FORT AVENUE A I
s' CITY OF SALEM, MASSACHUSETTS
a m BOARD OF HEALTH
s 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAx 978-745-0343
Kimberley Driscoll WWW.SALEM.COM
Mayor JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#271-07
DATE ISSUED: 6/6/2007
Property Located at: 14 Fort Avenue UNIT# 1
Owner/Agent: Cesar Mancebo
Address: 14 Fort Avenue
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-741-1147
An inspection of your vacant Dwelling/Rooming Unit at the above address has been approved
and is in compliance with 105 CMR 410.000: Massachusetts State Sanitary Code, Chapter ll"
Minimum Standards of Fitness for Human Habitation".
Therefore, this Certificate is issued by the Code Enforcement Division of the Salem Board of
Health and the unit may now be rented and/or occupied.
Maximum Number of occupants, must comply with 105 CMR 410.000.
Certificate valid for one year from date of issuance or until the current tenant vacates, whichever
is later.
This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy.
FOR THE BOARD OF HEALTH
- vtot—
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
p CITY OF SALEM, MASSACHUSETTS 1w..7►� BOARD OF HEALTH
• i 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
JOANNE SCOTT, MPH, RS, CHO
Kimberley Driscoll HEALTH AGENT
Mayor
APPLICATION FOR CERTIFICATE OF FITNESS
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT J� _ 1)p- _U NIT#�
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER C �/J ° C/II(ej' NAGER/AGENT
No P.O. Boxll No P.O. Box
ADDRESS 141 r-O V t 1q 1�2YL Lt ADDRESS
CITY CITY
RESIDENCE PHONE 97$ 7y J.-( YDUSINESS PHONE (24 HRS.)
BUSINESS PHONE 7 :G o116�l (O
TOTAL NUMBER OF ROOMS:
ROOM USE: L__ /4.)_ _
5. 6. 7. / X88,
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 V 7
D
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION _.DATE OF REINSPECTION___
7 •
DATE OF ISSUANCE OF CERTIFICATEC-�07 DATE FEE PAID:__..__.]
r7
TYPE OF UNIT: DWELLI OTHER__, CHECK #S-7 __,CHECK DATE _ a
NOTES:
CODE ENFORCEMENT INSPECTOR 9/28/98
I�A 1-v_t .�w x�
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET
HEALTH AGENT Tel:(976)741-1800
10/22/99 Fax:(978)740-9705
Albert G. Eisen -c/o Lusco-American Credit Union
39 Tremont Street
Peabody, MA 01960 &o"
PROPERTY LOCATED AT 14 Fort Avenue 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; State Sanitary Code, Chapter 1: 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. - 4:60 p.m. Thursday 8:00 a.m. - 7:00 p.m. and Friday 8:00
a.m. - 4:00 p.m.
Failure to comply with this procedure, may result in a fine of Twenty (20) dollars
per day for every day that the dwelling unit is occupied without a Certificate of
Fitness.
A $25.00. check payable to the City of Salem is required for each unit inspected at the
time of inspection.
A property owner is required to pay gas and electricity for residential tenants if there
is not a written letting agreement stating the tenant is responsible for those
utilities and if the meter(s) records electricity and gas use which is not used
exclusively by that tenant. The Department of Public Utilities has billed property
owners for their tenants' entire utility bills retroactive to the date of initial
occupancy in cases in which cross-metering has been proven to exist.
,FPR THE BOARD OW HEALTH REPLY TO
?oanne Scote, MPHRSCHO PABLO VALDEZ
Health Agent CODE ENFORCEMENT INSPECTOR
� 3
s ¢ CITY OF SALEM, MASSACHUSETTS lu
BOARD OF HEALTH P1th
120 WASHINGTON STREET,4w FLOOR prevent,Promote.Protect.
TEL. (978)741-1800 FAX(978) 745-0343
KIMBERLEY DRISCOLL Iramdin@salem.com salem.com
LARRY]LIMDIN,RS/RFHti,CHO,CP—FS
S
MAYOR HEAL'n--I AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#50-14
DATE ISSUED: 2/18/2014
Property Located at: 16 Fort Avenue UNIT#1
Owner/Agent: Allen Carcione
Address: 16 Fort Avenue#2
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:
Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division3, Section
705: Certificate of fitness of rented dwelling unit, apartment or tenement. An inspection of your
vacant Dwelling/Rooming Unit at the above address has been approved and is in compliance with
105 CMR 410.000: Massachusetts State Sanitary Code, Chapter ll" Minimum Standards of
Fitness for Human Habitation".
Therefore, this Certificate is issued by the Code Enforcement Division of the Salem Board of
Health and the unit may now be rented and/or occupied.
Maximum Number of occupants, must comply with 105 CMR 410.000.
Certificate valid for one year from date of issuance or until the current tenant vacates, whichever
is later.
This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy.
FOR THE BOARD OF HEALTH
LAR Y RAMDIN
HEALTH AGENT SANITARIAN
CITY OF SALEM, MASSACHUSETTS (/�(
-BOARD OF HEALTH
120 WASHINGTON STREET,.4"'FLOOR PubUcHealth
TEL. (978)741-1800 FAX(978) 745-0343
KIMBERLEY DRISCOLL Iratndin@salem.com
M
MAYOR _ Iratndin@salem.com
RADIN,Rti/R1;IIS,C1 10,01-17S
HF.ALTY-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 1 (e F—O -T 4i UNIT#
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE
OWNEMESSER 1 L N CA-k C L.0f\1 t- MANAGER/AGENT S M
NO P.O. BOX r
ADDRESS I (o R fi /� v Z ADDRESS
CITY, STATE,ZIP_ A L l7 CITY, STATE,ZIP
RESIDENCE PHONE G tom_ SGq}BUSINESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: S
ROOMUSE: 1. vine 2. SIlQLC 3. S tel' 4. IL, l-c 5. 17Pn
6. NJ7. 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 THETIME OF INSPECTION �]
APPLICANT'S SIGNATURE / tl %' 1 DATE -4
Inspectors use only
Date on initial inspection: �`�0 y Date of reinspection:
Date of issuance of certificate: Date fee paid:
Type of unit: Dwelling Other Check#1 / Check date: alICA
Notes: l_aZIC tmz' )re smab dPTf ( k C'/-Ujp-D.;, C'
caul60, aw)ee., ` Umis f-) a -t o,�(f� 10 0
CodC nforc entInspector
Y
CITY OF SALEM, MASSACHUSETTS
Bo-ARD OF FIFa1:fI-I
120 WASHINGT0IN STRFL.T,4". FLOOR
TF;L. (978) 741-1800
KII48E:RT> 1 DRISCO].,L FAX(978) 745-0343
MAYOR Iramdin sa1cm.com
L,V2121'IZlV�lDl v,RS/aGI IS,cHo, -
'HFAIa'II AGFSNf
CERTIFICATE OF FITNESS
CERTIFICATE#24-12
DATE ISSUED: 12/16/2011
Property Located at: 16 Fort Avenue UNIT#2nd Floor
Owner/Agent: Joseph Zagrobski
Address: 13 Crowdis Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-5153
An inspection of your vacant Dwelling/Rooming Unit at the above address has been approved
and is in compliance with 105 CMR 410.000: Massachusetts State Sanitary Code, Chapter ll"
Minimum Standards of Fitness for Human Habitation".
Therefore, this Certificate is issued by the Code Enforcement Division of the Salem Board of
Health and the unit may now be rented and/or occupied.
Maximum Number of occupants, must comply with 105 CMR 410.000.
Certificate valid for one year from date of issuance or until the current tenant vacates, whichever
is later.
This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy.
FOR THE BOARD OF HEALTH
�t-
L
HEALTH AGENT C E ENFORCElQt5NtfNSPECTOR
• CITY OF SALEM, MASSACHUSETTS
BOARD of HEAI,T[t
) �
120 WASHINGTON STREET,4... FLUOR
TEL. (978) 741-1800
KIMBEIU.Ey DRISCOLL FAX (978) 745-0343
MAYOR LRAMDIN a AJAHMJ oNI
1.mum,RAD:FDIN, RS/RFU IS,(:I RI,
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 Q
PROPERTY LOCATED AT / (� �d}^% f/I/£ I ,2 ��/I / UNIT#
IS THIS UNIT DISIGNATED/AS RIGHT LE FRONT OR BACK.PLEASE CIRCLE ONE
U
OWNERILESSER O-SF/01 MANAGER/AGENT
NO P.O. BOX y�
ADDRESS /3 C I?a&D/S S,r- ADDRESS
CITY, STATE, ZIP � A1% 171gT(9 CITY, STATE,ZIP
RESIDENCE PHONE ?7e 7}S—JIS3 BUSINESS PHONE(24HRS)
BURRfBSSPHONE 974!�-5766.532
TOTAL NUMBER OF ROOMS:
F
ROOM USE: Eh 2. eC-1) 1. /1VING 4 kl fc -41
6. 7. 8. 9. 10.
THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS F IS PAYABLE E TIME OF INSPECTION //
APPLICANT'S SIGNATURE DATE �i5 W//
Inspectors use only
Date on initial inspection: f a�� Date of reinspection:
Date of issuance of certificate: Date fee paid: _
Type of unit: Dwelling Other Check#Check date:
Notes:
r4C�&6-Vnf_b;6im'ent Inspector
.,y
CITY OF SALEM, MassAcHUsl-errs
BOARD OF HF�ALTH
1'-)OWASHINGTC7N S'T'REF.'T',4"' FLOOR
TEL. (978) 741-1800
ICNIBERLEY DRISCOLL FAx (978) 745-0343
MAYOR IR A%In-NIIa IINI r41I
L,.4IlRY RrANIDIN,KS/Ii1111S,0110,CP-I S
WArn I AGENT
Release
In accordance with Massachusetts General Laws Chapter 111; Code of Massachusetts Regulations 410.000 et. Seq. ;
State Sanitary Code Chapter I1 and Article X111 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.
Altq(\
Tenant/Lessee Owner/Lessor
AUC' 13 c>goki�I/S 51"�
Address Address
n71,,4V,6
Address on unit to be inspected
'9
Date
Updated 5/23/11
.t
CERT.# 347-99
s� § FEE $25.00
DATE: 07/07/99
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: 151 Fort Avenue UNIT #: House
OWNER/AGENT: Pamela Ryan
ADDRESS: 3 Pingree Farm Road
CITY/TOWN: Georgetown, MA ZIP CODE: 01833 24 HOUR PHONE: 535-6500
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
g��ONO T
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 Tel: (978)741-1800
Fax:(978)740-9705
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000
"MINIMUM STANDARDS OFpFITNESS
SFFOR HUMAN HABITATION'.
PROPERTY LOCATED AT
IS THIS UNIT DESIGNATED AS RIGHT LEFT RdNT13ACK PLEASE CIRCLE ONE
OW NER/LESSERIO&�MANAGER/AG ENT
No P.O. Box nn No P.O. Box
ADDRESS-3 i"st1 QAC -e- �A�l � ADDRESS A
CITY_ '�(� ? 17��{ _CITY_
RESIDENCE PHONE92135 BUSINESS PHONE (24 HRS.)
BUSINESS PHONE---
TOTAL
HONE _TOTAL NUMBER OF ROOMS: n
ROOM USE: 1.
THERE IS A TWENTY-FIVE($25.00)DOLLAR FEE, PAYABLE BY CHECK OR MONEY
ORDER TO THE CITY OF SALEM HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE
TIME OF INSPECTION.
APPLICANTS SIGNATURE_ Q —DATE " C} 7
INSPECTORS USE ONLY
QATE OF INITIAL INSPECTIONT -( - 9 9 DATE OF REINSPECTION c,
DATE OF ISSUANCE OF CERTIFICATE: _ DATE FEE PAID:Z �
TYPE OF UNIT: DWELLING POTHERCHECK#.,a 3 O I CHECK DATE -7 `--
NOTES:—,— --
i
CODE ENFORCEMENT INSPECTOR 9/28/98
t `
CITY OF SALEM, MASSACHUSETTS
+ • BOARD OF HEALTH
120 WASHINGTON STREET,4"FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR IMANCINI r&ALM.COM
JANET MANCI.NI
ACTING HEALTH H AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#62-09
DATE ISSUED: 2/2/2009
Property Located at: 155 Fort Avenue UNIT# 1
Owner/Agent: Donald Moore
Address: 155 Fort Avenue
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 927-0886
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 9 there is a valid Certificate of Occupancy.
FOR THE BOARD OF HEALTH
J ET MANCINI
'TING HEALTH AGENT blt EWORCEVAENT INS CTOR
• CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH Cy(
120 WASHINGTON STREET',4"'FLOOR
TEL. (978)741-1800
KIMBERLEY DRISCOLL FAX(978)745-0343
MAYOR iSCOTr a(�sAIENi.COM
JOANNE SCOTT,
HEALTH AGENT
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION."
FEE: $50.00
PROPERTY LOCATED AT UNIT#--Z_
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER^ i1i/��77 �B�I?/_ MANAGER/AGENT, �;2✓1�7SZ
NO P.O.BOX W /QC 7 1v
ADDRESS z QLD 1,e5?li ADDRESS
CITY, STATE,ZIP- L�/f �/L 0?20 CITY, STATE,ZIP
RESIDENCEPHONE__gZ ,�/S^ Lgp3 BUSINESSPHONE(24HRS)
BUSINESS PHONE f
TOTAL NUMBER OF ROOMS: .371-1 _ /
ROOM USE: 1._�T« 2. //Z 3. I�L%' 4. ®fF��/ e
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 PAAAVABLE AT THE TIME OF INSPECTION
APPLICANT'S SIGNATURE DATE
Inspectors use only
Date on initial inspection: Z-20 °� Date of reinspection:
Date of issuance of certificate: 2=2-4� Date fee paid: 2 - ?_-,n9
Type of unit: Dwelling ✓ Other Check# y`� g Check date:
Notes:
Code Enforcement Inspector
! CITY OF SALEM, MASSACHUSETTS
30ARD OF HEA; '`i
t20 VOAS'HnNGTON STREET, 4TH F�_SOR
SALEM, MA 01970
TE!.. 9780410800
F.Ax 9780450343
STANLEY USQ?MOn JR. JOANNE SCOTT, MRH, RS, CHO
MAYOR HEALTH.AGENT ......
RELEASE
in accordance with Massachusetts General Laws Chapter i 1 1 Code of Massachusetts
Regulation; 4 •.0.000 et. seq. ; State Sanitary Code Chapter II and Article XIII of
..e.e Gi0y of Salem ordinance, undersign;& dwner(ies3dr and teaanti 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 .
i..x tlrr_ event it is necessary that said inspection .< done in my/our absence, we
expressly authorize the same and for my/our successors and assigns hereby release
and discharge the City or Salem, Salem Board or Rea_ta and i2s authorized agn7,5
from any loss or injury Sustained of hate Ver nature and description dccasioaec:
by my/our absence during said inspeccion.
TENANTAESSEE I ,, OWNERILESSOR
ADDRESS ADDRESS
ADDRESS OF 1 "d ET TO BE WSPECTED
/09
DATE �lj(t ( � -�
ot%
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEkLTH lu
120 WASHINGTON STREET,4'"FLOOR PI1b11CHeA1th
Prevent,Promote.Protect.
TEL. (978)741-1800 Fax(978) 745-0343
KIMBERLEY DRISCOLL leamdin@saleni.com
- LaltRl RdbIDIN,RS/RL'.fiS,CFtO,CP-NS
MAYOR
Ht:�.��t:Ci-t AGIiN'1'
CERTIFICATE OF FITNESS
CERTIFICATE#449-12
DATE ISSUED: 11/20/2012
Property Located at: 155 FortAvenue UNIT# 1R
Owner/Agent: Donald Moore
Address: 155 Fort Avenue
City/Town: Salem, MA Zip Code: 0197024 Hour Phone: 978-317-6970
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
LOZPY I
RAMDIN
HEALTH AGENT SANITARIAN
� • CITY OF SALFM, NV�S5ICHUSL.1"I'S
�.
BOARD OF III AI I H
120 W ASHING 7 ON s-Rhr-i,4'"FLOOR
Tr),. (978) 741-1800
KIN[13Fit2Li;;l' DR1SC;01,1, F'.1N (978) 745-0343
1ml\ym IRA,MI)IN ?e,v.r.N1.e()1M
L.;VtiliY R,\�ti)IN,WS/1(11 iS,CI IO,(T-11S
I IISAI.I I I A(;[:N'I'
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"MINIMUM STANDARDSOF FITNESS FOR HUMAN HABITATION"
FEE: $50.00
PROPERTY LOCATED ATr� UNIT#
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER
- I`7.� (�vl t= MANAGERIAGENT /3?/!� _
NO F.O. BOX �
ADDRESS lv`�yi�T /�tJ ADDRESS
CITY, STATE,ZIP sl / ,5r CITY, STATE,ZIP d19 70
RESIDENCE PHONE Y7*- 71/3'-16'f� BUSINESS PHONE(24HRS) 2�
BUSINESS PHONE
r. I'
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. 2. C/rCiy 3. e'10 4.
6. 7.7 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 ISPAYABLEAT THE TIME OF INSPECTION
APPLICANT'S SIGNATURE / JJ � DATE1
Inspectors use only
Date on initial inspection: 1 'Z d 'M 2- Date of reinspection:
Date of issuance of certificate: 21- \- Date fee paid: 0-22-A
Z2-A
Type of unit: Dwelling—I,-- Other Check#_`,3�1 S Check date: J 1
Notes:
'Vt
Code Enforcement Inspector
r' .
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4"'FLOOR P11blicHea Ith
TEL. (978)741-1800 FAx(978) 745-0343
KIMBERLEYDRISCOLL 1ramdin ,salem.com
LARRY RnMroIN,Rs/Rea-ts,C1[0,c:r-Fs
MAYOR Hi:Al;i'FI AG:GNT
CERTIFICATE OF FITNESS
CERTIFICATE#413-14
DATE ISSUED: 11/10/2014
Property Located at: 155 Fort Avenue UNIT#2
Owner/Agent: Donald Moore
Address: 155 Fort Avenue
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:
Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division3, Section
705: Certificate of fitness of rented dwelling unit, apartment or tenement. An inspection of your
vacant Dwelling/Rooming Unit at the above address has been approved and is in compliance with
105 CMR 410.000: Massachusetts State Sanitary Code, Chapter II" Minimum Standards of
Fitness for Human Habitation".
Therefore, this Certificate is issued by the Code Enforcement Division of the Salem Board of
Health and the unit may now be rented and/or occupied.
Maximum Number of occupants, must comply with 105 CMR 410.000.
Certificate valid for one year from date of issuance or until the current tenant vacates, whichever
is later.
This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy.
OR THERD O T
i 1 y� C
i
LARRY RAMDIN =�
HEALTH AGENT SANITARIAN
P
CITY OF SALEM, MASSACHUSETTS
• . BOARD OF HEALTH I
120 WASHINGTQN STREET,4°1 FLOOR
TEL. (978)741-1800
KIMBERLEY DRISCOLL FAX(978)745-0343
MAYOR LRAMDIN@S 11.I:M.COM
LARRY RAMDIN,RS/REFIS,CI 10,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 iS5fiQV' UNIT#
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK.PLEASE CIRCLE ONE
OWNER/LESSER 42/V !,// Ooo AAK MANAGER/AGENT
NO P.O. BOX
ADDRESS— iZT' /�1'� ADDRESS
CITY, STATE,ZIP _CITY, STATE,ZIP
RESIDENCE PHONE D S 7 5�.S—/ t 9 2 BUSINESS PHONE(24HRS)
BUSINESS PHONE 97S 2/7 O T
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. 2. 3. . 5.
6. 7. 8. 9. 10.
THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE IS PAYABLE AT THE TIME OF INSPECTION
APPLICANT'S SIGNATURE
IIMectors use only
Date on initial inspection: 1 6C)h 4 Date of reinspection:
Date of issuance of certificate: Date fee paid:
Type of unit: Dwelling Other Check#_Check date:
Notes:
Code kdfbrent Inspector
City of Salem, Massachusetts
Board of Health
120 Washington Street, 4th Floor, Salem, PubliCHe�1 a
0D-NQ
MA 01970 Prevent.Promote. Protect.
Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, REHS, CHO
Mayor health@salem.com Health Agent
CERTIFICATE OF FITNESS
CERTIFICATE #: GHL-16456
DATE ISSUED: 11/17/2016
Property Located at: 155 FORT AVENUE UNIT#3
Owner/Agent: Don Moore
Address: 155 Fort Avenue
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(978) 745-1893
Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division 3, Section 705: Certificate of fitness of
rented dwelling unit, apartment or tenement. An inspection of your vacant Dwelling/Rooming Unit at the above address has
been approved and is in compliance with 105 CMR 410.000: Massachusetts State Sanitary Code, Chapter II "Minimum
Standards of Fitness for Human Habitation".
Therefore, this Certificate is issued by the Code Enforcement Division of the Salem Board of Health and the unit may now
be rented and/or occupied.
Maximum Number of occupants, must comply with 105 CMR 410.000.
Certificate valid for one year from date of issuance or until the current tenant vacates,whichever is later.
This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy.
Note: This approval does not certify compliance with the state lead law for occupants under 6 years of age.
Larry Ramdin, MPH, REHS, CHO
HEALTH AGENT SANITARIAN
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET 4"'FLOOR RlblicHealtll
P Prevent.Promote.Pralevl.
TEL. (978)741-1800 FAx(978)745-0343
KIMBERLEYDRISCOLL Itamdin salem.com
MAYOR LARRY1tAh1DIN,RS/RENS,CHO,CP-FS
HEALTH AGENT
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION"
FEE: $50.00
PROPERTY LOCATED AT—Ar4^ A#417;� UNIT#
IS THIS UNIT DISIGNATEDAS RIGHT LEFT FRONT OR BACK PLEASE CHICLE ONE
OWNER/LESSER Ot0t/ A/ V 0 ,r MANAGER/AGENT
NO P.O.BOX r
ADDRE _ IA AR7 AYE ADDRESS AO Ao;m
CITY, STATE,ZIP XR- j 10* /� CITY„STATE ZIP
RESIDENCE PHONE 7D 7y�j BUSINESS PHONE(24HRS)
BUSINESS PHONES 7 V
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. KOC 2. 3. gW 4. 5.
6. 7. 8. 9. 10.
THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE IS PAY LE AT THE
/rTIME OF INSPECTION
APPLICANT'S SIGNATURE w MEDATE 1 It
Inspectors use only
Date on initial inspection: 114717 a Z6 Date of reinspection:
Date of issuance of certificate:a- /27/2e)2� Date fee paid: l
Type of unit: Lhvellin Other Check# , 7D Check date: 1
Notes: a�
C?� ement pector
CI1 Y OF SALEM, MASSACHUSETTS
BOARD OF 1-1EALTH
120 WASHINGTON STREET_41 FLOOR - pIt$
plevW.Pmmma.P'0e0.
TEL. (978) 741-1800 FAs(978) 745-0343
KIMBERLEYDRISCOLL lrarndmnsalem.com
LARRY IL\btUlN,RS/IUSIIS,CI-IO,CN-lS
Mr1YOR Iit3ALP[Lt1C,BN'P
CERTIFICATE OF FITNESS
CERTIFICATE#41-15
DATE ISSUED: 1/29/2015
Property Located at: 155 Fort Avenue UNIT#4
Owner/Agent: Donald Moore
Address: 155 FortAvenue
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-745-1893
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 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
L
LAR MDIN
HEALTH AGENT SANITARIAN
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 Cl SeU.XM.COM
LARRY RAMDIN,RS/RFHS,CMO,( P-f'S
Hi?,,m TH 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 r r K) "�` UNIT# f
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE
OWNER/LESSER 7Pe n M,Z4)- MANAGER/AGENT CX41 -
NO P.O. BOX _
ADDRESS /S S 'I rY/-- ADDRESS
CITY, STATE,ZIP CITY, STATE,ZIP
RESIDENCE PHONE 7� 71�/ l3 BUSINESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: Ci
ROOM USE: 1. 2. J 3. 4. 5.
6. 7. 8. 9. 10.
THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE ISP YABLE AT THE TIME OF INSPECTION
APPLICANT'S SIGNATURE /1AOA DATE
Inspectors use only
Date on initial inspection: (),q LI.5 Date of reinspection:
Date of issuance of certificate: Date fee paid:
Type of unit: Dwelling Other Check# Check date: o�
Notes:
Code of ement Inspector