FRANKLIN STREET FRANKLIN STREET
CITY OF SALEM, MASSACHUSETTS V
BOARD OF HEALTH
120 WASHINGTON STREET 4""FLOOR P111111CI�P.81th
e rrc.mn,rromo,e.woior,.
TEL. (978) 741-1800 FAx(978) 745-0343
KIMBERLEY DRISCOLL k-amdin@salei-n.com
MAYOR LARRY RAb 1N,RS/REHS,C�IO ,('P-
HI:iAL rH 11GENT
CERTIFICATE OF FITNESS
CERTIFICATE#206-13
DATE ISSUED: 6/20/2013
Property Located at: 33 Franklin Street UNIT# Duplex
Owner/Agent: Judith &Larry Giunta
Address: 35 Franklin Street
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 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 OE HEALTH
LARRY RAMDIN
HEALTH AGENT
CITY OF SALEM MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4"'FLOOR PubUc ealt11
e.
TEL. (978)741-1800 FAx(978)745-0343
KIMBERLEY DRISCOLL Iramdin@salem.com
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 3 3 t�rci n K f h S F '�� p le)C UNIT#
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR RACY,PLEASE CIRCLE ONE
OWNEWLESSER AGENT
NO P.O.BOX
ADDRESS 3S Fri tcl-,,, Sf ADDRESS
CITY,STATE,ZIP S4le,x, WAL 61776 CITY, STATE,ZIP
RESIDENCE PHONE 178- 7W 76,.3 BUSINESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: -5
ROOM USE: 1. Ki hAe.v 2. /,-v, /t vn 3. gzd rw 4 lard r,,, 5 eeJAM
6. 7. 8. 9. 10
THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE IS PAYABLE AT THE TIME OF INSPECTION
APPLICANT'S SIGNATURE DATE
Inspectors use only
Date on initial inspection: l!!(� i '7 Date of reinspection:
Date of issuance of certificate: Date fee paid:
Type of unit: Dwelling Other Check#_C AAmck date:
Notes:
Code rc ent Inspector
CITY OF SALEM, MASSACHUSETTS
IV
BOARD OF HF A,LTH
120 WASHINGTON STREFT,4'"FLOOR �bliCm",� t
TEL. (978) 741-1800 FAx(978) 745-0343
KIMBERLEY DRISCOLL 1ramdin ,salem.com
Li\ART RAiv[llIN,RS/APRs,CFR),CY-FS
MAYOR HE%A] ['I-I AG ENI'
CERTIFICATE OF FITNESS
CERTIFICATE#304-14
DATE ISSUED: 9/15/2014
Property Located at: 37 Franklin Street UNIT#House
Owner/Agent: Deborah Guinee
Address: 14 Wauketa Road
City/Town: Gloucester, MA Zip Code: 01930 24 Hour Phone: 508-328-0153
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
HEA G NT SANITARIAN
CITY OF SALEM, MASSACHUSETTS 3V�
BOARD OF HEALTH Pub1iC,HCalth 7
120 WASHINGTON STREET,4 'FLOOR P..w.Pmmam.Protea.
TEL. (978)741-1800 FAX(978)745-0343
KIMBERLEY DRISCOLL lramdin@salem.com
MAYOR LAIt1tY ItAM1DIN,RS/RE}IS,CHO,(:I'-PS -
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—3 h 0F✓1 7 f 5o&l.evrt it UNIT#
IS THIS UNIT D SiGNATF.D As RIGHT LEFT FRONT OR_A�__.PLEASE CIRCLE.ONE _
OWNER/LESSER f U► A-t_. MANAGER/AGENT
NO P.O.BOX (-
ADDRESS Kk ADDRESS
CITY, STATE,ZIPC-[�LLD,^Ucm- AC r— ITIt c&kV CITY, STATE,ZIP
RESIDENCE PHONE3Z€O I,0"5 BUSINESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: k
ROOM USE: 1 kikt,Licm 2 i&6rnon»3j3LX 4 5
6. Lwin% � 7..Uroom►I 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 n
APPLICANT'S SIGNATURE DATE
ectors use onl
Date on initial inspection: S 1 Date of reinspection:
Date of issuance of certificate: Date fee paid: {
Type of unit: Dwelling Other Check# Check date: R I I O
Notes:
Code ement Inspector
CITY OF SALEM, MASSACHUSETTS
BOARD OF HF- LTH
120 WASHINGTON STREET,4`°FLOOR ��1XiC�CA 1�
i Present.Pmm",e.Cmle'
TEL. (978)741-1800 FAx(978)745-0343
KIMBERLFY DRISCOLL Iramdin e salem.com
LARRY RAMDIN,RS/REI-IS,C1 10,Cl-4C
MAYOR HEAI.:ni AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#303-14
DATE ISSUED: 9/1512014
Property Located at: 39 Franklin Street UNIT#
Owner/Agent: Deborah Guinea
Address: 14 Wauketa Road
City/Town: Gloucester, MA Zip Code: 01930 24 Hour Phone: 508-328-0147
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 Cade, Chapter II"Minimum Standards of
Fitness for Human Habitation".
Therefore,this Certificate is issued by the Code Enforcement Division of the Salem Board of
Health and the unit may now be rented and/or occupied.
Maximum Number of occupants, must comply with 105 CMR 410.000.
Certificate valid for one year from date of issuance or until the current tenant vacates, whichever
is later.
This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy.
FOR THE B ARD OSotiEALTH
LARRY RAMDIN
HEALTH AGENT SANITARIAN
CITY OF SALEM, MASSACHUSETTS 03.�
BOARD OF HEALTH PubliCHealtll
120 WASHINGTON STREET,47'FLOOR Pre ent.Promote.Protect.
TEL. (978).741-1800 FAx(978)745-0343
KIMBERLEY DRISCOLL lramdin a salem.com
MAYOR � - LARRY'RATviDIN,RS/RL',IIS,CFIO,CP-1.5 -
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 �A�CLIM (I n t' (� , / " ` UNIT#
IS THIS UNITDIISIGNATED AS RIGHT LEFF FRONT OR BACK PLEASE CIRCLE ONE
OWNERILESSER� /
YUJf\ l•Tt IVtAL- —MANAGER/AGENT
NO P.O.BOX
ADDRESS�j4 -ADDRESS
CITY, STATE,ZIP Gitr'k uet)4{.rT� h Q to CITY, STATE,ZIP
RESIDENCE PHONE 5OX 32S d 53 BUSINESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:-4 +Ttv 1�
ROOM USE: 1 /,t4r ux 2 3&Arao'a. 3 -6agraavw 4_ 5i ' 5 L% Wte�!'mm
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 SIGNATII4���� a - DATEq- is. 1
Insnectors use only
Date on initial inspection: Q f iL4 Date of reinspection:
Date of issuance of certificate: Date fee paid:
Type of unit: Dwelling—Other—Check#Check date: qI L
Notes:
Codea( ement Inspector
c l
CITY OF SALEM, MASSACHUSETTS
3 BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#48-05
DATE ISSUED: 1/20/05
Property Located at: 45 Franklin Street UNIT# 1
Owner/Agent: Marshall Strauss
Address: 10 Chestnut Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 594-5067
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 H�i�D OF HEALTH
.i� � C
JOANNE SCOTT, MPH, RS, CHO r
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
t '
CITY OF SALEM, MASSACHUSETTS
BOARp OF HEALTH
• 120 WASHINGTON STREET. 4TH FLOOR
SALEM. MA 01970
TEL. 978-741-1800
FAX 978-745-0343 -
STANLEY USOVICZ. JR. JOANNE SCOTT, MPH. RS, CHO
MAYOR HEALTH AGENT
APPLICATION FOR CERTIFICATE OF FITNESS
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
'MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION"
PROPERTY LOCATED AT ._UNIT n ?
IS THIS UNIT DESIGNATED AS RIGHT, LEFT FRONT RACK PLEASE CIRCLE ONE
OWNEWLESSER_A11-5)A1t �NWSf —
MANAGER/AGENT-No P.O. Box No P.O. Box
ADDRESS__/o
�d fin e — ADDRESS
CITY �,A / _CITY„
RESIDENCE PHONE f?TSfySp6 7_BUSINESS PHONE (24
BUSINESS PHONE S C{
TOTAL NUMBER OF ROOMS
ROOM USE; 1 2 _3 _ Ula` 4 _L�J�
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, q j
APPLICANTS SIGNATURE - .- .Lia- ^�-- - DATF
INSPECTORS USE ONLY
_ v
r
DATE OF INITIAL INSPECTION 1' t DAT E OF REINSPECT"101\1
DAH 0I 15;Ul,7�C ( O4 CEIiiIFK;AT4-� t (?Ali_ 11a-- i'AO f v
TYPE OP UN11 DWLI_L1N11 OTHER (-,I fl- 47 1) �� CIiGCK 1IAIJ
N')II
I(jt,Pi i,lOII
CITY OF SALEM; MASSACHUSETTS 1P
BOARD OF HEALTH
120 WASHINGTON STREET 4`FLOOR PI3b11CH881th
o Prevent.P,...1e.Protect.
TEL. (978) 741-1800 Fax(978) 745-0343
KIMBERLEYDRISCOLL Itamdin@salem.com
LARRY RAiXIDIN,RS/RFI-IS,CIiO,CP-I--S
MAYOR HEAL-:PH AG 13N,r
CERTIFICATE OF FITNESS
CERTIFICATE#348-13
DATE ISSUED: 9/25/2013
Property Located at: 47 Franklin Street UNIT#
Owner/Agent: Marshall Strauss
Address: 10 Chestnut Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 594-5067
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
L*ZftY RAMDIN
HEALTH AGENT SANITARIAN
CITY OF, SALEM, NtksSACHUSETTS
BOARD oi- HEALTIT
120 W\SHINGrON STRE.El,4 FLOOR
11I... (9 i 8) '41-1800
, IUD
KTMBFRLF YDRISCION, 1 1 (978) 745-0343
MAYOR
LAIM'y RvMDIN,RS/Md IS,C1 10,(,P-FS
tAk,(V
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 q� r6ao L(_\j r\ 54 Sn�,rA M R - 019 )b UNIT4
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNERJLESSER"O,rS� I S+(_CWOS MANAGER/AGENT/Jn(L L
NO P.O. BOX
ADDRESS JQO,he 5+y)u- - 5+ ADDRESS
(:�iD
CITY, STATE,ZIP Alefn Mff.()19�70 —CITY, STATE, ZIP M14. OtM_
979- y- 5-DG-7
RESIDENCE PHONE BUSINESS PHONE (24HRS) q -2 ---%(Dq - 1 �Ll 9
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:— (V
ROOMUSE:
6. au VerAy-,7. 8. 9. 10.
L
THERE IS A FIFTY ($50) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE ISP BLE AT TH�fm
"PECTION
APPLICANT'S SIGNATURV -,I��AVZ//-41/0*'9T/t,4/i9 DATE 9- 43
Inspectors use only
Date on initial inspection: 13 Date of reinspection:
Date of issuance of certificate: Date fee paid:
Type ofunit: Dwelling—Other—Check# iwCheck date: g1 �ti11
Notes:
Code tnv1,nWeEel_t Inspector
CITY 01, SALEM, NIASSAC.t-fLJSE'TTS
BOARD OF FIB.aI:fH
120($/15I fIN GPON S'f REET,4" F`1.UO$
T7a.. (978) 741-1800
KIMBOU.IX DRISCOLL F,1X(978) 745-0343
MAYOR lracndin t,)salem com
I_AKRY RAMMI-A N,RS/IW I IS,CI I(1,CP-IS
111;AJ XI I A(1 P.N'1'
Facsimile
Transmittal
To.
Fax # � /
RE: (�) annG
Date
Page(s): including this cover#
Message:
Board of Health News ----------- ___��_�_�________�____M_:For Your Information
OFFICE HOUR'S:
Monday, Tuesday, Wednesday 8:00 AM to 4:00 PM
Thursday. 8:00 AM to 7:00 PM
Friday 8:00 AM to 12:00 NOON
TRANSMISSION VERIFICATION REPORT
TIME 10/03/2013 03: 23
NAME
FAX 9767450343
TEL 9767411800
SER.# 000BON341991
DATEJIME 10/03 03: 22
FAX NO. /NAME 919707449614
DURATION 00:00:30
PAGE(S) 02
RESULT OK
MODE STANDARD
ECM
r CITY OF SALEM, MASSACHUSETTS lu
BOARD OF HEALTH
120 WASHINGTON STREET,4" ml
.FLOOR PublicHeA0l
Prt•ent I'ramom.Pc0ct.
TEL. (978)741-1800 FAX(978) 745-0343
KIMBERLEY DRISCOLL Itamdin&salem.com
MAYOR LARRY RAE
IN,RS�RHS,Clio,CP-FS
HF,\j;n I AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#298-14
DATE ISSUED: 9/4/2014
Property Located at: 49 Franklin Street UNIT#
Owner/Agent: Chalifour Family LP/Mary Woodcock
Address: 20 Belleview Ave
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 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
AWKA
I-A RAMDIN
HEALTH AGENT SANITARIAN
` (11T'Y OF SAI..EM, �VIASSACHUSE, I"
a. B():\tu,>{ vHtsrtL"rid
121')WAST f1N{Yi"{}NSTRLFr 4`11.001t
]G1 BERLEI" DRISCt7]'.J_ C'Ia.. (978)741-1800
MAY,-* F,vx (978)745-0343
diaCalsalc)n eam
LA It RY KAMIAN,ttSf-RIMS,t:1ft7,(:J°+S .
HI:nl:ri i ,\cr,�r
Faasimile
Transmittal
To:
RE:
Date :
Page(s): including this cover#
Message:_
Board of Health NewsYour Information
OFFICE HOUR!5:
Monday, Tuesday, Wednet&y 8:00 AM to 4:00 PM
Thursday 8:00 AM to 7:00 PM
Friday 8:00 AM to 12:00 NOON
TRANSMISSION VERIFICATION REPORT
TIME : 09/22/2014 20: 50
NAME :
FAX : 9787450343
TEL : 9787411800
SER. # : 000BON341991
DATEJIME 09122 20: 50
FAX NO. /NAME 919789212121
PAGE(S)
DURATION 00 :00:39
RESULT OK
MODE STANDARD
ECM
CITY OF SALEM, MASSACHUSETTS LLLJJ J
BOARD OF HEALTH
120 WASHINGTON STREET,4"t FLOOR PablicHealth
Prevent.Promote.Prateel.
TEL. (978)741-1800 FAx(978)745-0343
KIMBERLEY DRISCOLL Iramdin@salem.com LARRY RAM AN,RS/RFIHS,CI K>,CP-FS
MAYOR
HEAL.T'IT AGL•;N'1'
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION"
FEE: $50.00
PROPERTY LOCATED AT q lp n k l Ir) UNIT#
IS THISUNITDISIGNATED AS RIG LE FRONT OR BAC&PLEASE CIRCLE ONE
OWNER/LESSER cha\T'(Ar tCLvnAU, LNrrll?Q11 � qr MANAGER/AGENT *E
NO P.O.BOX "
ADDRESS �P/`\- - ADDRESS _
CITY, STATE,ZIP �\ 1 1 o�OV0 CITY, STATE,ZIP
RESIDENCE PHONEa� 443'LR2U BUSINESS PHONE(2414RS) gC11
BUSINESS PHONE . e4
TOTAL NUMBER OF ROOMS:
ROOMUSE: I. 2. y 3. 4. V) 5. �� �) �a' a�a
Cl I'/
6. 7. 8. 9. 10.
THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER T CITY OF SALEM
BOARD OF HEALTH THIS FEE IS PAYABLE AT THE TIME OF INSPECTION
APPLICANT'S SIGNATURE DATE
Ins�yectors use only
Date on initial inspection: - Date of reinspection:
Date of issuance of certificate: ' Date fee paid:
Type of unit: Dwelling Other Check# `I Check date:�����
Notes:
CodCod of&6ement Inspector Inspector
CITY OF SALEM, MASSACHUSETTS
r BOARD OF HEALTH
120 WASHINGTON STREET,4:`FLOOR
TEL. (978) 741-1800
KEV BERLEY DRISCOLL FAx(978) 745-0343
MAYOR ISCOTI SALEM.CODI
JOANNE SCOTT,
HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#351-08
DATE ISSUED: 8/1/2008
Property Located at: 51 Franldin Street UNIT#
Owner/Agent: Grand Realty
Address: 20 Belleview Ave
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-943-6920
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.
FOTHE BOARD OF I-�ALTH
JOANNE SCOTT, MPH, RS, CHOOO
HEALTH AGENT C06E ENFOR ENTENT INS^ ¢ SP O
CITY OF SALEM, MASSACHUSETTS
f ` BOARD OF HEALTH
120 WASHINGTON STREET,4"'FLOOR
TEL. (978)741-1800
KIMBERLEY DRISCOLL FAX(978)745-0343
MAYOR IscO'nnaSALEM 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 Tmky)0\r1 3-t UNIT#
IS THIS UNIT�DIIS,IGG,NATED AS RIGHT LEFT FROM OR BACK PLEASE CIRCLE ONE ,��
OWNERILESSER C�iSI� JN --_ MANAGER/AGENT a
NO P.O.BOX {{ ^^QQ, `
ADDRESS 2Z b& \RUJ ,,�11`ADDRESS
CITY, STATE,ZIP � A ��,{ (!))R—)C)..��)C) CITY, STATE,ZIP
RESIDENCE PHONE 011 ` lA t- 1`4�`t BUSINESS PHONE(24HRS)
BUSINESS PHONE Q01 " (' - (0Q0
TOTAL NUMBER OF ROOMS: y��
ROOM USE: 1. � \l 2. 3, 4. 5.b4�V
6. 7. 8. 9. 10.
THERE IS A FIFTY($50)DOLLARF ,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE IS P AB E A E E OF INSPECTION
APPLICANT'S SIGNATURE IWAIV I DATEl !
Inspectors use onluse only
Date on initial inspection: 7 I Date of reinspection:
Date of issuance of certificate: Date fee paid:
Type of unit: Dwelling Other Check# 349 W Check date:
Nates-.Wl txz*r int Vn tom'-%og� thi1tu,( in*, iad) - K3t
C,v -(y1n tCAiw1
jec
Code Eaforcement Inspector