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FORRESTER STREET 0 T CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH c *�. 120 WASHINGTON STREET, 4TH FLOOR - SALEM, MA 01970 TEL. 978-741-1 800 FAX 978-745-0343 - STANLEY USOVIC7, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#229-04 DATE ISSUED: 05/25/2004 Property Located at: 7 Forrester Street UNIT# 1 Owner/Agent: James Barina Address: 5 Hancock Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-745-6518 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 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 /q� 07 t 220 WASHINGTON STREET, 4TH FLOORa1 SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. ,JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT I 1 APPLICATION FOR CERTIFICATE OF FITNESS it IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER It, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT�_ 1n 2�TL°U ) S2 /� i u. UNIT #� IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNERILESSER�(wt. P Z, -04A , MANAGER/AGENT-- No ANAGER/AGENT _No P.O. Box ' f No P.O. Box ADDRESS. a k r Ge c__�, „ADDRESS.., CITY552, i,`!?&I b ( q I d CITY RESIDENCE PHONEjjet 24ja!GSr/� BUSINESS PHONE (24 HRS.) _ BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1.G111t 2.QtwCct� 3._�A �Qtk+44.�vc1�1tR2 THERE IS A TWENTY-FIVE($25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM HEALT EPA ENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. APPLICANTS SIGNATURE _ DATE!--Z Z�Z l INSPECTORS USE ONLY LATE OF INITIAL INSPECTION, V—DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: DATE FEE PAID: D TYPE OF UNIT: DWELLING _OTHER_ CHECK 9_94_-/_,CHECK DATEy' NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 �OND� rtH� City of Salem, Massachusetts a � Board of Health ' r LNt.,,o 120 Washington Street, 4th Floor, Salem, lth FPubliCHea MA 01970 Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, RENS, CHO Mayor Iramdin@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE #: GHL-15-376 DATE ISSUED: 11/10/2015 Property Located at: 7 FORRESTER STREET UNIT#2 Owner/Agent: James M. Barina Address: 5 Hancock Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: (978) 745-6518 Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division 3, Section 705: Certificate of fitness of rented dwelling unit, apartment or tenement. An inspection of your vacant Dwelling/Rooming Unit at the above address has been approved and is in compliance with 105 CMR 410.000: Massachusetts State Sanitary Code, Chapter II "Minimum Standards of Fitness for Human Habitation". Therefore, this Certificate is issued by the Code Enforcement Division of the Salem Board of Health and the unit may now be rented and/or occupied. Maximum Number of occupants, must comply with 105 CMR 410.000. Certificate valid for one year from date of issuance or until the current tenant vacates, whichever is later. This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy. FOR THE BOARD OF HEALTH Larry Ramdin, MPH, REHS, CHO HEALTH AGENT SANITARIAN CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 924 WASHINGTON STREET,4J FLOOR TEL. (978)741-1$00 KINMEJUEY DRISCOI.L FAX(978)745-0343 MAYOR t anna(alssiu t ea.cor 6 LARRY RAMDiN,RS/Ri:HS,010,f:P-)5 HrAmii AGENT } yn J (cwt. Ca 5, If Application for Certificate of Fitness IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 205 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" i, FEE: $50.00 [ PROPERTY LOCATED AT 1 V V '415il- 5 r UNIT# 2, IS THIS UNIT DISIGNATED ASRIGHT O R PLEASE CIRCLE ONE OWNER/LESSER Zt l S� • &V[Wz- MANAGER/AGENT ADDRESS.,r, xLtGo 54-,. , ADDRESS CITY,STATEZIP !2tlti " ^ CITY,STA TE,ZIP RESIDENCEPHONE q j 7qS` O_/� BUSINESS PHONE(24HRS) BUSINESS PHONE 1�7 ` q Jiff` ( yq TOTAL NUMBER OF ROOMS: i ROOM USE: 1 � c�tJ w 2. 3. t LL/(-t i 4. i t i t G 5. 6 7 8 9. 10 THERE IS A FIFTY($50)DOLLAR FIE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE IS PAYABLE_AT OF INSPECTION APPLICANT'S SIGNATURE " `""' DATEI� IMectots use only Date on initial inspection: 1-j-[ /2_01 S_ Date of reinspection: Date of issuance of certificate: Y_ 12.1Jr 1_r _ c? Date fee paid: -10V Type of unit: DwellingOther Check#�qU _Check date: L-/ 12-0S5 Notes: w3nFni„c hesf' Iar CMI” roam .J ' t m`Ss .n nr S IJ Cor cment IDS or , ` fi V^ CERT.# 782-99 3 � FEE $25.00 1�• .%'p DATE: 12/28/1999 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTHSTREET HEALTH AGENT Tel:(978)741-1800 Fax:(978)740-9705 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 7 Forrester Street UNIT #: 3 OWNER/AGENT: Joseph Scott ADDRESS: 7 Forrester Street CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-0564 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 j 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 . i FOR THE BOARD OF HEALTH i `l. I -JOANNE SCOTT, MPH,RS,CHO i HEALTH AGENT CODE ENFORCEMENT INSPECTOR �N INS 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 Fn:(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 17 UNIT# 3 IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER��/�� MANAGER/AGENT No P.O. Box No P.O. Box ADDRESS //rMreZ16f_ S _ ADDRESS CITY6t1/ CITY RESIDENCE PHONE,?Z!zLNI 5W BUSINESS PHONE (24 HRS.) BUSINESS PHONE i�al'7 760 97 TOTAL NUMBER ,,��O,,FF�ROOMS: _ ROOM USE: 1. U_ 2. L� 3. � 4. 5.-6.-7. 8. THERE IS A TWENTY-FIVE($25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. APPLICANTS SIGNATURE 5_2� _DATE Z Z� INSPECTORS USE ONLY DATE OF INITIAL INSPECTION^/ 1 -a-'K -4.l DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE:/,.-a-8 -'S DATE FEE PAID: / .)- -c( TYPE OF UNIT: DWELLING ,/'OTHER_ CHECK#.,25 �q I CHECK DATE/ I NOTES: 'l CODE ENFORCEMENT INSPECTOR 9/28/98 I{ R CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 RELEASE In accordance with Massachusetts General Laws Chapter III ; Code of Massachusetts Regulations 410.000 et. seq. ; State Sanitary Code Chapter II and Article XIII of the 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 author- ized agents to inspect the residence identified below in accordance with the aforementioned statutes, regulations and ordinances. In the event it is necessary that said inspection be done in my/our absence, I/we expressly authorize the same and for my/our successors and assigns hereby release and discharge the City of Salem, Salem Board of Health and its authorized agents from any loss or injury sustained of whatever nature and description occasioned ... by my/nue absence during said inspection. � TENANT/LESSEE OW - /LES OR ADDRESS ADDRESS q_C4 S 3 ADDRESS OF UNIT TO BE INSPECTED �5J;�_ a& i9� DATE �— i' v��co 1r CITY OF SALEM, MASSACHUSETTS �. BOARD OF HEALTH '8 * 120 WASHINGTON STREET, 4TH FLOOR si SALEM, MA 01970 CERT.# 266-02 FEE $25.00 TEL. 978-741-1800 DATE: 05/20/2002 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 11 Forrester Street UNIT #: 1 OWNER/AGENT: Philip Burnham ADDRESS: 11 Forrester Street CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-3259 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 19978-741-1800. FOR THE BOARD OF HEALTH q J q0zANN:fS_c4O1/T, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS /- �/✓ BOARD OF HEALTHY/ 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 - - FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO ` MAYOR HEALTH AGENT APPLICATION FOR CERTIFICATE OF FITNESS IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT �v'rP%St i.►- s } UNIT#-I IS xLco� IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE R�S� a OWNER/LESSER 90 QLi h4i,, MANAGERIAGENT j No P.O. Box No P.O. Box ADDRESS__"_ Fcr�S�gr ADDRESS CITY %RL- CITY RESIDENCE PHONE- -it,"- -*WBUSINESS PHONE (24 HRS.) BUSINESS PHONE TOTAL NUMBER OF ROOMS: a ROOM USE: 1. 2. 3. 4. 5. 6. 7. 8. THERE IS A TWENTY-FIVE($25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. r APPLICANTS SIGNATURE pJ DATE INSPECTORS USE ONLY DATE OF INITIAL INSPECTION INITIAL INSPECTION S��-o-oma DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE5"'�_9 z DATE FEE PAID: TYPE OF UNIT: DWELLING OTHEV— CHECK# b /d CHECK DATE�JD NOTES: `I CODE ENFORCEMENT INSPECTOR 9/28/98 ,t 4 R CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET i HEALTH AGENT 11%17/99 Tel:(978)741-1800 Fax:(978)740-9705 Philip Burnham 11 Forrester Street Salem, MA 01970 - PROPERTY LOCATED AT 11 Forrester 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. i 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 11: Minimum Standards of Fitness for Human Habitation. Please notify us if you do not intend to rent the unit. I 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. i 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 I tenants' entire utility bills retroactive to the date of initial occupancy in cases in i which. cross-metering has been proven eo exist. FOIJ THE BOARD OF YEALTH REPLY TO 0�9�7viC.e� anise Scott, MPH,RS,CHO PABLO.VALDEZ HEALTH AGENT CODE ENFORCEMENT INSPECTOR i i it i E �y fn CERT.# 179-98 FEE $25.00 3 gj DATE: 04/02/98 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: 11 Forrester Street UNIT #: 2 OWNER/AGENT: Philip Burnham ADDRESS: 11 Forrester Street CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-3259 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- MAXIMU14 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 "1"04,111111, 0 � w. t � �£zy.-� #'� -�'� -e,�}} x^?' 3: -y J''�'fiAF •et„- �n:�v y.,t i_". JJ�S 9 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 STANDARAS'.OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT 11 FCra CcF� S f UNIT If L OWNER/LESSER 6.��1 MANAGER/AGENT ADDRESS 11' 0 2 1 ri��R o� ADDRESS CITY S �y�p CITY RESIDENCE PRONE LA-- 1:3L3 BUSINESS PHONE (24 HRS.) 4usInSS PHONE — TOTAL NUMBER OF ROOMS: ROOM USE: 1. _2. 3. L,R 4 ._ p 5. 6. 7. 8. /l THERE IS A TWENTY-FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALFM BFALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION APPLICANTS SIGNATURE S� DATE , - R INSPECTORS USE ONLY DATE OF INITLAL INSPECTION: a -� e DATF OF RF INSPECT ION > DATE OF ISSUANCE OF CERTIFICATE-��' - FW DATE FEE PAID: TYPE OF UNIT: DWELLING }� OTHER___ NOTES : CODE ENFORCEMENT INSPECTOR CERT.# 880-96 3 !i FEE $2.- .00 DATE: 12/19/95 . nmA 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 CER'T'IFICATE OF FITNESS PROPERTY LOCATED AT: 11 Forrester Street UNIT #: 2 01,TNER/AGENT: Philip Burnham ADDRESS: 11 Forrester Street CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-3259 AN INSPECTION OF YOUR VACANT DWELLING/ROOMING UNIT AT THE ABOVE ADDRESS H.'-_S BEEN APPROVED AND IS IN COMPLIANCE WITH 105 CMR 410 .000: MASSACHUSETTS STa-TE SANITARY CODE, CHAPTER II, "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITI4-T70N" . THEREFORE, THIS CERTIFICATE IS ISSUED BY THE CODE ENFORCEMENT DIVISION OF '--,E 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, "MININFM 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 r � -JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CH4 - NINE NORTH STREET . HEALTH AGENT " Tel:(508)741.1800 APPLICATION FOR CERTIFICTE OF FITNESS Fax:(508)740-9705 IN ACCORDANCE WITH STATE SANITARV CODE, CHAPTER .II; 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". ! PROPERTY LOCATED AT UNIT # OWNER/LESSER �� i} n V U MANAGER/AGENT ADDRESS �� 0 rY £ Oji 4r ADDRESS - CITY G n I ) W CITY RESIDENCE PHONE SCz� - - ��".- b SR BUSINESS PHONE (24 HRS.) BUSINESS PHONE f TOTAL NUMBER OF ROOMS: ROOM USE: 1. 2. 3, 4. 5. _b. 7. 8. THERE IS A TWENTY-FIVE (25.00) DOLLAR SEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM'HEALTR DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTIO APPLICANTS SIGNATURE_ Qr DATE INSPECTORS USE ONLY DATE OF INITIAL INSPECTION:/,�j_- ( (P DA'Z'E OF REINSPECTION_ DATE OF ISSUANCE OF CERTIFICATE: . f 4. q4,, DATE FEE PAID:,,-'-:1- TYPE OF UNIT: DWELLING OTHER NOTES: -��"'�� CODE ENFORCEMENT INSPECTOR t e • tjlp � 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: 07/18/95 Fax:(508)740-9705 Philip Burnham 11 Forrester Street Salem, MA 01970 PROPERTY LOCATED AT 11 Forrester Street UNIT # 2L Dear Sir/Madam: It has come to our attention, that you may be considering renting a dwelling unit at the above address. 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 -A4 F ELECTRICITY Very truly yours, FOR THE BOARD OF HEALTH REPLY TO Joanne Scott, MPH,RS,CHO PABLO VALDEZ HEALTH AGENT CODE ENFORCEMENT INSPECTOR CERT.# 87-00 3 11IF FEE $25.00 DATE: 02/07/2000 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Fax:(978)740-9705 i CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 11 Forrester Street UNIT #: 3 OWNER/AGENT: Phil Burnham ADDRESS: 11 Forrester Street CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-3259 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 OF HEALTH JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR v� .cuNffl n � CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT APPLICATION FOR CERTIFICATE OF FITNESS Tee(978)741-1800 Fax:(978)740-9705 IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II; 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESSFORHUMAN HABITATION". PROPERTY LOCATED AT 11 1 oa-rC a�-�y- s�, UNIT# IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT ACK PLEASE CIRCLE ONE OWNER/LESSER DI� 6��} _ MANAGER/AGENT No P.O. Box1 No P.O. Box ADDRESS 11 FOrr4s4 5c S1' ADDRESS CITY S,1 1 rvl CITY RESIDENCE PHONE '5) 9I4JatP BUSINESS PHONE (24 HRS.) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1. 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. 11 APPLICANTS SIGNATURE � L�, J DATE1 7 INSPECTORS USE ONLY DATE OF INITIAL INSPECTION :� -0 _e> DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: D -? -6DATE FEE PAID:_ TYPE OF UNIT: DWELTe HERJL CHECK# 7 b CHECK DATE NOTES: V CODE ENFORCEMENT INSPECTOR 9/28/98 4 4 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT - Tel:(508)741-1800 Fax:(508)740-9705 RELEASE In accordance with Massachusetts General Laws Chapter Ili ; Code of Massachusetts Regulations 410.000 et. seq. ; State Sanitary Code Chapter II and Article XIII of tfie 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 author— ized agents to inspect the residence identified below in accordance withthe aforementioned statutes, regulations and ordinances. In the event it is necessary that said inspection be done in my/our absence, !/we expressly authorize the same and for my/our successors and assigns hereby release and discharge the City of Salem, Salem Board of Health and its authorized agents from any Noss 'or injury sustained of .whateveranature..and-description;.occasioned ,:;;:,. , by 'my%our 'absence during said inspection. ANT/L SSEE OWNER/LESSOR ADDRESS --� ADDRESS ADDRESS OF UNIT TO B INSPECTED Y DATE II , City of Salem, Massachusetts Board of Health 120 Washington Street 4th Floor, Salem, YUb1iGHeaith `J Prevent. Promote. Protect. MA 01970 Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, REHS,CHO Mayor Iramdin@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE #: GHL-15-125 DATE ISSUED: 6/18/2015 Property Located at: 12 FORRESTER STREET UNIT#1 Owner/Agent: Edward Czarnecki Address: 12 Forrester Street City(Town: Salem, MA Zip Code: 01970 24 Hour Phone:(978)498-4610 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 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 Larry Ramdin, MPH, RENS, CHO NITARIAN HEALTH AGENT CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978)745-0343 MAYOR I.RAMDIN@SAI.RM.COM LARRY RANIDIN,RS/RVI IS,CIJ0,CP-FS Hi-ALTtI AGIiNI' 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--/ �N��J T UNIT#_� �lIS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CHICLE ONE OWNER/LESSER —MANAGER/AGENT NO P.O. BOX ADDRESS /.2 2 ADDRESS CITY, STATE,ZII' ��i) < ��.. f�11/ C/(Y/17 U CITY, STATE,ZIP RESIDENCE PHONE_ BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS:— ROOM OOMS:ROOM USE: LLUw 2. ( ce 3. 6edre-a: 4.4n.y iya, 5. liy'i J /10 a 4 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 PA LE AT _Zr INSPECTION APPLICANT'S SIGNATURE C-ra / DATE Inspectors use only Date on initial inspection:QW1142 215" Date of reinspection: Date of issuance of certificate46201� Date fee paid:06a 201 S- Type of unit: Dwelling�Other Check# 2'$2.S Check date: 06/11/2025 Notes:MnLw in L+Lrmnm na is -fin be, (men,a2✓eA . C nfp cement Inn; ector CERT.# 77-98 3 k. FEE $25.00 1 (6s DATE: 02/10/98 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: 14 Forrester Street UNIT #: 2 OWNER/AGENT: Harbor Rental ADDRESS: 111 DerbV Street CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-3778 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 r CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO 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 OWNER/LESSER- (V_D MANAGER/AGEN ADDRESS ADDRESS CITY 4E CITY RESIDENCE PHONE BUSINESS PHONE (24 HRS.) Bus itss PaoNE q X14 y -c��11 TOTAL NUMBER OF ROOMS:' ROOM USE: I. R 2. 3. _4. 5. 6. 7. 8. THERE IS A TWENTY-FIVE (25.0 DOLLAR FEE, PAYABLE BY CBECR OR MONEY ORDER TO THE CITY OF SALEM HEAL :TtSFEE S PAYABLE AT THE TINE OF INSPECTION APPLICANTS SIGNATURE DATE__ 4zb INS CTORS USE ONLY - DATE OF INITIAL INSPECTION: `1i'�t� �ClDATE OF REINSPECTION _ DATE OF ISSUANCE OF CERTIFICATE:2'CU ( ZS DATE FEE PAID: 2 d TYPE OF UNIT: DWELLING OTHER NOTES: CODE ENFORCEMENT INSPECTOR r CERT) 449-93 FEE: $ 25.00 a DATE: 6/7/93 CITY OF SALEM HEALTH DEPARTMENT BOARD OF HEALTH Salem, Massachusetts 01970 ROBERT E. BLENKHORN 9 NORTH STREET HEALTH AGENT - 508-741-1800 CERTIFICATE OF FITNESS PROPERTY LOCATED AT 14 Forrester Street UNIT / 2 OWNER/AGENT Shawn Gordon ADDRESS 22 Albion Place CITY/TOWN Boston, MA ZIP CODE 02129 24 HOUR PHONE 242-5588 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 ROBERT E. BLENKHORN, C.H.O. HEALTH AGENT CODE ENFORCEMENT INSPEC V <� OFFICE USE ONLY CERT.._/ A DATE: _ CITY OF SALEM HEALTH DEPARTMENT BOARD OF HEALTH Salem, Massachusetts 01970 -ROBERT-E-BLENKHORN 9 NORTH STREET HEALTH AGENT 508-741-1800 APPLICATION FOR CERTIFICATE OF FITNESS IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". 1� r PROPERTY LOCATED AT // � ?^r S . �T UNIT OWNER L lgL� v0 eoo,-- MANAGER/AGENT ADDRESS 2-2�JAlelol-' - ADDRESS CITY �y7z r / G/� U Z/�� CITY RESIDENCE PHONE Z>12- BUSINESS PHONE (24 HRS. ) BUSINESS PHONE Z�t Z.- TT TOTAL NUMBER OF ROOMS: ROOM USE: 1 . 2. 3. 4 . 5. —6.-7. THERE IS A TWENTY-FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM HEALTH DEPARTMENT UPON COMPLIANCE AND ISSUANCE OF CERTIFICATE., APPLICANTS SIGNATURE/' �'� u � 7 DATE 1719-3 INIPECTOR S USE ONLY DATE OF INITIAL INSPECTION: L f/ DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: - DATE FEE PAID: r TYPE OF UNIT: DWELLING OTHER NOTES: �. f C,OD• ENFORCEMENT INSPECTOFf t P CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH IV 120 WASHINGTON STREET 4t"FLOOR PublicFIealth STREET, Prevent.Promote.Protect. TEL. (978) 741-1800 FAX(978) 745-0343 KIMBERLEY DRISCOLL lramdingsalem.com LARRY 1L4MDIN,I2S/RPkIS,Cl-IO,CP-FS MAYOR HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#204-13 DATE ISSUED: 6/13/2013 Property Located at: 15 Forrester Street UNIT# 1 Owner/Agent: Jean Costa Address: 17 Forrester Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-821-5000 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 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 SANITARIAN CITY OF SALEM,MASSACHUSETTS J, Boa RD OF HEALTH 120 WASHINGTON STREET FLOOR Pu11liC�Ith ,4 i'rcwnt.Prometa.Proleet. TEL.(978)741-1800 FAX(978)745-0343 KIMBERLEY DRISCOLL ltamdia[t salem.�om MAYOR LARRY RAMDIN,RS/REHS,CHO,CP-FS HEALTH AGENT Application for Certificate of Fitness IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" FEE`. $50.00 PROPERTY LOCATED AT ,S UNIT# IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR RAM PLEASE CIRCLE ONE OWNER/LESSER &.vw $�a_ MANAGER/AGENT NO P.O.BOX ADDRESS / T ADDRESS CITY,STATE,ZIP S Aye O I`� Z'y CITY, STATE,ZIP RESIDENCE PHONE 1 $ � ,s(,W BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1. -9,4k 2. D 3. L P- 4. A RZ 5. 6. 7. 8. 9. 10. THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE IS PAYABLE AT THE TIME OF INSPECTION APPLICANT'S SIGNATURE .51�t_ DATE Ci '/ 3 Inspectors use only Date on initial inspection: (6-Q-)3 Date of reinspection: Date of issuance of certificate: b'13- )`� Date fee paid: Type of unit: Dwelling_,--' Other Cherk# 1 3 3 U Check date: i 3-12 Notes: tode Enforcement Inspector CITY OF SALEM, MASSACHUSETTS BOARD OF HHALTH lu 120 WASHINGTON STREET 4""FLOORPublicHealth neve",.Promote.Protect. TSL. (978) 741-1800 FAx(978) 745-0343 KIMBERLEY DRISCOLL Iramditi@salcin.com - LARRY RAMU]N,ROW Ffti,CFIQ CP—'f'S MAYOR H1SAI:CI1 AGI?NT CERTIFICATE OF FITNESS CERTIFICATE#93-14 DATE ISSUED: 3/24/2014 Property Located at: 15 Forrester Street UNIT#2 Owner/Agent: Jane Costa Address: 17 Forrester Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-821-5000 Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division3, Section 705: Certificate of fitness of rented dwelling unit, apartment or tenement. An inspection of your vacant Dwelling/Rooming Unit at the above address has been approved and is in compliance with 105 CMR 410.000: Massachusetts State Sanitary Code, Chapter II" Minimum Standards of Fitness for Human Habitation". Therefore, this Certificate is issued by the Code Enforcement Division of the Salem Board of Health and the unit may now be rented and/or occupied. Maximum Number of occupants, must comply with 105 CMR 410.000. Certificate valid for one year from date of issuance or until the current tenant vacates, whichever is later. This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy. FOR THE BOARD OF HEALTH i (�. AY4 '- LA RAMDIN HEALTH AGENT SANITARIAN I • CITY OF SALEM, MASSACHUSETTS BOARD OF HEAUfH 120 WASHINGTON STRFET,4°i FLOOR pllbliOHealth Prevcni.Promote.Protect. TEL.. (978) 741-1800 FAx(978) 745-0343 KIMBERLEY DRISCOLL lramdin ,salem.com MAYOR e LARRY R:1 MD IN,RS/RB'J-iS,C HO,CP-I'S FIF.M,1'ff 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" LFEE: $50.00 PROPERTY LOCATED AT - 14 f) Z n=kt S 'lam- S t UNIT# IS THIS IJKIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE OWNER/LESSER AA,,., .") �� MANAGER/AGENT NO P.O. BOX .;I ADDRESS Z CSLJZa-S 4� 'fiADDRESS CITY, STATE,ZIP �ra Q Q.- !(il , (Q Z� CITY, STATE,ZIP RESIDENCE PHONE C1'7� - g�1 -5608 BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: 3 ROOM USE: 1. 13 a 2. L Y2. 3. k-," 4. 5. 6. 7. 8. 9. 10. THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE IS PAYABLE AT THE TIME OF INSPECTION APPLICANT'S SIGNATURE 06n S-t-a— DATE - Z- 1 Inspectors use only Date on initial inspection:A.5 l p oZ � Date of reinspection: Date of issuance of certificate: Date fee paid: Type of Dwelling Other Check#LE_ _Chleck date: / Notes: V '�y� �ee'{�1 FS ca Y r-Qb`�,r S I �I YOny1') so Code ElilKorcWent Inspector CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4.`t FLOOR pllb)iCHC81t11 Prevent,Promote.Protect. (978) 741-1800 FAX(978) 745-0343 KIMBERLEY DRISCOLL 1mmdin e salem.com L/AIiRI, RAMI) /R IN,RSEBS,CI 10,CP-FS MAYOR I ."A L PI-1.AG 13N'I' 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. s Tenant/Lessee 07r/Lessor J1� 4"+"'/ /"0' F, ��s Address Address l� nn-'e� fx� St Address on unit to be inspected 1/(te2 /' Updated 523/11 z CITY OF SALEM, MASSACHUSETTS a • BOARD OF HEALTH 120 WASHINGTON STREET,4"i FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL Fax(978) 745-0343 MAYOR DGREF.NBAUM@SALFM.COM DA VID GlibI NBAum,RS A(.,1'IN(;HrA];I'I-I.AGEi,NI' CERTIFICATE OF FITNESS CERTIFICATE#425-10 DATE ISSUED: 8/30/2010 Property Located at: 15 Forrester Street UNIT#3 Owner/Agent: Jan Costa Address: 17 Forrester 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. FORT/�O OF HEALTH DAVID GREENBA M, RS ACTING HEALTH AGENT COD FORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS I 9 ' BOARD OF HEALTH r 120 WASHINGTON STREET,4°'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGREENBAUM&SALEM.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 / L 3 t.et•— C'f UNITO IS THIS UNIT DISIGNATED AS RIGHT LEVr FRONT OR-BAC TLEASE CIRCLE ONE OWNER/LESSER C Q S -f-v— MANAGER/AGENT NO P.O.BOX _ ADDRESS I ', v�c.�' e_ ADDRESS l CITY, STATE,ZIP �� C,1 7-7 C'�CITY, STATE,ZIP RESIDENCE PHONE qy�/ S&[ S)6 d BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: 5- ROOM ROOM USE: 1. i -'J--2 L L-z 3 'b a- 4 e212 5 R 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 CTS DATE Inspectors use only Date on initial inspection: 1_30 ,r 0 Date of reinspection: �— Date of issuance of certificate: �U p Date fee paid: 3 /0 Type of unit: Dwelling V Other Check# 0 a Check date: Q Notes: Code En ent Ins ector P CITY OF SALEM, MASSACHUSETTS • • BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 ICINMERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGREF.NBAUM@SALFM.COM DAVID GREENBA UM - ACTING HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#512-09 DATE ISSUED: 10/14/2009 Property Located at: 15 Forrester Street UNIT#3A Owner/Agent: J.W. Costa Address: 17 Forrester 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 DAVID GREENBAUM ACTING HEALTH AGENT C NFORCE INSPECTOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4...FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGREENBAUM&ALLM.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 IT# 3 IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE L ESSER S MANAGER/AGENT N BOX ADDRESS ADDRESS CITY, STATE,ZIP a p, 94 0 CITY, STATE, ZIP RESIDENCE PHONE—97� 5-O 0 0 BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: 3 ROOM USE: 1. hJCI2.-.-- 2. .Q 6A. -A A. 3. (rLdZ-,+w --4. 5 6. 7. U 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 —r Inspectors use only Date on initial inspection: (O/�I�q Date of reinspection: Date of issuance of certificate: Date fee paid: Type of unit: Dwelling Other Check#_Check date: I Notes: LI` WScret;ro F�ur win J,�-u ; rJibyiAo COp/dgfez+pr) r� r cloa7 �n �Q`rhr�oYh ��na:,�I; Li✓ �,�1�- in h�i'1�vo�yn InE�.�1 . C66 4�. e orcement Inspector CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH a 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 CERT.# 210-02 TEL. 978-74 1-1800 FEE $25.00 FAX 978-745-0343 DATE: 04/18/2002 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 15 Forrester Street UNIT #: 3A Left OWNER/AGENT: Harbor Rental ADDRESS: 111 Derby Street CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 740-2442 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 SJ JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR S` CITY OF SALEM, MASSACHUSETTS (OD BOARD OF HEALTH120 WASHINGTON STREET, 4TH FLOORSALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. ,JOANNE SCOTT, MPH, RS, CHO I MAYOR HEALTH AGENT , it € APPLICATION FOR CERTIFICATE OF FITNESS IN ACCORDANCE WITH STATE SANITARY CODE,CHAPTER 11, 105 CMR 410.000 " �,� HABITATION". MINIMUM STANDARDS OF FITNESS, OR_H,UMAANN _ y�/ PROPERTY LOCATED AT /1 X 1.3 UNIT* 7T- IS THIS UNIT DESIGNAT D AS GH LEFT FRO T BACK PLEASE CIRCLE ONE OWNERILESSER MANAGERJAGENT No P.O. Box . N P.O. Box ° ADDRESS_//l, ( „�7T_ADDRESS CITY CITY F f RESIDENCE PHONE BUSINESS PHONE (24 HRS.) BUSINESS PHONE �- TOTAL NUMBER OF ROOMS: �i,1 f� ) ROOM USE: 1._ 2.�3._ f 4. 5. 6. 7.�8. THERE IS A TWENTY-FIVE($25.00) DO FEE, PAYAB BY CHECK OR MONEY ORDER TO THE CITY OF S -HE DEPARTM FEE IS PAYABLE AT THE TIME OF INSPECTION. I b APPLICANTS SIGNATURE f DATE INSPECTORS U NL DATE OF INITIAL INSPECTION " "a DATE OF REINSPECTION--- DATE EINSPECTION_ ._DATE OF ISSUANCE OF CERTIFICATE: r -0—L-DATE FEE PAID: z" TYPE OF UNIT: DWELLINGTOTHER_ `CHECK#_ & 6 CHECK DATE NOTES: 7``- — CODE ENFORCEMENT INSPECTOR 9/28198 i d s CITY OF SALEM, MASSACHUSETTS m BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT - CERTIFICATE OF FITNESS CERTIFICATE#332-07 DATE ISSUED: 7/20/2007 Property Located at: 15 Forrester Street UNIT# 3B Owner/Agent: J.W. Costa Address: 17 Forrester Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 744-3587 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. I This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy. FOR THE BOARD OF E} JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR t CITY OF SALFm. MASSACHUSETTS f BOARD OF HEALTH • 120 WASH4NGTOM STREET. 4TH FLOOR SALEM. MA 01970 TEL. 978-741-1800 FAX 978-745.0343 - JOANNE SCOTT, MPH, RS, CHO Kimbedey Driscoll HEALTH AGENT Mayor I 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 __r,Ljt-y`_ _,f- r-__ UNIT #,{ IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACQrC PLEASE CIRCLE ONE OWNERILESSER —('Q-$,�_cr -- MANAGERIAGENT. _ No P.O.SBax No P.O.Box ADDRES��7 _E-0 rY e_S_t-e ADDRESS_ RESIDENCE PHONEM46 3 57('BUSINESS PHONE (24 HRS)___--__ Hd3MESS PHONE,__q7q:(ta(_JZ_�751� TOTAL NUMBER OF ROOMS:__.__— ROOM USE: 1.,._ YL 2.-,.-.L- K_ _3__-k-- 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 __ . —07 _ PEC LSE ONLY jJ' t3 DATE QE IINITIAL INSPECTION? G DATE OF REINSPECTION DATE OF ISSUANCE Ot CERTIFICATE?- 7 DATE 4 EE PAID TYPE OF UNIT DWELL OTHER CHECK ;I�5 © 5 CHLCIK DATE NOTE Uvcj_� — "e4 L✓�. ( P c e dr's P�rz CODE ENPORCI-ML.W INSI'EGIOH 9121i;Gt3 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • 120 WASHINGTON STREET, 4TH FLOOR n e SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR 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 Hoard of Health or its author– ized agents to inspect the residence identified below in accordance with the aforementioned statutes, regulations and ordinances. In the event it is necessary that said inspection be done in my/our absence, !/we expressly authorize the same and for my/our successors and assigns hereby release and discharge the City of Salem, Salem Board of Health and its authorized age:,-s I from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. T.=NAINT/LESSEE OW NY isSSOR 1A, P.Ess ADDREss — -- P.DDRESS OF UNIT TO BE INSPECT• `7- ©7 DATE -- CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH a * 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 0!970 CERT.# 211-02 TEL. 978-74 t-1800 FEE 04/18/ FAX 978-745-0343 DATE: 04/18/2002 STANLEY USOVICZ, JR. ,JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 15 Forrester Street UNIT #: 3R OWNER/AGENT: Janice Costa c/o Sherry Kerr ADDRESS: ill Derby Street CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 740-2442 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 . FO�ARD OF HEALTH JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTSOp, BOARD OF HEALTH ' � • 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-749-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT APPLICATION FOR CERTIFICATE OF FITNESS IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 10 MR 410.000 "MINIMUM STANDARDS OF FITN SO MAN HA PROPERTY LOCATED AT� _ BITATIO UNIT#�3 IS THIS UNIT DEStQNATEQAS RIGHT LEFT FRO T BACK PLEASE CLE ONE OWNER/LESSEttNo MANAGER/AGENT r No P.O. Box P.O.Box ADDRESSADDRESS_CITYCITY y RESIDENCE PHONE BUSINESS PHONE (24 HRS.) BUSINESS PHONE—?/ TOTAL NUMBER OFI1ROOMS:� ROOM USE: 1._41L._2. k 3. 4. 5. 6. THERE 1S A TWENTY-FIVE($25.00)DO !R FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY'OF SALEM HE LTH'OEPARTMEN TIS FEE IS PAYABLE AT THE TIME OF INSPECTION. i APPLICANTS SIGNATURE DATE �r�C C I SP ORS SE NLY DATE OF INITIAL INSPECTION Y-19-0-27: DATE OF REINSPECTION_ DATE OF ISSUANCE OF CERTIFICATE: z,DATE FEE PAID: 0 Z' TYPE OF UNIT: DWM1lELLING',_OTHER_ CHECK#74ta 3"' CHECK DATE NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 o CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH y; 120 WASHINGTON STREET, 4TH FLOOR a SALEM, MA 01970 g�/TNB TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#568-05 DATE ISSUED: 9/14/05 Property Located at: 16 Forrester Street UNIT# 1 Owner/Agent: Den Jin Set Address: 18 Forrester Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 744-2489 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 JOA E SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR f CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH J • • 120 WASHINGTON STREET. 4TH FLOOR CEJ SALEM, MA 01970 TEL. 978-741-1600 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_ff0_ ) 1/8 1 &Le --.—UNIT#, IS THIS UNIT DESIGNATED AS RIGHT�LEFFT' FRONT BACK PLEASE CIRCLE ONE �_OWNER/LESSER �" " "/ _MANAGER/AGENT No P.O. Sox No P.O.Box ADDRESS cI QpYY {2.� ADDRESS GITY u �_ CITY_ RESIDENCE PHONE j70p %�5!tsUSINESS PHONE (24 HRS.), BUSINESS PHONE TOTAL NUMBER OF ROOMS:_ _ �/�� / t n YJ ROOM USE' 1.'!f 2L«i _ 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 THF TIME OF INSPECTION. t� APPLICANTS SIGNATURE _DATE _ _ 9��FpSr INSPECTORS USE_ONLY DATE OF INITIAL INSPECTION O DATE OF REINSPECTION r DATE OF ISSUANCE OF CERTRFICAT'E?'%V 'O', - .. DATE FEE PAID _ !�j _�V O .+ TYPE OF UNIT. DWELLIOTHER CHECK �f -72 L CHECK DATE NOTES �\ CODE ENFORCEMENT INSPECTOR • - .� ' CITY OF SALEM, MASSACHUSETTS ye BOARD OF HEALTH 3j 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 Roger Pied 23 Phelps Street Saelm, MA 01970 PROPERTY LOCATED AT 24 Forrester Street Unit 1 Dear Sir/Madam: It has come to our attention, that you may be considering renting a dwelling unit at the above address. In accordance with Chapter 11,Article XIII of the City of Salem Code of Ordinances, Section 2- 334, titled "Certificate of Fitness," each dwelling unit must be inspected and certified prior to allowing occupancy. The inspection will be conducted in accordance with 105 CMR 410.000; State Sanitary Code, Chapter 11: Minimum Standards of Fitness for Human Habitation. Please notify us if you do not intend to rent the unit. Please contact this department within 24 hours of receipt of this notice at 978-741-1800, to schedule an appointment for an inspection. Our office hours are Monday thru Wednesday from 8:00 a.m. —4:00 p.m. Thursday 8:00 a.m. to 7:00 p.m. and Friday 8:00 a.m. — 12:00 p.m. Failure to comply with this procedure, may result in a fine of Twenty($20.00) dollars per day for every day that the dwelling unit is occupied without a Certificate of fitness. A$25.00 check payable to the City of Salem is required for each unit inspected at the time of 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 Heal t Reply to i idanne Scott MPH, RS, CHO Pablo Valdez Health Agent Code Enforcement Inspector CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR 'a c SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 1/24/05 Roger Pied 23 Phelps Street Salem, MA 01970 PROPERTY LOCATED AT 24 Forrester Street Unit 1 Dear Sir/Madam: It has come to our attention, that you may be considering renting a dwelling unit at the above address. In accordance with Chapter 11,Article XIII of the City of Salem Code of Ordinances, Section 2- 334, titled "Certificate of Fitness," each dwelling unit must be inspected and certified prior to allowing occupancy. The inspection will be conducted in accordance with 105 CMR 410.000; State Sanitary Code, Chapter 11: Minimum Standards of Fitness for Human Habitation. Please notify us if you do not intend to rent the unit. Please contact this department within 24 hours of receipt of this notice at 978-741-1800, to schedule an appointment for an inspection. Our office hours are Monday thru Wednesday from 8:00 a.m. —4:00 p.m. Thursday 8:00 a.m. to 7:00 p.m. and Friday 8:00 a.m. — 12:00 p.m. Failure to comply with this procedure, may result in a fine of Twenty($20.00) dollars per day for every day that the dwelling unit is occupied without a Certificate of fitness. A$25.00 check payable to the City of Salem is required for each unit inspected at the time of 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 he Board of HealthReply to J anne Scott MPH, RS, CHO Pablo Valdez Health Agent Code Enforcement Inspector V 1, CERT.# 235-97 3 FEE $25.00 DATE: 04/17/97 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: 26 Forrester Street UNIT #: 1 OWNER/AGENT: Fred Cardella ADDRESS: 63 Memorial Drive CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-0047 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 .00CUPANTS, 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 v JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR I 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 ATp �-pyY.../c��!� y- IN IT I --1 OWNER/LESSER �n��? j(�t p�///{cam_ MANAGER/AGENT ADDRESS63246 `dgl,!k, og IP e ADDRESS CITY /J/%( CITY .-RESIDENCE PHONEBUSINESS PHONE (24 HRS.) BUSINESS PHONE i TOTAL NUMBER OF ROOMS:_ // ROOM USE: 1 . / ,Q 2. �j�� 3. ,cj'1t--/j 4. J>/�j/�Y 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 TIIIE OF INSPECTION lfi APPLICANTS SIGNATURE i// & DATE 1 - INSPECTORS USE ONLY DATE OF INITIAL INSPECTION:-y-, / T17DATE OF REINSPECTION _ DATE OF ISSUANCE OF CERTIFICATE: A� - Z �y, 7 DATE FEE PAID: Ll TYPE OF UNIT: DWELLING OTHER NOTES : — CODE ENFORCEMENT INSPECTOR f ,�OONDIT,t� City of Salem, Massachusetts Board of Health 120 Washington Street, 4th Floor, Salem, PublicHealth F O MA 01970 Prevent. Promote. Protect. Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, REHS, CHO Mayor Iramdin@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE #: GHL-15-79 DATE ISSUED: 5/28/2015 Property Located at: 29 FOSTER STREET UNIT# Owner/Agent: Mary Woodcock Address: 19 Foster Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(978) 943-6920 Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division 3, Section 705: Certificate of fitness of rented dwelling unit, apartment or tenement. An inspection of your vacant Dwelling/Rooming Unit at the above address has been approved and is in compliance with 105 CMR 410.000: Massachusetts State Sanitary Code, Chapter II "Minimum Standards of Fitness for Human Habitation". Therefore, this Certificate is issued by the Code Enforcement Division of the Salem Board of Health and the unit may now be rented and/or occupied. Maximum Number of occupants, must comply with 105 CMR 410.000. Certificate valid for one year from date of issuance or until the current tenant vacates, whichever is later. This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy. FOR THE BOARD OF HEALTH l Larry Ramdin, MPH, REHS, CHO e HEALTH AGENT SANITARIAN M CITY OF SALEM, MASSACHUSETTS + n . BOARD OF HEALTH 120 WASHINGTON STREET,4°1 FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR LRAMDINQSAI.LM.COM LARRY RAMDIN,RS/RENIS,CHO,CP-PS Hi.,.M xI-I 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__V UNIT#) X n IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE OWNER/LESSER ` A✓0 ( MANAGER/AGENTVt 9 . ADDRESS 1 t �,(�(� ADDRESS CITY, STATE,ZIP �9M !' IA yJ�(-I 7(X CITY, STATE, ZIP RESIDENCE PHONE 1�L) I�I��b 12 VJ BUSINESS PHONE (24HRS) /CJ ' 11'3- 92 BUSINESS PHONE �l l TOTAL NUMBER OF ROOMS: / ROOM USE: 1. fl &0 2. IAV 3. 4. 5. 6. 7. 8. 9. 10. J THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE IS AYABL A E TIME OF INSPECTION APPLICANT'S SIGNATURE DATE / Lectors use only Date on initial inspection: ' � Date of reinspection: Date of issuance of certificate: Date fee paid: $ Type of unit: Dwelling Other Check# 117 Check date:T� Notes: Code F orc ent Inspector 5—? '(` OIdU1T CERT.# 87-02 FEE $25.00 ,y DATE: 02/20/2002 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970 . JOANNE SCOTT,MPH,RS,CHO 120 Washington Street, 4a'Floor HEALTH AGENT Tel: (978) 741-1800 Fax(978) 745-0343 CERTIFICATE OF FITNESS j PROPERTY LOCATED AT: 28 Forrester Street UNIT #: 1 Front OWNER/AGENT:Ryszard Xonarski ADDRESS: 28 Forrester Street CITY/TOWN: Salem, MA ' ZIP CODE: 01970 24 HOUR PHONE: 744-0713 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" . I THEREFORE, THIS CERTIFICATE IS ISSUED BY THE CODE ENFORCEMENT DIVISION OF THE 11 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" . i SECTION 410.400 (B): DWELLING UNIT (X) AND 410 .400 (C) : ROOMING UNIT I 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. I� I FOR THE BOARD OF HEALTH J� OOTT, MPH,RS,CHO - HEALTH AGENT CODE ENFORCEMENT INSPECTOR I ;I rI AI ' CITY OF SALEM, MASSACHUSETTS4 D BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY LISOVICZ, JR. JOANNE SCOTT, MPH, 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 A2 fOR R E ST'C� Cv I - UNIT# ' IS THIS UNIT DESIGNATED AS RIGHT LEF FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER p1/s2+gD KON4_1SKIMANAGER/AGENT No P.O. BoxNo P.O. Box ADDRESS a9 6RQES7"EA S, ADDRESS CITY S6-L-&M (IY74 019-10 CITY RESIDENCE PHONE` a _"l'1_0713 BUSINESS PHONE (24 HRS.) BUSINESS PHONE S 4y*"lC-_ TOTAL NUMBER OF ROOMS: 5 ROOM USE: 1. ✓�o<rt 2. ge�1w1M 3. 1?1"IM4 4 L/ VIA'C'7 5. 1� 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. 11 APPLICANTS SIGNATURE_ -" DATE C2 9 0 a INSPECTORS USE ONLY DATE OF INITIAL INSPECTION -2 •Z 0 " G 'A'DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE:Z f�L O 'y?-DATE FEE PAID:_Z —Yo -o e-- TYPE OF UNIT: DWELLING r0THER_ CHECK#CHECK DATEa-�O -�a NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 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 RELEASE In accordance with Massachusetts General Laws Chapter I11 ; Code of Massachusetts R:agulatior.s 410.000 et. seq. ; State Sanitary Code Chapter II and Articie XIII of rhe City of. Salem Ordinance, undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Hoard 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 [hat said inspection be done in my/our absence, !/we expressly authorize the same and for my/our successors and assigns hereby release and discharge the City of Salem, Salem Board of Health and its authorized agents from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. TENANT/LE ' E OkNER LESSOR R FSTtT, S%__ ADDRESS ADDRESS ADDRESS OF UNIT TO BE INSPECTED DATE [ �� OND1T n ��Mllyg 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 01/26/2001 Jozef & Serafina Pozdziorny 29 Forrester Street Salem, MA 01970 PROPERTY LOCATED AT 29 Forrester 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 the State Sanitary Code, Chapter II: Minimum Standards of Fitness for Human Habitation. i 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. FOR THE BOARD OF HEALTH REPLY TO Jo tt,& MPH,RS,CHO PABLO VALDEZ HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS HEALTH AGENT $f 120 WASHINGTON STREET, 4TH FLOOR as SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 KIMBERLEY DRISCOLL JSCOTT@SALEM.COM MAYOR JOANNE SCOTT HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#455-07 DATE ISSUED: 9/15/2007 Property Located at: 30 Forrester Street UNIT# 1 Owner/Agent: Kristine Doll Address: 30 Forrester Street#2 City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 740-4089 An inspection of your vacant Dwelling/Rooming Unit at the above address has been approved and is in compliance with 105 CMR 410.000: Massachusetts State Sanitary Code, Chapter ll" Minimum Standards of Fitness for Human Habitation". Therefore, this Certificate is issued by the Code Enforcement Division of the Salem Board of Health and the unit may now be rented and/or occupied. Maximum Number of occupants, must comply with 105 CMR 410.000. Certificate valid for one year from date of issuance or until the current tenant vacates, whichever is later. This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy. FOR THE BOARD OFF HEALTH ( ��+�/ �✓ JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS p, BOARD OF HEALTH y i 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA Ot97o TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, R ,.('�S, CHO `3 -"1..' Kimberley Driscoll HEALTH AGENT Mayor APPLICATION FOR CERTIFICATE OF FITNESS IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN,HABITATION". PROPERTY LOCATED AT�®�� _y "�l�Y UNIT # IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER—� 4 � 'L ��"SMANAGERIAGENT,— .. _ No P.O. Box No P.O. Box ADDRESS � ` : Yy LAS 7 r _._._A.DDRESS (— {�_ __CITY RESIDENCE PHONE_qjuQ ,� O k$USINESS PHONE (24 HRS.) i BUSINESS PHONE---- TOTAL HONE _ —TOTAL NUMBER OF ROOMS:— ROOM USE: i._ 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 NSPECT S USE ONLY DATEOF INITIAL INSPECTIONREINSPECTIOcNN__-- DATE OF ISSUANCE OF CERTIFICATE: 13:Z DATE FEE PAID: _ 7 TYPE OF UNIT: DWELLIN OTHER___ CHECK # 1_ CHECK DATE �__L.3 .3 NOTES: ---.— ---- CODE ENFORCEMENT INSPECTOR 9/28/98 CITY OF SALEM, MASSACHUSETTS ` r BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR DGRC!1-,NBAUM@SA1,EM.00M DAVID GREENBAum,RS AC'r1NG Hf:AL:17-1 AGI?N1. CERTIFICATE OF FITNESS CERTIFICATE#441-10 DATE ISSUED: 9/13/2010 Property Located at: 31 Forrester Street UNIT# 1 Owner/Agent: Mary Madore Address: 31 Forrester Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-979-3547 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 /Au DAVID GREENBAUM, RS ACTING HEALTH AGENT COD E ORCEMENT INSPECTOR • CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH f 120 WASHINGTON STREET,41°FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGREG:NBAUM(C>75ALEM.CO\f 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 5/-• UNIT# IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE OWNER/LESSER /Y7/l.�� MANAGER/AGENT NO P.O. BOX _ ADDRESS ADDRESS3 I /5/�c — J- 2je S?- CITY, STATE, ZIP.S4Le-�--"'7 , CITY, STATE,ZIP /✓7A - W 19`76 ( 4 ) RESIDENCEPHONE `/ '� f¢��¢r7 gPHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: M� ROOM USE: 1. 1-11 T 94--W 2. f7 a/�l 3. 17L--7v 4. Rno") 6. &-4--e)-I 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 `-' j DATE Inspectors use only Date on initial inspection: cj, Date of reinspection: Date of issuance of certificate: Date fee paid: III Type of unit: Dwelling Other Check#Check date: Notes: Code Ndorcement Inspector a CITY OF SALEM, MASSACHUSETTSBOARD 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 05/23/2002 Harbor Rental 111 Derby Street Salem, MA 01970 PROPERTY LOCATED AT 36 Forrester Street UNIT # 1 Dear Sir/Madam: It has come to our attention, that you may be considering renting a dwelling unit at the above address. In accordance with Chapter 11, Article XIII of the City of Salem Code of Ordinances, Section 2-334,titled "Certificate of Fitness, " each dwelling unit must be inspected and certified prior to allowing occupancy. The inspection will be conducted in accordance with 105 CMR; 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. OR THE BOAR HEATH REPLY TO (Jioanne Scott, MPH,RS,CHO PABLO VALDEZ Health Agent CODE ENFORCEMENT INSPECTOR r CERT.# 81-98 3 FEE $25.00 111 �F DATE: 02/10/98 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) CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 36 Forrester Street UNIT #: 1 OWNER/AGENT: Harbor Rental ADDRESS: 111 Derby Street CITY/TOWN: Salem- MA ZIP CODE: 01970 24 HOUR PHONE: 744-3778 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 HE BOARD O/ F HEALTH e JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR a -/49 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,AS.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 HABITATTIIO_N". PROPERTY LOCATED AY !!Q��}/1 q �J p n � op UNIT # � OWNER/LESSER MANAGER/AGENT ADDRESS II' ADDRESS CITY CITY RESIDENCE PHONE 1 y I n�7 BUSINESS PHONE (24 HRS.)2J BUSINESS PHONE ��-' TOTAL NUMBER OF ROOMS: `N ROOM USE: 1. 2. 5. 6. 7. 8. THERE IS A TWENTY-FIVE (25 ) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM HEALTH DE THIS E IS PAYABLE AT THE TINE OF INSPECTION APPLICANTS SIGNATURE A OA ADATE ((a INSP TORS USE ONLY DATE OF INITIAL INSPECTION: G ��a 'f F DATE OF REINSPECTION _ DATE OF ISSUANCE OF CERTIFICATF.:_2- l Z) DATE FEE PAID: r s' TYPE OF UNIT: DWELLING OTHER NOTES: CODE ENFORCEMENT INSPECTOR ( CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH s' s 120 WASHINGTON STREET, 4TH FLOOR o' SALEM, MA O 1970 �^ TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. UISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 6/13/05 Louis Conrad & Lois Bisson 41 Forrester Street#2 Salem, MA 01970 PROPERTY LOCATED AT 41 Forrester Street Unit 1 Dear Sir/Madam: It has come to our attention, that you may be considering renting a dwelling unit at the above avldress. In accordance with Chapter 11, Article XIII of the City of Salem Code of Ordinances,Sectlion 2- 334, titled "Certificate of Fitness," each dwelling unit must be inspected and certified priof to allowing occupancy. The inspection will be conducted in accordance with 105 CMR 410.0100; 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 fc 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 writ?,,n letting agreement stating the tenant is responsible for those utilities and if the meter(s) records electric:'v and gas use which is not used exclusively by that tenant. The Department of Public Utilities has billo.: property owners for their tenant's entire utility bills retroactive to the date of initial occupancy in c--:.,-,es in which cross-metering has been proven to exist. F r the Board of Heal Reply to 9Oanne Scott MPH, RS, CHO Pablo Valdez Health Agent Code Enforcement Inspector CERT.# 796-00 FEE $25.00 DATE: 12/20/2000 ��7MP78 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978) 741-1800 Fax:(978)740-9705 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 41 Forrester Street UNIT #: 1 OWNER/AGENT: Louis Conrad & Lois Bisson ADDRESS: 41 Forrester Street #2 CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-3173 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 NOTE: Living room ceiling needs repainting. Bathroom wall near shower needs repair (small area) . 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 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION'. PROPERTY LOCATED AT y &rfe {er S i UNIT#�. IS THIS UNIT DESIGNATED ASI� GHT LEFT FRONT BACK PLEASE CIRCLE ONE i OWNERlLESSER Lou artqftl!6! S MANAGER/AGENT No P.O. Box _ No P.O. Box ADDRESS a f o r f!54rr '} #�2- ADDRESS_ Sarn( _ CITY fo m/f- CITY RESIDENCE PHON(-Vi)9j�- I�'�__._BUSINESS PHONE (24 HRS.) A BUSINESS PHONE /1/!^: TOTAL NUMBER OF ROOMS:_ ROOM USE: 1, 5. 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_ '9�i y` 72�t DATE__f INSPECTORS USE ONLY DATE OF INITIAL INSPECTION .. / _/oa DATE OF REINSPECTION) DATE OF ISSUANCE OF CERTIFICATE: J ao a DATE FEE TYPE OF UNIT: DWELLING ✓OTHER_ CHECK# M�CHECK DATE NOTES:_ r" _`�E _. `e ?fqa_A,:, �r .CPa7�r 4.A//_�'r.Q,r S'.;�+,� tiyg%�✓1?en %�_� .a//.�iz,Q� CO FO EME-�PECTOR 9!28!98 1 i g� Ilk �r CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT.MPH,RS,CHO NINE NORTH STREET HEA_TH AGENT Tel:(508)741-1800 Fax:(508)740-9705 RELEASE In accordance with Massachusetts General Laws Chapter III ; Code of Massachusetts Regulations 410.000 et. seq. ; State Sanitary Code Chapter II and Article XIII of the Cit; of Salem Ordinance, undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health or its author- ized agents to inspect the residence identified below in accordance with the aforementioned statutes, regulations and ordinances. In the event it is necessary that said inspection be done in my/our absence, 1/we expressly authorize the same and for my/our successors and assigns hereby release and discharge the City of Salem, Salem Board of Health and its authorized ages-i-5 from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. TENANT/LESSEE OWNER/i._ S R -- 1-ADD _qLforrr67�1- 61- ADD RE S S RESS — ADDRESS ADDRESS OF UNIT TO BE INSPECTED DATE CITY OF SALEM, MASSACHUSETTS „ BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 3/23/06 Kathleen &John Simons, III 41 Forrester Street Salem, MA 01970 PROPERTY LOCATED AT 41 Forrester 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. r the Board of Heolh Reply to t=PH, RS, CHO Pablo Valdez Health Agent Code Enforcement Inspector CITY OF SALEM, MASSACHUSETTS `V BOARD OF HEALTH 120 WASHINGTON STREET 4' FLOOR Pli111 Pcpv¢el.PlOm01e.Pfo[Cc[. TEL. (978) 741-1800 FAx(978) 745-0343 KIMBERLEY DRISCOLL lramdin osalem.com LARRY ltr\'bfD1N,Rti/RLiFIS,CHO,CI'-PS MAYOR _ HFALfl-1 AGI?N'I' CERTIFICATE OF FITNESS CERTIFICATE#369-13 DATE ISSUED: 10/2/2013 Property Located at: 44 Forrester Street UNIT# 1 Owner/Agent: Joel W. Foster Address: 43 Forest Street City/Town: Danvers, MA Zip Code: 01923 24 Hour Phone: 777-0595 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 UEALTH LARRY RAMDIN HEALTH AGENT SANITARIAN CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET 41'FLOOR PublicHwIth e Prevent.Promote.Protect. TEL. (978) 741-1800 FAX(978)745-0343 KIMBERLEY DRISCOLL h-amdin@salem.com LARRY BW4131N,RS/RENS,CHO,CP-I+S MAYOR HEiAL1'H ACPNI 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 S Y o r r S�L' 1V UNIT# IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK.PLEASE CIRCLE ONE OWNER/LESSERG tQ.W VOS4y_V' MANAGER/AGENTs)o ,I 6,kl NO P.O.BOX ADDRESS 6"g r6res� ADDRESS '�3 CITY, STATE,ZIP2nAver�r al� if?-,1_3 CITY, STATE,ZIP XAhv��S YP�1] o �9z3 RESIDENCE PHONE 9 7 F' ?77-6 S-95 BUSINESS PHONE(24HRS) Bb7SR,fM PHONE TOTAL NUMBER OF ROOMS: S ROOMUSE: 1.1-u{Cktw 21,1d"oonc 3�5,eJr0o1( 4,�r rn9r�a( 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 Y LE AT TIME OPECTION APPLICANT'S SIG NA DATE Inspectors use only Date on initial inspection: ) Q-t-n Date of reinspection: Date of issuance of certificate: 18-2-')� Date fee paid: ) d ` Z'''3 Type of unit: Dwelling Other Check# S(o l(S Check date: )0-1 I' Notes: Co a Enfor ement pert CITY OF SALEM, MASSACHUSETTS BOARD OI^`HEALTIj 120 WASHINGTON STREET,4 ,FLOOR TLi,. (978) 741-1800 KIMBERLEY DRISCO11 FAX(978)745-0343 MAYOR IX.Rr,, sNanuMONAt T- COM DAvnJ Giu!'ENBA UM,RS A(-FING Ht:AI:n-z A<=taN,r CERTIFICATE OF FITNESS CERTIFICATE#424-10 DATE ISSUED: 8/30/2010 Property Located at: 44 Forrester Street UNIT#2 Owner/Agent: Joel W. Foster Address: 43 Forest Street City/Town: Danvers, MA Zip Code: 01923 24 Hour Phone: 978-774-0617 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 il" 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 BOA \.JOE HEALTH f� DAVID GREENBAUM, RS _ ACTING HEALTH AGENT CODE ENF EMENT INSPECTOR i a CITY OF SALEM, MASSACHUSETTS Bo,wnorlli vl:ri-i q w� . kM� 120\x':AsmN(;roN' Srjzi;i"1. 4'°F71,O(,m Tea.. (978) 741-9800 K1 N4BER7_EY DR I SC:OLL F n x (978)74 5- equot Highlands �IE�`�lame P I�IAY �It u:c rrrtau .fSi # 0137— — -- Date Received )WNNI:SCO 1-1, Purchase Order# --- I It" ,'n i A(:IeN r Batch# GL Code ----- -- Amount to be Paid Approved By ----- Application for Certificate of Fitness 1N ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION." FEE: $50.00 PROPERTY LOCATED AT !a 4 S UNITIi_0S IS THIS UNIT DISIGN'ATED AS RIGHT LEFT F`RON'T OR RACK,]'LEASE CIRCLE ONE 1 OWNER/LESSER_ E_ / I } MANAGER/AGENT W�� j`_� . NO P.O.BOX ADDRESS �_ ADDRESS 1. , CITY, STATE,ZIP S,1¢,y✓y ["y\`} CITY, STATE,ZIP -7 RESIDENCE PHONE BUSINESS PHONE(24HRS)_,_ L'jS__"7!j L.(2;34-( BUSINESS PHONE TOTAL NUMBER OF ROOMS:_ Jy ROOM USE: 1. I 312)x4 rt�I�y! 6. 7. —$, 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 i APPLICANT'S SIGNATURE-- � i ^�--^DATE . , Ins ectors use only Y Date on initial inspection: _, a��lU Date of reinspection: -�----- Date of issuance of certificate: /(J Date fee paid: r b Type of unit; Dwelling V Other Check# 7q &7SO Check date: tS 0?(9 �U Notes: ' C de En rcement Inspector • � vgt*�Ampm � CERT.# 443-99 FEE $25.00 59 DATE: 08/12/99 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Fax:(978)740-9705 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 46 Forrester Street UNIT #: 1 OWNER/AGENT: Walter & Dana Schukert ADDRESS: 46 Forrester Street CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-5690 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 tt V 10= SCO ,, MHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT APPLICATION FOR CERTIFICATE OF FITNESS Tel:(978)741-1800 Fax:(978)740-9705 IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS1 FOR HUMAN,HABITATION". PROPERTY LOCATED AT L O E6'rCeS ft V UNIT# IS THIS UNIT DESIGNATED AS RIGHT LEFT , FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER_�"' , nn}}nn 1'�eCk 4Xl C�' ANWA� AGENT �J - No P.O. Box No P.O. Box ADDRESS�p-Y t_, _/_M qCr_ � ADDRESS— � �t� CITY�Wh1 RESIDENCE PHONE ~ 40 BUSINESS PHONE BUSINESS PHONE--- TOTAL HONE _TOTAL NUMBER OF ROOMS: (0 _.. ROOM USE: 1LAI 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^ Y t1Vl ► DATE INSPECTORS USE ONLY DATE OF INITIAL INSPECTIONR ��4 DATE OF REINSPECTIOON'' //_ DATE OF ISSUANCE OF CERTIFICATE: �a- f DATE FEE PAID:�h_ 7 TYPE OF UNIT: DWELLING OTHER` CHECK#CHECK DATE ,-'i 2 NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 6 n tjrp� CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 RELEASE In accordance with Massachusetts General Laws Chapter 111 ; Code of Massachusetts Regulations 410.000 et. seq. ; State Sanitary Code Chapter II and Article XIII of the Cit; of Salem Ordinance, undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health or its author- ized agents to inspect the residence identified below in accordance with the aforementioned statutes, regulations and ordinances. L•i the event it is necessary that said inspection be done in my/our absence, 1/we expressly authorize the same and for my/our successors and assigns hereby release and discharge the City of Salem, Salem Board of Health and its authorized agents from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. TETE_ NT E OWNER/iESSOR ADDRESS ADDRESS — ADDRESS OF UNIT TO BE INSPECTED k12 9 DATE Jeyq,�k.-.ay, -4, iY ��ON91T �v 4rylryg CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH,RS,CHO 07/22/99 NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Gregory Burns & Catheryn Cahill Fax:(978)740-9705 54 Forrester Street Salem, MA 01970 PROPERTY LOCATED AT 54 Forrester Street UNIT # 1 Dear Sir/Madam: It has come to our attention, that you may be considering renting a dwelling unit at the above address. In accordance with Chapter 11, Article XIII of the City of Salem Code of Ordinances, Section 2-334, titled "Certificate of Fitness, " each dwelling unit must be inspected and certified prior to allowing occupancy. The inspection will be conducted in accordance with the State Sanitary Code, Chapter II: Minimum Standards of Fitness for Human Habitation'k 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 seating 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. JR THE BOARD OF REPLY TO Joanne Scott MPH RS CHO PABLO VALDEZ HEALTH AGENT CODE ENFORCEMENT INSPECTOR 7IIPOR ANT MESSAGE FOR DATE �� Y TI / JP M M PHONE AREA CODE NO BER EXTENSION 0 FAX 0 MOBILE AREA CODE UMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE +U WILL CALL AGAIN WANTS TO SEE OU RUSH RETURNED YOUR CAL WILL FAX TO YOU MESSAGE SIGNED VrO��7 FORM 4009 U S,MARE IN U.S.A. f f m & CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tel: (978)741-1800 Fa : (978)740-9705 04/03/2001 John Citrano 37 Kenmere Road Medford, MA 02155 PROPERTY LOCATED AT 56 Forrester Street UNIT #P la�� 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. R THE BOARD O)j HEALTH REPLY TO oanneSco , MPH,RS,CHO PABLO VALDEZ Health Agent CODE ENFORCEMENT INSPECTOR f CERT.# 538-97 FEE $25.00 DATE: 08/07/97 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: 56 Forrester Street UNIT #: 1 - OWNER/AGENT: Shawn Shea ADDRESS: 108 Broadway CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-1665 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 4.10 .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 v JOANNE SCOTT, MPH,RS,CHO v HEALTH AGENT CODE ENFORCEMENT INSPECTOR n 11IP kill mra 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 J D %."�rUNIT #� OWNER/LESSER/ p �fy� G✓p�fi �4 - MANAGER/AGENTf �C_ ADDRESS LGU /SSC.%'1a,-L`f ADDRESS CITY !�4 CITY _ RESIDENCE PHONE BUSINESS PHONE (24 HRS.) BUSINESS FROM S� TOTAL NUMBER OF ROOMS: ROOM USE: 1. // 2. 3. _ 4 . 5. 6. 7. 8. THERE IS A TWENTY-PIPE (25.00) DOLLAFITF AYASLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM HEALTH DEPARTMENT THT I PAYABLE AT THE TIMHOF INSPEC ION APPLICANTS SIGNATURE DATE-- • INSPECTORS USE ONLY DATE OF INITIAL INSPECTION: i_�DATE OF REINSPECTION _ DATE OF ISSUANCE OF CERTIFICATE:�i i 7 DATE FEE PAID:V, 7 7 TYPE OF UNIT: DWELLING OTHER NOTES: — CODE ENFORCEMENT INSPECTOR 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: 11/21/96 Fax:(508)740-9705 Common Trust c/o Shawn Shea P.O. Box 8586 Salem, MA 01970 PROPERTY LOCATED AT 56 Forrester Street UNIT # 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 -his 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, wila 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. Verytruly yours, FOR THE BOARD OF HEALTH REPLY TO qoan t, MPH,RS,CHO PABLO VALDEZ HEALTH AGENT CODE ENFORCEMENT INSPECTOR City of Salem, Massachusetts r Board of Health 120 Washington Street,et 4th Floor, Salem, „r th MA01974 N,",".,. Kimberley D•iscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, RENS,CHO Mayor Iramdin@s,alem.com Health Agent CERTIFICATE: OF FITNESS CERTIFICATE#: GHL-16-39 DATE ISSUED: 2/5/2016 Property Located a t: 62 FORRESTER STREET UNIT#1 Owner/Agent: St. Nicholas Orthodox Church Address: 64 Forrester Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:744-5869 Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division 3, Section 705: Certificate of fitness of rented dwelling un L 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: IAassachusetts State Sanitary Code, Chapter ii "Minimum Standards of Fitne ss for Human Habitation". Therefore, this Ce tificate is issued by the Code Enforcement Division of the Salem Board of Health and the unit may now be rented and/or e-cupied. Maximum Numbei of occupants, must comply with 105 CMR 410.000. Certificate valid fer one year from date of issuance or until the current tenant vacates, whichever is later. This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy. FOR THE BOARD OF HEALTH ""1 Larry Ramdin, MFH, RENS, CHO tf HEALTH AGENT SANITARIAN Y I + CITY OF SALEM, MASSACHUSETTS BOARD OF HE. LTH 120 WASHINGTON STREET,4"'FLOOR I'ub1lCHealth Prevent.Promote.Protect. TEL. (978) 741-1800 Rjx(978) 745-0343 KIMBERLEY DRISCOLL Iramdinna,salem.com LARRY ItAMDIN,RS/KERS,(J 10,CP-FS MAYOR HI?ALTj-1 AGI?N'I' Application for Certificate of Fitness IN ACCORDANCE WITH STATE SANITARY CODE CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" f FEE: $50.00 PROPERTY LOCATED AT_6 2 r rreS`�e t S UNIT# IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE 1 Ck (>A V* ed0 OWNER/LESSER��'•N � `�^ r� C'1MANAGER/AGENTC- . � � NOP.O. BOX ADDRESS L4 TJ6r• est tr S� �ce�z�. P^ s4 ADDRESS CITY, STATE, ZIP S mle w. M CITY, STATE,ZIP 2a w., 0 ,t RESIDENCE PHONE �Q 0 BUSINESS PHONE(24HRS) BUSINESS PHONE l g y _S7 go(, 9 TOTAL NUMBER OF ROOMS: S— ROOM USE: 1. r 2. �- t` 3. Q &Z. 4. �--e 0 5. r�r 6. 7. 8. 9. 10. THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE IS PAYABLE AT THE TIME OF INSPECTION APPLICANT'S SIGNATURE DATE G ii Inspectors use only Date on initial inspection: 7. d II� Date of reinspection: Date of issuance of certificate: Date fee paid: ara N Type of unit: Dwe�llll�ing Othelr�� Check# 59,Z,5 Check Check date: Notes: Oyu L42- W hdot,) To VICtw ,t.. CQA6 k U4. (6 Co&JA f • ment Inspector _ i O . k CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH --120 WASHINGTON STREET,41"FLOOR 'Public$C811th--- - Prevem.Fromnie Protnt. - TEL. (978) 741-1800 Fax(978) 745-034.3 KIMBERLEY.DRISCOLL Lamdln@.saLlem.com ]�,U21tY12AMUiN,RS�REHS,C1iO,Ch-FS - MAYOR FIEr11,T1-IAGI;iN'T - CERTIFICATE OF FITNESS CERTIFICATE#47-15 DATE ISSUED:2/26/2015 Property Located at: 62 Forrester Street UNIT#2 Owner/Agent: St. Nicholas Russian Church Address: 64 Forrester Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 744-5869 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 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 ' 9 .w LAR RAMDIN <f HEALTH AGENT SANITARIAN I +i ~ CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH _- . 120 WASHINGTON STREET,4"FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR LRAMDIN Q@SN.EM.COM LARRY RAN[IJIN,RS/REfIS,CHO,CP-FS HFAIxi I 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 PROPERTY LOCATED AT � Z- r o� ° e s�e'" � UNIT# IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE OWNER/LESSER S �- 4� IOG�B Ictif © r ��EK S MANAGER/AGENT JL r-K �r r NO P.O. BOX S ADDRESS ADDRESS � ��s r CITY, STATE,ZIP S �� n�R a\a�� CITY, STATE,ZIP n l2 l 6 c� 0 RESIDENCE PHONE t ` Z t q y BUSINESS PHONE(24HRS) -S 14 BUSINESS PHONE Sloe TOTAL NUMBER OF/ROOMS: ROOM USE: Lk 2 R 3. (�, 12 4. t1 Yz, 5. 5'7' P 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 (a (l / I DATE Inspectors use only Date on initial inspection: Q + � Date of reinspection: Date of issuance of certificate: Date fee paid:_ Type of unit: Dwelling Other Check# Check date: _ Notes: Co—cy E�fYd�pent Inspector