0007 FREEMAN STREET i
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CITY OF SALEM, MASSACHUSEfTS
BOARD OF Hn-�LTH
120 WASHINGTON STREET,4...FLOOR Prevent.Promote.Protect.
TFL. (978) 74t-1 800 FAx(978) 745-0343
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CERTIFICATE OFFITNESS
CERTIFICATE#1Q8^14
DATE ISSUED: 5/29/2014
Property Located at: 7Freeman Street UN|T#
Owner/Agent: BenSNv8nowioz
Address: 8OJackman Street
City/Town: Georgetown, yWAZip Code: O183324Hour Phone: 781~Q53`430&Andrea Dodge
Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division3, Section
7U5: Ceddficatenffitness nfrented dwelling unit, apartment ortenement. Aninspection ofyour
vacant Dwelling/Rooming Unit aithe above address has been approved and isincompliance with
1O5CMR 410.000: Massachusetts State Sanitary Code, Chapter Ile Minimum Standards o[
Fitness for Human Hobitation"
Therefore, this Certificate is issued by the Code Enforcement Division of the Salem Board of
Health and the unit may now berented and/or occupied.
Maximum Number tfoccupants, must comply with 1U5CMR 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 OFH
LARRfTaMDIN
HEALTH AGENT SANITARIAN
K j C CITY OF SALEM, MASSACHUSETTS
y
BOr1RD OF HC-uTx
120 WASHTNGTON STRFFT, 4'"FLOOR /
TFL. (978) 741-1800
h TAMERLEY DRISCOLL FAx(978)745-0343
K YOR LRA\TDIN(n�SAI EM U-W
LARRY R 1Nmr\T,Its/REEFS,cf-IO,Cp-7=S
HPAT,CH A(-,F,\-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 ATr(e VK" 5�t • ��L&kA UNIT# -�
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK, PLEASE CIRCLE ONE�--
OWNER/LESSERL JVI OWCGZ-MANAGER/AGENT� YZ>�
NO P.O. BOX -�
ADDRESS �0 �A 1M 0.✓1 - > Z �t(rfC n
CITY, STATE,ZIP Geo ked, oo ll 01 ,9-33 CITY,STATE,
RESIDENCE PHONE BUSINESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUMBER O�F.rR,OOMS:_,_._ p 2
ROOM USE: 1, 2. 3. �(,j6x t6 4. :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 �\ ��� DATE 1
Inspectors use only
Date on initial inspection: J &l (� Date of reinspection:
Date of issuance of certificate: Date fee paid: _(� _
Type of unit: DwellingOther Check#_ Q�1 Check date:/j
Notes:
Code n`ko convent Inspector
f yky
CITY OF SALEM, MASSACHUSETTS
SO,txD or Hr-,kL7'H
130 WASHINGTON HINGTON STRFFT,4'"FLOOR
TFL.(978)741-1800
hIMBERLEY DR[SC(-)LL _ Fkt(978)745-0343
URRY RAi,NfDTtti---,RS/Rr tuis,ci-r0,c:p-T s
Release
In accordance with Massachusetts General Laws Chapter 111; Code of Massachusetts Regulations 410.000 et. Seq. ;
State Sanitary Code Chapter 11 and Article XIII of the City of Salem Ordinance,undersigned owner/lessor and
tenant/lessee of a unit of residential property,hereby authorize the Salem Board of Health or its authorized agents to
inspect the residence identified below in accordance with the aforementioned statutes, regulations and ordinances.
In the event it is necessary that said inspection be done in my/out absence. I/we expressly authorized the same and for
my/our successors and assigns hereby release and discharge the City of Salem, Salem Board of Health and its
authorized agents from any lose or injury sustained of whatever nature and description occasioned by my/out absence
during said inspection.
Tenant/Lessee Owner/Lessor
S e+ �3 8d BIZ mat,
� J �
Address Address 1 33
Address on unit to be inspected
Date
Updated 5/23/11