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FOWLER STREET �ND�Ko City of Salem, Massachusetts 9 Board of Health 120 Washington Street, 4th Floor, Salem, PubliCHeStith Prevent. Promote. Protect. 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-16-142 DATE ISSUED: 5/3/2016 Property Located at: 8 FOWLER STREET UNIT#2 Owner/Agent: Jeffrey Crofts Address: 8 Fowler Street#1 City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(978)771-8865 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 0,--� Y7/kwa��/ Larry Ramdin, MPH, REHS, CHO HEALTH AGENT SANITARIAN i CITY OF SALEM, MASSACHUSETTS V BOARD OF HEALTH L���y�a�..� 120 WASHINGTON STREET,4m FLOOR P.mt. Plot TEL. (978)741-1800 FAX(978)745-0343 KIMBERLEY DRISCOLL Iramdin@salem.com ' MAYOR LARRY RA MllDJ,RS/KERS,CFRJ,CP-IS HEAL771 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--I IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT ORD PLEASE CIRCLE ONE OWNERILESSER � Cc'o 5 MANAGER/AGENT NO P.O. BOX ADDRESS 5 } 1 ADDRESS CITY, STATE,ZIP I{ t A o) 7y CTI 1', STATE,ZIP RESIDENCE PHONE USINESS PHONE(241IRS) J' BUSINESS PHONE TOT AL NUMBER OF ROOMS: /��"S ROOM USE: 1. e�Coowl 2.1>ACcF0f 1 )9; I' A4 4. "-%viA5. K'11,�en 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 AYAB AT TIME OF INSPECTION APPLICANT'S SIGNATURE DATE Y Inspectors use only Date on initial inspection: 0Y125-12-0,6 Date of reinspection: 0 Y12-V2=0-ZZ Date of issuance of certiScate:0 V4 212016 Date fee paid: O cf� �20Z( Type of unit: Dwellin Other Check# Check date: OSl2o _ i Notes: See fg cement pector �Inspecijon of a Yl Qpat�4*IeA4Date Time Name i p AddressAI. Owner_j6a CY S Tel. No. l (�—` /�—OdAS—� Type of Inspection_L>CY�'r ��CEL�P. fX .F4zllrLs Inspector ( ' ) Remarks and Violations are listed below: _ lv1 nW Wnr S rlaY1T S AO SL-&JPA t r n Of rLill �Ict t ),/ or',VJ9.4 L4 rl ILL, 1 CAA r WaKV el u" irf Re, kr � C YW llnrssrl�4 � ✓clI/S r t kL� ' 1 ' rr ,,-L4 lay In u 54 &- fnrrc" � DwnP_:� I ��0 Coll }ar pyl ?srta A� I�h W✓ ejt x,I©'orgy.s ka-yeli,g td r � Report Received by: CITY OF SALEM, MASSACHUSETTS o ; BOARD OF HEALTH 8 120 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 #510-06 DATE ISSUED: 10/23/2006 Property Located at: 9 Fowler Street UNIT# 1 Owner/Agent: Bruce Saunders Address: 57 Broad Street City/Town: Saelm, MA Zip Code: 01970 24 Hour Phone: An inspection of your vacant Dwelling/Rooming Unit at the above address has been approved and is in compliance with 105 CMR 410.000: Massachusetts State Sanitary Code, Chapter If' Minimum Standards of Fitness for Human Habitation". Therefore, this Certificate is issued by the Code Enforcement Division of the Salem Board of Health and the unit may now be rented and/or occupied. Maximum Number of occupants, must comply with 105 CMR 410.000. Certificate valid for one year from date of issuance or until the current tenant vacates, whichever is later. This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy. FOR THE BOARD OF HEALTH f J�SANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR R CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH /ID it • • 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 1_61&)Ico_ T UNIT# I IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER'3QuuEv Snvnv ,v c MANAGER/AGENT TAv„aA I ScwNQSinS No P.O. Box No P.O. Box ADDRESS S-A vS400,w Src ADDRESS CITY 'S a Lc CITY v`,ra RESIDENCE PHONE SR&360 oZt,q BUSINESS PHONE (24 HRS.) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1. K kr.h FU 2. Liv tws N 3. %o¢oo� 4_51n 1n 4c>o,.,.` 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-\'_)FL� Sc 2 ws DATE Q 3 cc-1-al, INSPECTORS USE ONLY DATE OF INITIAL INSPECTION /l' 3-t DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: %n�y &DATE FEE PAID:_ 7- 3 TYPE OF UNIT: DWELLINGI / OTHER_ CHECK# CHECK DATE NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 CITY OF SALEM, MASSACHUSETTS ASSESSING DEPARTMENT ' `• 93 WASHINGTON STREET SALEM, MA 01970 TEL. 978-745-9595 ryg FAX 978-744-2069 assessors@salem.com MAYOR DIRECTOR KIMBERLEY DRISCOLL FRANK KULIK BOARD OF ASSESSORS DONALD T. BATES RICHARD W. JAGOLTA, JR. DAMIAN JOHNSON January 24, 2007 Community Teamwork, Inc Eileen P. Healey, Director of Leased Housing 167 Dutton Street Lowell, MA 01852 Re: 9 Fowler Street Dear Ms. Healey: 9 Fowler Street, contains 2 units, unit#1 and unit 92 which covers property with address range of 5-7-9 Fowler Street and has the legal number of 9 Fowler Street Sincerely, Deborah A. Jackson Assistant Director of Assessing i F I CERT.# 294-97 n FEE $25.00 DATE: 0 05/12/5/12/ X11' . IfF^ 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: 9 Fowler Street UNIT #: 2 OWNER/AGENT: John E. Kelleher ADDRESS: 9 Fowler 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 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 Y 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 4 10:000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". UNIT / PROPERTY LOCATED AT a OWNS /LESSER �' eG71 erer MANAGER/AGENT ADDRESS ADDRESS CITY CITY _ RESIDENCE PHONE BUSINESS PHONE (24 HRS.) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1 . e, T 2. 7�e 3. G ,e 4 . a-L)� 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 SIGNATURE­r DATE _— INSPECTORS USE ONLY DATE OF INITIAL INSPECTION: / a DATE OF REINSPECTION _ DATE OF ISSUANCE OF CERT"I,FICATE:—� . / -L, �ij DATE FEE PAID: G ✓� Z TYPE OFF UNIT: DWELLINOTHER NOTES CODE ENFORCEMENT INSPECTOR ti ✓r e �ONDIT CERT.# 588-00 FEE $25.00 a DATE: 09/13/2000 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 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 11 Fowler Street UNIT #: 1 OWNER/AGENT: Henry Kantorosinski ADDRESS: 11 Fowler Street CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-8173 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 IT, "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 O,F HEALTH S JOANNE SCOTT, MPH, RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT APPLICATION FOR CERTIFICATE OF FITNESS Tet:(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 I _ } (.t/ l �Z � TI _UNIT#_Z IS THIS UNIT DESIGNATED AS RIGHT F FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER ii�NAGER/AGENT_C � No P.O. Box o P.O. Box ADDRESS w ADDRESS CITY C) CITY RESIDENCE PHONE b BUSINESS PHONE (24 HRS.) BUSINESS PHONE OD '7� � 37/ TOTAL NUMBER OF ROOMS: ROOM USE: 1, LR 2."_3.i& 4.� 5._[_6. _7.-8.- THERE . 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 SIG(NAAT�TUppR DAT �? O S US q-('Wl DATE OF INITIAL INSPECTION �I 0 DATE OF REINSPECTION / DATE OF ISSUANCE OF CERTIFI ATE: -0 DATE FEE PAID: ( _.0 7D TYPE OF UNIT: DWELLING OTHER__ CHECK#CHECK DATE—� NOTES: CODE ENFORCEMENT INSPECTOR � NJll�l,E 9/28198 SET U SLP i 3 2000 HI ALOTHDEPT. p N CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH, RS,CHO NINE NORTH STREET HEALTH AGENT 12/16/99 Tel:(978)741-1800 Fax:(978)740-9705 Henry Kantorosinski 11 Fowler Street Salem, MA 01970 PROPERTY LOCATED AT 11 Fowler 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 c in accordance with the State Sanitary Code, Chapter II: Minimum Standards of Fitness for Human Habitation. Please notify us if you do not intend to rent the unit. Please contact this department within One Week of receipt of this notice at 978-741-1800, to schedule an appointment for an inspection. Our office hours are Monday thru Wednesday from 8:00 a.m. - 4:00 p.m. Thursday 8:00 a.m. - 7:00 p.m. and Friday 8:00 a.m.- 4:00 p.m. A $25.00 check payable to the City of Salem is required for each unit inspected at the time of inspection. A property owner is required to pay gas and electricity for residential tenants if there is not a written letting agreement stating the tenant is responsible for those utilities and if the meter(s) records electricity and gas use which is not used exclusively by that tenant. The Department of Public Utilities has billed property owners for their tenants' entire utility bills retroactive to the date of initial occupancy in cases in which cross-metering has been proven eo exist. FOR THE BOARD OF HEALTH REPLY TO , JoanneScott, HO PABLO VALDEZ HEALTH AGENT CODE ENFORCEMENT INSPECTOR I To ❑ AM Date SLLSLLJ3ime ❑ PM WHI E YOU ERE OUT M of Phone U Area Code her Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU JURGENT RETJJRNED YOUR CALL Message Operator AMPAD REORDER ®EFFICIENCY® sza-aoo Iry� 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: 03/08/96 Fax:(508)740-9705 Henry Kantorosinski 11 Fowler Street Salem, MA 01970 PROPERTY LOCATED AT 11 Fowler 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. It is incumbent upon you as owner(s) to contact the City of Salem Health Department to apply for a CERTIFICATE OF FITNESS before any vacant dwelling unit is rented or occupied, or to notify us of your intent for this unit. Each dwelling unit must be inspected and certified by the Salem Health Department prior to allowing occupancy in accordance with Chapter 111, Sections 127A and 127B, of the Massachusetts General Laws, 105 CMR 400 .00; State Sanitary Code, Chapter 1 : General Administrative Procedures and 105 CMR 410 .000; State Sanitary Code, Chapter 11 : Minimum Standards of Fitness for Human Habitation, and in accordance with Chapter 11, Article XIII of the City of Salem Code of Ordiances, Section 2-334, Certificate of Fitness. There is a twenty-five (25) dollar fee payable by check, or money order to the City of Salem Health Department. This fee is payable at the time of inspection- Inspection will not be performed without receipt of payment. Failure to comply with this procedure, will result in a fine of twenty (20) dollars per day for every day that the dwelling unit is occupied without approval of the Code Enforcement Division of the Salem Health Department. Contact this department within 24 hours of receipt of this notice- (508) 741-1800 Monday thru Wednesday from 8:00 a.m. - 4:00 p.m. Thursday 8:00 a.m. - 7 :00 p.m. or Friday 8:00 a.m. to noon to schedule an appointment for an inspection. SEE ENCLOSED SECTION 105 CMR 410.354 METERING OF GAS & ELECTRICITY Very truly yours, FOR THE BOARD OF HEALTH REPLY TO I �AA_X " Joanne Scott, MPH,RS,CHO PABLO VALDEZ HEALTH AGENT CODE ENFORCEMENT INSPECTOR • �, '� 4. CERT.# 790-97 FEE $25.00 DATE: 12/01/97 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Fax:(978)740-9705 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 11 1/2 Fowler Street UNIT #: 1 OWNER/AGENT: Russell T. Eckel- Jr. & Jennifer Costain ADDRESS: 1 South Shore Avenue CITY/TOWN: Peabody. MA ZIP CODE: 01960 24 HOUR PHONE: 532-8648 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 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 f� /j v1 !uLiu r UNIT # OWNER/LESSER2LjSSf,(L Ec(CCI MANAGER/AGENT ADDRESS / U�71�ILdi st/ _ ADDRESS CITY aCO / /y CITY RESIDEKCE PHONE .5%;k<• �(r '{ BUSINESS PHONE (24 HRS.) BUSINESS PHONE ,�:j,�- 597 -— TOTAL NUMBER OF ROOMS: (o 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 APPLICANTS SIGNATURE `I(tdt?�I.� 1 .— DATE I o`Z INSPECTORS USE ONLY — DATE OF INITIAL INSPECTION: ( — DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: ) ,2'— j �j -7 DATE FEE PAID: TYPE OF UNIT: DWELLING OTHER" NOTES : CODE ENFORCEMENT INSPECTOR 4 _ % CITY OF SALEM BOARD OF HEALTH Salem, Massachuseks 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 ! Il ; Code of Massachusetts Regulations 410.000 et. seq. ; State Sanitary Code Chapter II and Article XIII of the Citv of. Salem Ordinance, undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health or its author- ized agents to inspect the residence identified below in accordance with the aforementioned statutes, regulations and ordinances. In the event it is necessary that said inspection be done in my/our absence, !/we expressly authorize the same and for my/our successors and assigns hereby release and 'discharge the City of Salem, Salem Board of Health and its authorized agents from any loss4or injurysustained of whatever nature, and descziption'occasioued . by my/our- absence during said inspection: TEPIAN LESSE'r, OWNER LESSOR / ADDRESS ADDRESS ADDRESS OF UNIT TO BE INSPECTED DAiE 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: 11/13/97 Fax:(508)740-9705 Russell T. Eckel, Jr. & Jennifer Costain 16 Grafton Street Salem, MA 01970 PROPERTY LOCATED AT 11 1/2 Fowler 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. It is incumbent upon you as owner(s) to contact the City of Salem Health Department to apply for a CERTIFICATE OF FITNESS before any vacant dwelling unit is rented or occupied, or to notify us of your intent for this unit. Each dwelling unit must be inspected and certified by the Salem Health Department prior to allowing occupancy in accordance with Chapter 111, Sections 127A and 127B, of the Massachusetts General Laws, 105 CMR 400.00; State Sanitary Code, Chapter 1: General Administrative Procedures and 105 CMR 410.000; State Sanitary Code, Chapter 11: Minimum Standards of Fitness for Human Habitation, and in accordance with Chapter 11, Article XIII of the City of Salem Code of Ordiances, Section 2-334, Certificate of Fitness. There is a twenty-five (25) dollar fee payable by check, or money order to the City of Salem Health Department. This fee is payable at the time of inspection. Inspection will not be performed without receipt of payment. "Failure to comply with this procedure, will result in a fine of twenty (20) dollars per day for every day that the dwelling unit is occupied without approval of the Code Enforcement Division of the Salem Health Department. 'Contact this department within 24 hours of receipt of this notice. (508) 741-1800 Monday thru Wednesday from 8:00 a.m. - 4:00 p.m. Thursday 8:00 a.m. - 7 :00 p.m. or Friday 8:00 a.m. to noon to schedule an appointment for. an inspection. SEE ENCLOSED SECTION 105 CMR 410.354 METERING OF GAS & ELECTRICITY. Very truly yours, FOR THE BOARD OF -HEALTH REPLY TO b Joanne Scott, MPH,RS,CHO PABLO VALDEZ HEALTH AGENT CODE ENFORCEMENT INSPECTOR IMPORTANT MESSAGE DATE �`s� (o _q �(p�,�� ,TIM E PHONE AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESS q E SIGNED MOPS. MADE IN U S �1jiF CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Date: 04/30/98 Fax:(978)740-9705 Mary Lynch c/o Mary Freeman 12 Fowler Street Salem, MA 01970 PROPERTY LOCATED AT 12 Fowler 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. 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 t of Salem Health Department. This fee is payable at the time of inspection. Inspection will not be performed without receipt of payment. Failure to comply with this procedure, will result in a fine of twenty (20) dollars per day for every day that the dwelling unit is occupied without approval of the Code Enforcement Division of the Salem Health Department . Contact this department within 24 hours of receipt of this notice. (508) 741-1800 Monday thru Wednesday from 8:00 a.m. - 4 :00 p.m. Thursday 8:00 a.m. - 7 :00 p.m. or Friday 8:00 a.m. to noon to schedule an appointment for an inspection. SEE ENCLOSED SECTION 105 CMR 410 .354 METERING OF GAS & ELECTRICITY Very truly yours, FOR THE BOARD OF HEALTH REPLY TO Joanne Scott, MPH,RS,CHO PABLO VALDEZ HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS m ; BOARD OF HEALTH s 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 STANLEY J. USOVICZ, JR. FAx 978-745-0343 MAYOR W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 10/18/05 Naoma Homan 14 Fowler Street Salem, MA 01970 PROPERTY LOCATED AT 14 Fowler Street Unit 1 st floor Dear Sir/Madam: It has come to our attention, that you may be considering renting a dwelling unit at the above address. In accordance with Chapter 11,Article XIII of the City of Salem Code of Ordinances, Section 2- 334, titled "Certificate of Fitness," each dwelling unit must be inspected and certified prior to allowing occupancy. The inspection will be conducted in accordance with 105 CMR 410.000; State Sanitary Code, Chapter 11: Minimum Standards of Fitness for Human Habitation. Please notify us if you do not intend to rent the unit. Please contact this department within 24 hours of receipt of this notice at 978-741-1800, to schedule an appointment for an inspection. Our office hours are Monday thru Wednesday from 8:00 a.m. —4:00 p.m. Thursday 8:00 a.m. to 7:00 p.m. and Friday 8:00 a.m. — 12:00 p.m. Failure to comply with this procedure, may result in a fine of Twenty($20.00) dollars per day for every day that the dwelling unit is occupied without a Certificate of fitness. A$25.00 check payable to the City of Salem is required for each unit inspected at the time of inspection. A property owner is required to pay gas and electricity for residential tenants if there is not a written letting agreement stating the tenant is responsible for those utilities and if the meter(s) records electricity and gas use which is not used exclusively by that tenant. The Department of Public Utilities has billed property owners for their tenant's entire utility bills retroactive to the date of initial occupancy in cases in which cross-metering has been proven to exist. For the Board of Health Reply to .lL �anne=cottPH, RS, CHO Pablo Valdez Health Agent Code Enforcement Inspector V CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR o' SALEM, MA 01 970 TEL. 978-741-1800 Fax 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 12/23/04 Naoma Homan 14 Fowler Street Salem, MA 01970 PROPERTY LOCATED AT 14 Fowler Street Unit 1 st floor Dear Sir/Madam: It has come to our attention, that you may be considering renting a dwelling unit at the above address. In accordance with Chapter 11,Article XIII of the City of Salem Code of Ordinances, Section 2- 334,titled "Certificate of Fitness," each dwelling unit must be inspected and certified prior to allowing occupancy. The inspection will be conducted in accordance with 105 CMR 410.000; State Sanitary Code, Chapter 11: Minimum Standards of Fitness for Human Habitation. Please notify us if you do not intend to rent the unit. Please contact this department within 24 hours of receipt of this notice at 978-741-1800, to schedule an appointment for an inspection. Our office hours are Monday thru Wednesday from 8:00 a.m.—4:00 p.m. Thursday 8:00 a.m. to 7:00 p.m. and Friday 8:00 a.m.— 12:00 p.m. Failure to comply with this procedure, may result in a fine of Twenty($20.00) dollars per day for every day that the dwelling unit is occupied without a Certificate of fitness. A$25.00 check payable to the City of Salem is required for each unit inspected at the time of inspection. A property owner is required to pay gas and electricity for residential tenants if there is not a written letting agreement stating the tenant is responsible for those utilities and if the meter(s) records electricity and gas use which is not used exclusively by that tenant. The Department of Public Utilities has billed property owners for their tenant's entire utility bills retroactive to the date of initial occupancy in cases in which cross-metering has been proven to exist. For,the Board of Health Reply to Ji nne Scott MPH, RS, CHO Pablo Valdez Health Agent Code Enforcement Inspector s 4%, Yj' i N T CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 10/15/99 Fax:(978)740-9705 Service Realty Trust C/o Scott Thibodeau 146 Bridge Street Salem, MA 01970 PROPERTY LOCATED AT 14 Fowler 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; 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. iTHE BOARD OF HEALTH REPLY TO e Scot , MPH,RS,CHO PABLO VALDEZ alth Agent CODE ENFORCEMENT INSPECTOR t 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 CERTIFICATE OF FITNESS CERTIFICATE#240-06 DATE ISSUED: 5/12/06 Property Located at: 19 Fowler Street UNIT#3 Owner/Agent: Charles L. Bean Address: 19 Fowler Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 508-397-5988 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. FOFj,THE BOARD OF HEALTH JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR ..., y. . ,. -�,., .. �_ •-`CR'YOFSAt�; CtttlSE't't5 - _ BWgRo of H e 220 WASHINGTON SA 010WALT, FLOOR FoR //tt �`/✓LXX(".—+ SAI.EN, NA 01970 TEX-979.741-1800 FAX 978-7A5.0343 STANIQY USOVICZ.JR. JOANNE SCOTT, MPH. RS. CHO MAYOR HEALTH AGENT APPLICATION FOR CERTIFICATE OF FITNESS IN ACCORDANCE WITH STATE SANITARY CODE,CHAPTER It. 105 CMR 410.000 'MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION-. PROPERTY LOCATED AT . Y &6 Z !�T UNIT a IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER— �MANAGERIAGENT_ _ No P.O. Box No P.O. Box ADDRESS"'?�— � ADDRESS_ CITY�� CITY —F- Sa&-- '3q 7- v12;2S RESIDENCE PHONE '7y1SBUSINESS PHONE (?_4 HRS.} BUSINESS PHONE TOTAL NUMBER OF ROOMS � �/�� f ROOM USE: 2-_��A/3. _jJE- 4 ___i-✓+!p 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 Al- THE TIME OF INSPECTION- J APPLICANTS SIGNATURE I� 'i DA'TI_ I INS!_E-CIOR -USE,ONLY DATE OF INITIAL INSPECTION ` 1 ( DAl F 01- W-INSPi-CI10N C)ATEfJf� VSSUANCi ilii-l}i {^l TYt>f. OI UN1l DArvi l.1-iNt C I 1111"R l:i i; CI< Pp'D i s 11 t K PA I I PN)II S ' :<}iri i kiIliit .V Mi NI IN 11'1 , I111 . ,. I � 7/AA �. CD2 �C�.�r�'bi✓ i 4N o i �t�sa s 1 CITY OF SALEM, MASSACHUSETTS BOARD OF I IEALTH - . .-_ - --- - - - 120 WASHING`T'ON STREET,4�u-FL(-)OR PIlb11CHP.81th f Pra'rnt Prom,.Protto, TEL. (978) 741-1800 FAX(978) 745-0343 KIMBERLEY DRISCOLL Itamdin@salem.com L\RR]'IL\bID[N,RS/RI7.1-IS,CIiO,CP-ISS MAYOR I hi\LTH AC I?NP CERTIFICATE OF FITNESS CERTIFICATE#71-15 DATE ISSUED: 3/19/2015 Property Located at: 20 Fowler Street UNIT# Owner/Agent: Avalito D. Garcia/Dynamtic Realty Management Address: 203 Washington Street#316 City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 781-715-1488 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 LAAORAMDIN HEALTH AGENT SANITARIAN a i CITY OF SALEM, MASSACHUSETTS 120 WASHINGTON STREET,4"'FLOOR / TEL.(978)741-1800 K.IMBERLEY DRISCOLL FAX(978) 745-0343 r1 l ✓ . MAYOR 1,RA7-V1o1N& 1EMCOM LARRY RAMI)IN,RS/RFIRS,CHO,CP-FS HEAL;I•F1 A(;EN•r 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 ' �< t - 9 . UNIT# "/)j_ IS THIS UNIT DISIGNATED AS RIGHT LEff FRONT OR BACK,PLEASE CIRCLE ONE I OWNER/LESSER � { G)- J AG AGENT) X ��� NO P.O.BOX p/.nc ry 4•, .ADDRESS =!J Dt, ADDRESS CITY, STATE,ZIP b✓h M IQ Oi Q?L CI'T'Y, STATE,ZIP RESIDENCE PHONE BUSINESS PHONE(24HRS) 7�1 --m BUSINESS PHONE 2 I . 7!_S r L/S `! TOTAL NUMBER OF ROOMS: J 7 ROOM USE: 1 BE 2 �K 3. 6K 4. L—r, 5. b. 7. 8. 9. M 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 fF DATE61/ Inspectors use only Date on initial inspection: 'J�l� �!� Date of reinspection: Date of issuance of certificate: Date fee paid: Type of unit: Dwelling Other Check#_Jz—$3—Check date: Notes: Co eraent Inspector drpNDl ,t City of Salem, Massachusetts I_\_,(''l('/—I 6 LJ a Board of Health 120 Washington Street, 4th Floor, Salem, PublicHeAIth Prevent. Promote. Protect. 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-15-252 DATE ISSUED: 8/28/2015 Property Located at: 24 FOWLER STREET UNIT#1 Owner/Agent: John Kozlowski Address: �I2,*Locust Street City/Town: Danvers, MA Zip Code: 01923 24 Hour Phone:(978)774-8477 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 SANIT IAN - R CITY OF SALEM, MASSACHUSETTS • • BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR LRAMDIN@SALFM.COM LARRY RAMDI N,RS/RF1 IS,CJ R),C114S He:ALTH A(;FN'r 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,04 CtJ/ �J UNIT#__�_ IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CHICLE ONE OWNER/LESSER2 /5 JCI�ZGdGJ � MANAGER/AGENT NO P.O.BOX �7 ADDRESSrx�� L ��S l ST ADDRESS CITY, STATE, CITY, STATE,ZIP d 2 RESIDENCE PHONE BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: _ '�1� ROOM USE: 1. Z1 2. ,/� �/� 3. `�' 4. co 5. 6. 7. 8. 9. 10. THERE IS A FIFTY($50)DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE IS PAY T TH TIME SECTION APPLICANT'S SIGNATURE DATE dors use onl Date on initial inspection: bQ/2L,apir Date of reinspection: Date of issuance of certificate: 26 S Date fee paid: Type of unit: Dwelling OtherCheck II# RIIo 7 _D Check date: 02/Z S— Notes: CO-C6h Mono� j ja ehc+or^ ne3 _$ Co nfoy ement Insp for n CITY OF SALEM, MASSACHUSETTS BOARD OF HF-�LTH 120 WASHINGTON STREET 4"l FLOOR PtibilCHC8t�1 STREET, Prevent,Promote.Protect. TEL. (978) 741-1800 FAx(978)745-0343 KIMBERLEY DRISCOLL kamdin salem.com MAYORLARRY RAMDIN,RS/til".I{S,CHQ,CP-PS HI3Al:rFI AGC:N'I' CERTIFICATE OF FITNESS CERTIFICATE#67-13 DATE ISSUED: 2/13/2013 Property Located at: 24 Fowler Street UNIT#2 Owner/Agent: John &Donna Kozlowski Address: 213 Locust Street City/Town: Danvers, MA Zip Code: 01923 24 Hour Phone: 774-8477 ---- ._.. -- -- — .. --- - - - Pursuant to the requirements- -- - of City of-Salem- ordinance--- -- - C-hapter------ A 2 rti-cle-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 If' Minimum Standards of Fitness for Human Habitation". Therefore, this Certificate is issued by the Code Enforcement Division of the Salem Board of Health and the unit may now be rented and/or occupied. Maximum Number of occupants, must comply with 105 CMR 410.000. Certificate valid for one year from date of issuance or until the current tenant vacates, whichever is later. This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy. ^ FOR THE B ARD 0 EALTH II� LARRY RAMDIN �A/"✓ HEALTH AGENT SANITARIAN q � CITY OF SALEM, MASSACHUSETTS BwRD OF HFALTH 120 WASHINGTON STREET 4`"FLOOR PubhcHealth P e V`revuni.Promote PIM111. TEL. (978) 741-1800 FAX (978) 745-0343 KIMBERLEY DRISCOLL Iramdin@salem.com _ LARRY RA\iURti IN, /RP;hC iS, HO,CP-FS MAYOR - Hi.;;lrar-f AG'FN'r Application for Certificate of Fitness IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" 2 FEE: $50.00 PROPERTY LOCATED AT a2j_ UNIT#-,Z_ IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE OWNER/LESSER J K Z Lo LJ n,, f MANAGER/AGENT NO P.O. BOX ADDRESS a/3 L_ocos i S 1 ADDRESS CITY, STATE,ZIP /t'J.I)• 0/92� CITY, STATE,Z1P RESIDENCE PHONE 72L27T �¢77 BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS:__ / ROOM USE: 1_ k/ ( 2. �/� 3. f3�R 4. J3 Je— 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 ATIME OF INSPECTION APPLICANT'S SIGNATURE DATE 2 Inspectors use only Date on initial inspection: 2—I`Z�I'� Date of reinspection: Date of issuance of certificate: 2_I 1-13 Date fee paid: Z-I'S-)3 Type of unit: Dwelling_kef:!:!�Other Check# S-10 Check date: 2--)Z-1-1 Notes: rl,AJt ode Enforcement Inspector