tenant/lessee of a unit
of residential property, hereby authorize the Salem Board of Health or its author-
ized agents to inspect the residence identified below in accordance with the
aforementioned statutes, regulations and ordinances.
In the event it is necessary that said inspection be done in my/our absence, !/we
expressly authorize the same and for my/our successors and assigns hereby release
and discharge the City of 'Salem, Salem Board.o,f.Health .and its authorized agents
from any_loss or',injury. sustained..o.f. wbatever,nature all e.sc iption occasioned
by my/our absence during said inspection.
TENANT/LESSEE OWNER/LESSOR
ADDRESS ADDRESS
It 2 of A 3F
ADDRESS OF UNIT TO BE INSPECTED
UAiE
f
3
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT Tel:(508)741-1800
Date: 05/15/97 Fax:(508)740-9705
Robert & Joanna Adams
66 Coolidge Avenue
Needham, MA 02192
PROPERTY LOCATED AT 35 Flint Street UNIT # 205
Dear Sir/Madam:
It has come to our attention, that you may be considering renting a dwelling unit
at the above address.
It is incumbent upon you as owner(s) to contact the City of Salem Health Department
to apply for a CERTIFICATE OF FITNESS before any vacant dwelling unit is rented or
occupied, or to notify us of your intent for this unit.
Each dwelling unit must be inspected and certified by the Salem Health Department
prior to allowing occupancy in accordance with Chapter 111, Sections 127A and 127B, of
the Massachusetts General Laws, 105 CMR 400.00; State Sanitary Code, Chapter 1: General
Administrative Procedures and 105 CMR 410.000; State Sanitary Code, Chapter 11: Minimum
Standards of Fitness for Human Habitation, and in accordance with Chapter 11, Article
XIII of the City of Salem Code of Ordiances, Section 2-334, Certificate of Fitness.
There is a twenty-five (25) dollar fee payable by check, or money order to the City
of Salem Health Department. This fee is payable at the time of inspection. Inspection
will not be performed without receipt of payment.
Failure to comply with this procedure, will result in a fine of twenty (20) dollars
per day for every day that the dwelling unit is occupied without approval of the Code
Enforcement Division of the Salem Health Department.
Contact this department within 24 hours of receipt of this notice. (508) 741-1800
Monday thru Wednesday from 8:00 a.m. - 4:00 p.m. Thursday 8:00 a.m. - 7 :00 p.m. or
Friday 8:00 a.m. to noon to schedule an appointment for an inspection.
SEE ENCLOSED SECTION 105 CMR 410 .354 METERING OF GAS & ELECTRICITY.
Very truly yours,
�FOR THE BOARD OF HEALTH - REPLY TO
Joanne Scott, MPH,RS,CHO PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
conmlr
BC/,y�NE
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET
HEALTH AGENT Tel:(978)741-1800
08/31/2000 Fax:(978)740-9705
Dial Realty Trust c/o Anthony & C.A. Dicroce, Trustees
100 Corporate Place Suite 306
Peabody, MA 01960
PROPERTY LOCATED AT 35 Flint Street UNIT # 206
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; State Sanitary Code, Chapter I: General Administrative
Procedures and 105 CMR 410.000; State Sanitary Code, Chapter II: Minimum Standards of
Fitness for Human Habitation.
Please notify us if you do not intend to rent the unit .
Please contact this department within 24 hours of receipt of this notice at
978-741-1800, to schedule an appointment for an inspection. Our office hours are Monday
thru Wednesday from 8:00 a.m. - 4 :00 p.m. Thursday 8:00 a.m. - 7 :00 p.m. and Friday 8:00
a.m. - 4 :00 p.m.
Failure to comply with this procedure, may result in a fine of Twenty (20) dollars
per day for every day that the dwelling unit is occupied without a Certificate of
Fitness.
A $25 .00 check payable to the City of Salem is required for each unit inspected at the
time of inspection.
A property owner is required to pay gas and electricity for residential tenants if there
is not a written letting agreement stating the tenant is responsible for those
utilities and if the meter(s) records electricity and gas use which is not used
exclusively by that tenant. The Department of Public Utilities has billed property
owners for their tenants' entire utility bills retroactive to the date of initial
occupancy in cases in which cross-metering has been proven to exist .
4OR THE BOARDHEA TH REPLY TO
9" t, MPH,RS,CHO PABLO VALDEZ
Health Agent CODE ENFORCEMENT INSPECTOR
wtw
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970^3928
JOANNE SCOTT,MPH,RS.nHO NINE NORTH STREET
HEALTH AGENT Tel:(978)741'1800
10/19/99 Fax: r40'V705
Brian & Laura O'Connor
35 Flint Street #]Ol
Salem/ M& 01970
PROPERTY LOCATED AT 35 Flint Street UNIT # 301
Dear Sir/Madam:
It has come to our attention, that you maybe considering renting a dwelling unit
at the above address.
In accordance with Chapter ll, Article XIII of the City of Salem Code of
ordinances, Section 2-334, titled "Certificate of Fitness, " each dwelling unit moot be
�
inspected and certified prior to allowing nncnpaonl/. The inspection will be conducted
in accordance with the State Sanitary Code, Chapter II: Minimum Standards of Fitness
for Human Habitation.
Please notify no if you do not intend to rent the unit.
Please contact this department within One Week of receipt of this notice at
978-741-1800, to schedule an appointment for an inspection. Our office hours are Monday
tbcn Wednesday from 8:00 a.m. - 4:00 p.m. Thursday V:OV a.m. - 7;00 p.m. and Friday 8:00
a.m,- 4:00 p,m.
& $25.00 check payable to the City of Salem in required for each unit inspected at the
\ time of ioogaotino^
& property ovmneziorequired to gay gas and electricity for residential tenants if there
in not a written letting agreement stating the tenant is responsible for those utilities
and if the meter(s) records eIectrioity and gas use which is not used exclusively by
that tenant. The Department of Public Utilities has billed property nvnzero for their
tenants' entire utility bills retroactive to the date of initial occupancy in cases in
� nbinb cross-metering has been proven eo exist.
/
4R, R8PI2� TJ.
Joanne Scott, MP8,88,C8O 2ABLO \QQQDE%
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
�
�
i
'
�
i
-CERT.# 127-97
3 3 FEE $25.00
DATE: 02/28/97
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: 38 Flint Street UNIT #: House
OWNER/AGENT: Clara Hennessy it Connie McCarthy
ADDRESS: 132 Lionhead Trail
CITY/TOWN: Scarborough, CAN ZIP CODE: M1B2J8 24 HOUR PHONE: 741-0500
'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 HUDIAN 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
(� 04
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
FEB 25_,-'997 01 :02 PM SALEM HEALTH
+5007409705 Page 1
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT.MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT T'6f.(506}741-5800
APPLICATION FOR CERTIFICTE OF FITNESS Fax:(508)74D-9705
IN ACCORDANCE WIT-11 STATE SANITARY:CODE, ZHAPTER II, 105 CHR 410:.000 "MINIMUM
STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED Ai _ (IAI i_�.- FKDrn . 1�iCv UNIT I�! _
OWNER/LESSER� xilt MANAGERIAGENT-
IIDDRESS� �1aliliA dittttL ADDRESS OilIvAl
sir G��"
al�lr aPr D alv c:iiY
'RESIDENCE PHONE BUSINESS PHONE (24 MS.) -7 -Don
BUSINESS PHONE —
TOTAL NUMBER OF ROOMS: /
ROOM USE: l . 2. UU.A1 r o 3. )&" _4. 1dO,M
5. )0—6. 7. 8.
THERE IS A TWENTY-FIVE (25.00) DOLLAR FEE„ PAYABLE BY CHECK OR HONEY ORDER TO THE
CITY OF SALE ((LTH D ARTMENT THIS FEE IS PAYABLE AT THE TDIR OF INSPECTION
APPLICANTS SICNA
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION: b28��jpp—gDATE OF REI.NSPECTION_�
DATE OF ISSUANCE OF CERTIFICATE:— 020' / 7 TDATE FEE PAID:
TYPE OF UNIT: DUELLING OTHER
NOTES:
3 h
7
11 IT
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3918
JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT Tel:(508)741-1800
Date: 12/11/96 Fax:(508)740-9705
Gladys Mackay c/o Clara Hennessy
132 Lionhead Trail `
Scarborough, CAN M1132J8
PROPERTY LOCATED AT 38 Flint Street UNIT # House
Dear Sir/Madam:
It has come to our attention, that you may be considering renting a dwelling unit
at the above address.
It is incumbent upon you as owner(s) to contact the City of Salem Health Department
to apply for a CERTIFICATE OF.,FITNESS before any vacant dwelling unit is rented or
occupied, or to notify us of your intent for this unit.
Each dwelling unit mus'. b4 inspected and certified by the Salem Health`Department
prior to allowing occupancy inaccordance with Chapter 111, Sections 127A.and 127B, of
the Massachusetts General Haws, 105 CMR 400.00; State Sanitary Code, Chapter 1.: General
Administrative Procedure`s and 105 CMR 410.000; State Sanitary Code, Chapter 11: Minimum
Standards of Fitness for Human Habitation, and in accordance with Chapter 11, Article
XIII of the City of Salem Code of Ordiances, Section 2-334, Certificate of Fitness.
There is a twenty-five (25) dollar fee payable by check, or money order to the City
of Salem Health Department. This fee is payable at the time of inspection- Inspection
will not be performed without receipt of payment.
Failure to comply with this procedure, will result in a fine of twenty (20) dollars
per day f&r everyday that the dwelling unit is occupied.cwithout approval of the Code
Enforcement Division of the Salem Health Department.
Contact this department within 24 hours of receipt of this notice. (508) 741-1800
Monday thru Wednesday from 8:00 a.m. - 4:00 p.m. Thursday 8:00 a.m. - 7 :00 p.m. or
Friday 8:00 a.m. to noon to schedule an appointment for an inspection.
SEE ENCLOSED SECTION 105 CMR 410.354 METERING OF GAS & ELECTRICITY.
Very truly yours,
FO THE BOARD Oi� Fk/� REPLY TO
Joanne Scott, MPH,RS,CHO PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CERT.# 322-95 -
'"� ' FEE $25.00
� P a DATE: 05/23/95
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: 38 Flint Street UNIT #: House
OWNER/AGENT: Estate of Gladys McKay c/o Connie McCarthy
ADDRESS: 132 Lionhead Trail
CITY/TOWN: Scarborough ZIP CODE: Canada 24 HOUR PHONE: 284-8127
AN INSPECTION OF YOUR VACANT DWELLING/ROOMING UNIT AT THE ABOVE ADDRESS HAS
BEEN APPROVED ANDISIN 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
qz�, d000x� V
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
6
GfY OF SALEM BOARD OF HEALTH
Salem,Massachusetts 01970-3928
JOANNE SCOTT,MPH,RS,CHd NINE NORM STREET
HEALTH AGENT Tel:(508)741-1800
APPLICATION FOR CERTIFICTE OF FITNESS Fax:(508)740.9705
IN ACCORDANCE WITH STATE SANITARY*CODE, ZHAPTER II, 105 CMR 410.000 "MINIMUM
STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED
/AT' /`//�fi 7 . J UNIT {gip
OWNER/LESSER (7"(Cj r," � e2 y- !*,4t/ MANAGER/AGENT
' �O,E1/(/�/rte ('C�a✓7v
ADDRESS 13a .�atil,�<. �Y/�� / � �y ADDRESS
CITY / f
-'RESIDENCE PRONE BUSINESS PHONE (24 HRS.)
- BUSINESS PHONE
TOTAL NUMBER OF ROOMS:: '
ROOM USE: i. 2.�3. Z771�._4. 0�
5. 6. 7. g,
THERE IS A TWENTY-FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE
CITY OF SAIMf HEALTH DEPAICITIENT IS F)WABLE AT THE TIME OF INSPECTION
APPLICANTS SIGNATURE g, DATE
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION: L7- OL 3 '('Q EINSPECTION
DATE OF ISSUANCE OF CERTIFI TE: S` - } S� �j� y DAT FEE PAID:
TYPE OF UNIT_ DWELLING OTHER
NOTES:
CODE ENFORCEMENT INSPECTOR
U.S.Postal Servicesh,
CERTII IED MAIL. RECEIPT
(Domestic Mail only;No Insurance Coverage Provided)
For delivery information visit our we6slte at www.usps.Come
r
PS Form 0800.June 2002 See Reverse for Instructions
i
CITY OF SALEM, MASSACHUSETTS
.f BOARD OF HEALTH
s
:9 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
9` g TEL. 978-741-1800
FAX 978-745-0343
KIMBERLEY DRISCOLL JSCOTT@SALEM.COM
MAYOR
JOANNE SCOTT
HEALTH AGENT
3/7/08
Ronald Cimon
52 Flint St., Apt. 313
Salem, MA 01970
PROPERTY LOCATED AT 52 Flint Street All Units
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.
Ar the Board of H th Reply to
Joanne Scott MPH, RS, CHO Pablo Valdez
Health Agent Code Enforcement Inspector
Sent Certified Mail: 7005 3110 0000 7160 3927
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
o SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
6/1/05
Ronald J. Cimon
52 Flint Street Apt. 3R
Salem, MA 01970
PROPERTY LOCATED AT 54 Flint Street Unit 2
Dear Sir/Madam:
It has come to our attention, that you may be considering renting a dwelling unit at the above address.
In accordance with Chapter 11,Article XIII of the City of Salem Code of Ordinances, Section 2-
334, titled "Certificate of Fitness," each dwelling unit must be inspected and certified prior to
allowing occupancy. The inspection will be conducted in accordance with 105 CMR 410.000; State
Sanitary Code, Chapter 11: Minimum Standards of Fitness for Human Habitation.
Please notify us if you do not intend to rent the unit.
Please contact this department within 24 hours of receipt of this notice at 978-741-1800, to schedule an
appointment for an inspection. Our office hours are Monday thru Wednesday from 8:00 a.m. —4:00 p.m.
Thursday 8:00 a.m. to 7:00 p.m. and Friday 8:00 a.m. — 12:00 p.m.
Failure to comply with this procedure, may result in a fine of Twenty($20.00)dollars per day for every
day that the dwelling unit is occupied-without a Certificate of fitness.
A$25.00 check payable to the City of Salem is required for each unit inspected at the time of
inspection.
A property owner is required to pay gas and electricity for residential tenants if there is not a written letting
agreement stating the tenant is responsible for those utilities and if the meter(s) records electricity and
gas use which is not used exclusively by that tenant. The Department of Public Utilities has billed
property owners for their tenant's entire utility bills retroactive to the date of initial occupancy in cases in
which cross-metering has been proven to exist.
Foyfthe Board of Health, Reply to
t anne Scott MPH, RS, CHO Pablo Valdez
Health Agent Code Enforcement Inspector
` CITY OF SALEM, MASSACI f USE TTS
BOARD OF HEAI:rI-I
120WASfHNG'FONSTREET 4... FLUOR
11a'. (97 8) 741-1800
KIMBFRLL:Y DRISCOf.L F�A,X(978) 745-0343
MAYOR Iramdin@sAcm.com
Lmw),JZ,\MDIN,RS/1W;I[S,(j 10,CP-I'S
F11:m:i'I I AcICN'I
CERTIFICATE OF FITNESS
CERTIFICATE#31-12
DATE ISSUED: 1/23/2012
Property Located at: 73 Flint Street UNIT# 1
Owner/Agent: Ellen Russell
Address: 73 Flint Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:
An inspection of your vacant Dwelling/Rooming Unit at the above address has been approved
and is in compliance with 105 CMR 410.000: Massachusetts State Sanitary Code, Chapter 11"
Minimum Standards of Fitness for Human Habitation".
Therefore, this Certificate is issued by the Code Enforcement Division of the Salem Board of -
Health and the unit may now be rented and/or occupied.
Maximum Number of occupants, must comply with 105 CMR 410.000.
Certificate valid for one year from date of issuance or until the current tenant vacates, whichever
is later.
This Certificate of Fitness is valid only if there is a valid.Certificate of Occupancy.
FOR THE BOARD OF HEALTH
I
LAL,q R dG'
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, NiASSAC1-IUS1-:1Tf51
LARRYIZANIDIN,RS/R11 IS,CIR),
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION"
PROPERTY LOCATED AT Z,5' IliA-J7- cYr 1"-4 UNIT#_
is THIs UN7ffISIGNATED AS RIGHT LEFr FRONT ORBAC PLEASECIRCLEONE
OWNERJLESSER k1-4C-9) 1).34-6L�- MANAGER/AGENT—
ADDRESS ADDRESS
CITY, STATE,Zlp-s;�I-eew CITY, STATE, Z
RESIDENCE PHONE/-.�e�- BUSINESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUM13ER OF ROOMS:
THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE �YABLE THE TIME OF INSPECTION
APPLICANT'S SIGNATURE—, DATE /- If 127
Illspectors use on
Date on initial inspection: Date of reinspection:—
Date of issuance of certificate:
Type of unit: Dwelling--J,, Other Check#—q�.�Check date: 1 -)2. - ) 1
1WUL —
--' --'----''—t--c—W�
�
�
|
+6, CITY OF SALEM MASSACHUSETTS
�! HEALTH AGENT
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745.0343
KIMBERLEY DRISCOLL - JSCOTT@SALEM.COM
MAYOR
JOANNE SCOTT
HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#534-07
DATE ISSUED: 11/1/2007
Property Located at: 75 Flint Street UNIT# House
Owner/Agent: Jennifer Okundaye
Address: 75 Flint Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:
An inspection of your vacant Dwelling/Rooming Unit at the above address has been approved
and is in compliance with 105 CMR 410.000: Massachusetts State Sanitary Code, Chapter II"
Minimum Standards of Fitness for Human Habitation".
Therefore, this Certificate is issued by the Code Enforcement Division of the Salem Board of
Health and the unit may now be rented and/or occupied.
Maximum Number of occupants, must comply with 105 CMR 410.000.
Certificate valid for one year from date of issuance or until the current tenant vacates, whichever
is later.
This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy.
FOR THE BOARD OF HEALTH
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
• 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
JOANNE SCOTT, MPH, RS, CHO
Kimberley Driscoll HEALTH AGENT
Mayor
APPLICATION FOR CERTIFICATE OF FITNESS
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION--"/ _
PROPERTY LOCATED AT 7S� � � 2G? UNIT# Y1,1
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE C
OWNERILESSER' W `wjANAGERAGENT
No P.O. Box o P.O. Box
ADDRESS (n! S ADDRESS
CITY my� lr CITY
RESIDENCE PHONE //qP'`9.;ZCSBUSINESS PHONE (24 HRS.)
BUSINESS PHONE__7& (Q
TOTAL NUMBER OF ROOMS:p _ h
ROOM USE: 1.LIUlnary M. GoA,,1,,''_3._ 4. �iAAI rXX�'
5. ��6.�2�7. - 6-, 8. uvti+tly
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 ___DATEj0
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION IJ r DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: �L —6LDATE FEE PAID: %j!
TYPE OF UNIT: DWELLXOTHER_ CHECK# 0 CHECK DATE/[ 6
NOTES: /��`
CODE ENFORCEMENT INSPECTOR 9/28/98
CITY OF SALEM, MASSACHUSETTS
o BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAx 978-745-0343
Kimberley Driscoll WWW.SALEM.COM
Mayor JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
Release
In accordance with Massachusetts General Laws Chapter 111; Code of Massachusetts
Regulations 410.000 et. Seq. ; State Sanitary Code Chapter II and Article XIII of the City
of Salem Ordinance, undersigned owner/lessor and tenant/lessee of a unit of residential
property, hereby authorize the Salem Board of Health or its authorized agents to inspect
the residence identified below in accordance with the aforementioned statutes,
regulations and ordinances.
In the event it is necessary that said inspection be done in my/out absence. I/we expressly
authorized the same and for my/our successors and assigns hereby release and discharge
the City of Salem, Salem Board of Health and its authorized agents from any lose or
injury sustained of whatever nature and description occasioned by my/out absence during
said inspection.
Tenant/Lessee Owner/Lessor
A4 s �
Address Address v
Addreit to be inspected
Date
L
CITY OF SALEM, MASSACHUSETTS
I" 6Co IT i
�v BOARD OF HEALTH
3 120 WASHINGTON STREET, 4TH FLOOR
_ CERT.# 274-02
SALEM, MA 01970
FEE $25 .00
TEL. 978-741-1800
FAx 978-745-0343 DATE: 05/23/2002 'I
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 80 Flint Street UNIT #: 1
OWNER/AGENT: Pamela Roberts
ADDRESS: 80 Flint Street #2
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-7630
AN INSPECTION OF YOUR VACANT DWELLING/ROOMING UNIT AT THE ABOVE ADDRESS HAS
BEEN APPROVED AND IS IN COMPLIANCE WITH 105 CMR 410 .000 : MASSACHUSETTS STATE
SANITARY CODE, CHAPTER II, "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" .
THEREFORE, THIS CERTIFICATE IS ISSUED BY THE CODE ENFORCEMENT DIVISION OF THE
SALEM BOARD OF HEALTH AND THE UNIT MAY NOW BE RENTED AND/OR OCCUPIED.
MAXIMUM NUMBER OF OCCUPANTS, BASED ON 105 CMR 410 .000: MASSACHUSETTS STATE
SANITARY CODE, CHAPTER II, "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" .
SECTION 410 .400 (B) : DWELLING UNIT (X) AND 410.400 (C) : ROOMING UNIT
MINIMUM SQUARE FOOTAGE FOR SLEEPING PURPOSES: .
NOTE: THIS APPROVAL DOES NOT CERTIFY COMPLIANCE WITH THE STATE LEAD LAW FOR
OCCUPANTS UNDER 6 YEARS OF AGE. FOR MORE INFORMATION CALL 978-741-1800.
OR THE BOARD S,OF HEALTH
r
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
u CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
3 ! 120 WASHINGTON STREET, 4TH FLOOR
Yui SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
APPLICATION FOR CERTIFICATE OF FITNESS
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT t. UNIT#_1
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER P„ke.lc_ ALF S MANAGER/AGENT
No P.O. BoxNo P.O. Box
ADDRESSr_h U Y I A St . I ZADDRESS
CITY S A `ern CITY
RESIDENCE PHONE F- 7y 5-7(030 BUSINESS PHONE (24 HRS.)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: S
ROOM USE: 1. OJev\ 24v�-3.Aid. kw\ 4. J- kvw
5.Lil. kfV\ 7. 8.
THERE IS A TWENTY-FIVE($25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY
ORDER TO THE CITY OF SALEM HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE
TIME OF INSPECTION.
APPLICANTS SIGNATURE DATEL�ZJO Z
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION 5,1 3 y 2— DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATES.>3 I,' L DATE FEE PAID: ";_'a 3 Z
TYPE OF UNIT: DWELLWG(OTHER_ CHECK# Si r CHECK DATE
NOTES: /�
CODE ENFORCEMENT INSPECTOR 9/28/98
CITY OF SALEM, MASSACHUSETTS
• * BOARD OF HF_,1LTH
120 WASHINGTON STREET,4"FLOOR
TEL. (978)741-1800
KIMBERLEY DRISCOLL FAx(978)745-0343
MAYOR 11?I(?NNr(t7?NfNf.COAt
JANv'r DIONNI',
AcHNG I-Ih,A rH A(;uN'C
CERTIFICATE OF FITNESS
CERTIFICATE#611-08
DATE ISSUED: 11120/2008
Property Located at: 80 Flint Street UNIT#1 Left
Owner/Agent: Pamela Roberts
Address: 80 Flint Street#2
City(rown: Salem, MA Zip Code: 01970 24 Hour Phone:
An inspection of your vacant Dwelling/Roaming 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 BOARrLnF HEALTH
J
TIN HEALTH AGENT CWE ENFORCEKENT INSPECTOR
I
CITY OF SALEM, MASSACHUSETTS I trp�
BOARD OF HEALTH l9�
120 WASHINGTON STREET,401 FLOOR
TEL. (978)741-1800
KIMBERLBY DRISCOLL FAx(978)745-0343
MAYOR IDIONNI3 SAIE' .COM
i
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."
FEE: $50.00 tt
PROPERTY LOCATED AT i S �� l e UNIT#_�
IS THIS UNIT DISIGNATED AS RIGHT ,Fr RONT OR BAC PLEASE CIRCLE ONE
OWNER/LESSER Am e-Zjq �o �e IZ.fS MANAGER/AGENT
NO
S 0 F 4 5 — 2 ADDRESS S `
CITY, STATE,ZIP CAN 019-7-C> CITY, STATE,ZIP
1
RESIDENCE PHONE �� 7�� O BUSINESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: s _
ROOMUSE: 1 I' +,-ke.. 2 Liying6rwv\ 4. 6d✓'y'.. 5. 6jr,
6 7. $. 9. 10.
THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE IS PAYABLE AT THE TIME OF INSPECTION /C—)
APPLICAN'T'S SIGNATURE DATE r Zo [
Inspectors use only
Date on initial inspection: ��I aD /Ca$ Date of reinspection:
Date of issuance of certificate: Date fee paid:
Type of unit: Dwelling _Other_ Check# � Check dater
Notes W( o ' r) . T
CC6d nforcement�r
i
CITY OF SALEM, MASSACHUSETTS
a
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOORCERT.# 418-02
SALEM, MA 01970 FEE $25.00
TEL. 978-74 1-1800 DATE: 06/13/2002
FAX 978-745-0343
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 81 Flint Street UNIT #: 2
OWNER/AGENT: Mildred Weiss
ADDRESS: 81 Flint Street
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-6272
AN INSPECTION OF YOUR VACANT DWELLING/ROOMING UNIT AT THE ABOVE ADDRESS HAS
BEEN APPROVED AND IS IN COMPLIANCE WITH 105 CMR 410 .000: MASSACHUSETTS STATE
SANITARY CODE, CHAPTER II, "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" .
THEREFORE, THIS CERTIFICATE IS ISSUED BY THE CODE ENFORCEMENT DIVISION OF THE
SALEM BOARD OF HEALTH AND THE UNIT MAY NOW BE RENTED AND/OR OCCUPIED.
MAXIMUM NUMBER OF OCCUPANTS, BASED ON 105 CMR 410.000 : MASSACHUSETTS STATE
SANITARY CODE, CHAPTER II, "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" .
SECTION 410.400 (B) : DWELLING UNIT (X) AND 410.400 (C) : ROOMING UNIT
MINIMUM SQUARE FOOTAGE FOR SLEEPING PURPOSES: .
NOTE: THIS APPROVAL DOES NOT CERTIFY COMPLIANCE WITH THE STATE LEAD LAW FOR
OCCUPANTS UNDER 6 YEARS OF AGE. FOR MORE INFORMATION CALL 978-741-1800.
FOR THE BOARD OF HEALTH
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
ti
aNw CITY OF SALEM, MASSACHUSETTS 6
BOARD OF HEALTH �-
s 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TFL. 978-741-1800
FAX 978-745-0343
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
APPLICATION FOR CERTIFICATE OF FITNESS
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER Ii, 105 CMR 410.000 _ D�z
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT �7' UNIT#
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
q �
OWNER/LESSER1 1'rivLQ 4,Q91� MANAGER/AGENT
No P.O. Box � No P.O. Box
ADDRESS_ nn ADDRESS
CITY � �e /✓ 61 V/ 70 CITY
RESIDENCE PHONE?7o L4L06_27ZBUSINESS PHONE (24 HRS.)
BUSINESS PHONE
i
TOTAL NUMBER OF ROOMS:_
ROOM USE: 1. 2. 3.- 34 —
5— 6. 7. 8.
THERE IS A TWENTY-FIVE($25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY
ORDER TO THE CITY OF SALEM HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE
TIME OF INSPECTION.
APPLICANTS SIGNATURE �� w-eLJ' DATE l ,d z
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION !?-(3 —0 a DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE:2-1 ti v DATE FEE PAID: � -t 3 'a
TYPE OF UNIT: DWELLING OTHER_ CHECK# A Yz CHECK DATE
NOTES:
CODE ENFORCEMENT INSPECTOR 9/28/98
CITY OF S_ ALEMt MA$SACFIUSETTS`�
BOARD OF HEALTH _
" 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAX 978.745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#444-04
DATE ISSUED: 09/29/2004
Property Located at: 81 Flint Street UNIT#2L
Owner/Agent: Mildred Weiss
Address: 81 Flint Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-6272
An inspection of your vacant Dwelling/Rooming Unit at the above address has been approved and is in
compliancewith 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.
OO�OARD F HEALTH
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
STANLEY USOVICZ, JR JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
APPLICATION FOR CERTIFICATE OF FITNESS
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410,000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT ef//;s; UNIT#2
IS THIS UNIT DESIGNATE AS RIG LEFT IEFRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER —MANAGER/AGENTl_/QZt4_�. & a1;ei4
No P.O. Box No P.O.Box
ADDRESSIP ---ADDRESS
CITY —CITY—,
RESIDENCE PHONE
_97kAvk_/_26USINESS PHONE (24 HRS.)_
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:___i__r
ROOM USE: I 2._i4 3, 18 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
INSPECTORS ONLY
DATE OF INITIAL DATE OF REINSPECTION
DATEOF ISSUANCE OF CERTIFICATE� 9—:t-4�DATE FEE PAID:,
TYPE OF UNIT: DWELLIN OTHER CHECK# CHECK DATE
NOTES:
CODE ENFORCEMENT INSPECTOR 9128/98
CITY OF SALEM, MASSACHUSETTS
o BOARD OF HEALTH
a 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAx 978-745-0343
Kimberley Driscoll WWW.SALEM.COM
Mayor JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#306-07
DATE ISSUED: 7/10/2007
Property Located at: 82 Flint Street UNIT# 1
Owner/Agent: William &Jeannie Pitman
Address: 14 Barr Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:
An inspection of your vacant Dwelling/Rooming Unit at the above address has been approved
and is in compliance with 105 CMR 410.000: Massachusetts State Sanitary Code, Chapter If'
Minimum Standards of Fitness for Human Habitation".
Therefore, this Certificate is issued by the Code Enforcement Division of the Salem Board of
Health and the unit may now be rented and/or occupied.
Maximum Number of occupants, must comply with 105 CMR 410.000.
Certificate valid for one year from date of issuance or until the current tenant vacates, whichever
is later.
This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy.
FOR THE BOARD OF HEALTH
V
ANNE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
• 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800 S
FAX 978-745-0343 d
I
JOANNE SCOTT, MPH, RS, CHO
Kimberley Driscoll HEALTH AGENT
Mayor
APPLICATION FOR CERTIFICATE OF FITNESS
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION'.
PROPERTY LOCATED AT� �in f S _ UNIT # I_
IS THIS UNIT DESIGNATED AS RIGHTEFT FRONT BACK PLEASE CIRCLE ONE
WE LESSER GIIANAGER/AGENT
_ NGI
OBox
c� No P.O. Box
ADDRESS iq I1)-r _ADDRESS_..,
CITY. _,0 CITY-A!&
RESIDENCE PHONE BUSINESS PHONE (24 HRS )
BUSINESS PHONE_ _
TOTAL NUMBER OF ROOMS:-----
ROOM
OOMS:--- _ROOM USE: 1'.k/jdio 2/"Oom 3/'#jjto0V 4 P1Ktrtf opuf
THERE IS A TWENTY-FIVE(525.00) 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
DATE OF INITIAL INSPEC710N_a �D � _ DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE:?-Lt zJ_ 7_DATE FEE PAID 1r% �.. 7
TYPE OF UNIT: DWELLIN, OTHER.___ CHECK i'_-j 9�3-` CHECK DATE
NOTES: --'- _---- ----- - - -- - -
CODE ENFORCEMENT INSPECTOR 9/28/98
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4:0'FLOOR
LOOR
TFi- (978)741-1800
ICMERLEY DRISCOLL FAX(978)745-0343
MAYOR ISCAWIT&SALEM.COM
JOANNE Sayrr,
HEALTH AGPNr
CERTIFICATE OF FITNESS
CERTIFICATE#431-08
DATE ISSUED: 8/28/2008
Property Located at: 87 Flint Street UNIT#
Owner/Agent: Bogdan Jucewicz
Address: 12 Forest Road
City/Town: Wakefield, MA Zip Code: 01880 24 Hour Phone: 978-314-9352
An inspection of your vacant Dwelling/Rooming Unit at the above address has been approved
and is in compliance with 105 CMR410.000: 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 4t0,000.
Certificate valid for one year from date of issuance or until the current tenant vacates,whichever
is later.
This Certificate of Fitness is valid orgy if there is a valid Certificate of Occupancy.
FOR THE BOARD OF rrHEALTH
WDIONNE
ANITARIAN CODE ENFORCEMENT INSPECTOR
r
13)
• CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120`$/ASHINGTON STREET,4"FLOOR
TFL. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978)745-0343
MAYOR ISCarr&ALLM.COM
JOANNE SCOTT,
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."
FETE: $50.00
PROPERTY LOCATED AT q7 F/ I/��/ -<' UNIT#
IS THIS
//UNI ISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE
OWNER/LESSER UOl �(iC / C Z MANAGER/AGENT
NO P.O. BOX
ADDRESS 12 f E5. ICI!) ADDRESS p
CITY, STATE,ZIP /������L-1 L CITY, STATE,ZIP /`7/� o J 91 L
RESIDENCE PHONE BUSINESS PHONE(24HRS) 9 7,? 3i �� 3 ,S 2—
BUSINESS
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:_ _7
ROOM USE: 1. 13edi-004 2. &dc-0J 13. 1 2&h'X 4.&*Or, 5. 4L1 kb
6. w/'*Vb- 7. d4fli r 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 �9
APPLICANT'S SIGNATURE DATE
Inspectors use only
Date on initial inspection: Date of reinspection:
Date of issuance of certificate: OT Date fee paid:
Type of unit: Dwelling Other Check#-G-2 SrCheck date: T- '24 rd�
Notes: T S-m c ✓�c�� ��i'�i e g ��M Nd�f
1
Code Enforcement Inspector
CITY OF SALEM, MASSACHUSETTS
' BOARD OF HEALTH
120 WASHINGTON STREET,4"FLOOR
TEL. (978) 741-1800
KINMERLEY DRISCOLL FAX(978) 745-0343
MAYOR lscorr snt.em.CON1
JOANNE SCOTT,
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 descriptionoccasioned by my/out absence
during said inspection.
A
Tenant/Lessee Owne ess
Address Address
Address on unit to be inspected
Date
J