GENEVA STREET CITY OF SALEM, MASSACHUSETTS
of BOARD OF HEALTH
9 120 WASHINGTON STREET, 4TH FLOOR
ryRY SALEM, MA 01970
9� TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. UISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
June 11, 2003
Michael Salerno
2 Geneva Street
Salem, MA 01970
PROPERTY LOCATED 2 Geneva Street Unit# 1
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 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.—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 ($20.00) 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 tenants' entire utility bills retroactive to the date of initial occupancy in cases in
which cross-metering has been proven to exist.
F rt�of Heal Reply to
Joanne Scott MPH, RS, CHO Pablo Valdez
Health Agent Code Enforcement Inspector
CITY OF SALEM, MASSACHUSETTS
o
p
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
}} SALEM, MA 01970 CERT,# 640-03
'S TEL. 978-741-1800 FEE $25.00
FAX 978-745-0343 DATE' 12/18/03
STANLEY USOVICZ, JR, JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
r
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 2 GENEVA STREET UNIT #: 2
OWNER/AGENT: MICHAEL SALERNO
ADDRESS: 2 GENEVA STREET, ill
CITY/TOWN: SALEM - ZIP CODE: 01970 24 HOUR PHONE: 978-741-1933
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 (g) 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 NOR BUILDING RELATED CODES. FOR MORE
INFORMATION CALL 978-741-1800.
FO T0 OF 22HEALTH
JOANNE SCOTT, MPH, RS,CIIO
HEALTH AGENT JW. VAU •-
CODE ENFORCEMENT INSPECTOR
- TOP SASH OF BATH WINDOW FUNCTIONS FOR VENTILATION -
CITY OF SALEM, MASSACHUSETTS
• BOARD OF HEALTH ^z
• i 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970 1 6 r
( TEL. 978-741-1800 (9
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 it, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESSSS�'FOR HUMAN HABITATION'.
PROPERTY LOCATED ATy P�C�U�f UNIT#_cr�
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BAC PLEASE CIRCLE ONE
OWNERILESSER/ 't1�/ '//`� UMANAGER/AGENT
No P.O.Box /� cry No P.O.Box
ADDRESS_ �7I,UpP�P1/�I J/ ADDRESS ?
CITY— CITY— ,--// /�j
RESIDENCE PHONE!74
4 �z/ r l USINESS PHONE (24 HRS.)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
\ ROOM USE: 1. 2. 3. 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. / 7
APPLICANTS SIGNATURE" u 'a/vim_ DATE
rjSPECjTOR USE ONLY
DATE OF INITIAL INSPECTION /cJ//�/Q DATE OF REINSPECTION /(//A
DATE OF ISSUANCE OF CERTIFICATE: DATE FEE PAID:
TYPE OF UNIT: DWELLING t/OTHER_ CHECK# 23SS"=CHECK DATELJLp7
NOTES: ���tosa� �t f ura<r 2 1/a rr: -
COD CEMENT 1 PECTOR 9128/98
i i�
CITY OF SALEM, MASSACHUSETTS
' BOARI)OF HEALTH
120 WASHINGTON STREET,4"`FLOOR
TEL. (978)741-1800
KIMBERLLY DRISCOIL FAX(978) 745-0343
MAYOR DGIWFNLI UM(CY�SAI RN A
DAVID GRI L3NBAUM
ACTING H'EAr.rH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#626-09
DATE ISSUED: 12/10/2009
Property Located at: 3 Geneva Street UNIT#2
Owner/Agent: Daniel W. Robitalle
Address: 8 Mooney Road
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:
An inspection of your vacant DvvellingtRooming Unit at the above address has been approved
and is in compliance with 105 CMR 410.000: Massachusetts State Sanitary Code, Chapter W'
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
S/BOARD OF HEALTH
DAVID GREENBAUM
ACTING HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
t BOARD OF HEALTH
120 WASHINGTON STREET,4"'FLOOR �{J vvvvvv ��----
TEL. (978)741-1800
VJMBERLEY DRISCO1L FAx(978)745-0343
MAYOR DGREENBAUM@ ALEM.COM
DAVID GREENBAum
ACTING HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#' 626-09
DATEISSUED: 12/11 /09
Property Located at: 3 Geneva St Unit 2
Owner/Agent: Daniel .Robitaille
Address: 8 .Mooney Rd
City/Town: Salem MA 41970 Phone: 978-741 -2483_
An inspection of your vacant Dwelling/Rooming Unit at the above address has been approved
and is in compliahoe 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 OFHEALTH
QA I�NBAUM
ACTING HEALTH AGENT CODE ENFORCEMENT INSPECTOR
i
CITY OF SALEM, MASSACHUSETTS
J e BOARD OF HEALTH
120 WASHINGTON STREET,4...FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR DGRUFNBAUM@SALFM.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
IS THIS UNIT DISIGNA�TED AS 91GHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER ,D ii f / t^ ',L ��MANAGER/AGENT
NO P.O. BOX � /
ADDRESS /Vln�%%,,� �� !I ld/ 5,k 4-7 4.%-ADDRESS
CITY, STATE,ZIP , �Lv � CITY, STATE,ZIP Gl.� 7Q
RESIDENCE PHONE ; ��F% _'/�(� -:Z!�5� BUSINESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:_
ROOM USE: 1.t l2 2. )� 3. 13 4. /s l 5 Yi z
6. K T�6Ph7. 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
EIIS_PAYABLE AT THE TIME OF INSPECTION
APPLICANT'S SIGNATURE/ �It�tn /.�Lr ,, DATE 6
Inspectors use only
Date on initial inspection: ) '�r���l 1 Date of reinspection:
Date of issuance of certificate: 1,3110 , CI t Date fee paid: TWO
O
Type of unit: Dwelling I/ Other Check# 1 Check date:
Notes: MitlooK .i G ll cI All H
,So I L �i�iJfll�5 • G`� C C� '•� to �y1 " ��k�j
C , .
C1 7 S'' �a 3 .. C1 ISO
Code theorcement Inspector
• CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4"'FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL PAX(978) 745-0343
MAYOR DGRrsaNBAUM(@SAraiM COM
DAVID GREENBAUM - -
ACTING HEALTI-1 AGENT -
CERTIFICATE OF FITNESS
CERTIFICATE #576-09
DATE ISSUED: 11/12/2009
Property Located at: 4 Geneva Street UNIT# 1
Owner/Agent: Dawn-Heise'y-Grove
Address: 2 Andrea Drive
City/Town: Conton, MA Zip Code: 0202124 Hour Phone: 617-905-2333
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
kGR'
D ABUMAi
ACTING HEALTH AGENT COO EN'FORCNEAT INSPECTOR
/ E 4G V
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
r 120 WASHINGTON STREET,4."FLOOR
TEL. (978) 741-1800
K-INIBERLEY DRISCOLL FAX()78) 745-0343
MAYOR ocRir;rn BMAI(ir,A]A Al.COM
DAVID G'RLENBAU�t,
ACTING HEAL'fH 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 4 Geneva Street UNIT# 1
IS THIS UNIT DISIGNATED AS RIGHT EF ONT OR BACK,PLEASE CIRCLE ONE .
OWNER/LESSER Dawn Heisey-Grove MANAGER/AGENT
NO P.O.BOX
ADDRESS 2 Andrea Drive
CITY, STATE, ZIP Canton MA 02021
RESIDENCE PHONE BUSINESS PHONE(24HRS) (617)905-2333
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:?
ROOM USE: 1. Living Room 2. Bedroom 3. Bedroom 4. Bedroom
5. Dining Room 6. Kitchen 7. Bathroom 8. 9. 10.
THERE IS A FIFTY ($50)DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THISFEE IS PAYABLE AT HE TIME OF INSPECTION
APPLICANT'S SIGNATURE DATE l Z v
nspectors use only
Date on initial inspection: �� + ('a I�q Date of reinspection:
Date of issuance of certificate: Date fee paid:
Type of nit: Dwelling Other Check# Check date: /�
Notes: U1 �ct (ku� �iY bC✓�£VkJty1 c�, s �r'lct,a
zav
Enforcement Inspector
i
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4"FLOOR
TEL. (978)741-1800
KIMBERLEY DRISCOLL FAx(978)745-0343
MAYOR DGRPNNBAUM{ SAIFMCOM
DAVID GRI.ENBAUM
ACTING FIF.ALTI3 AGENT
Facsimile
Transmittal
To
Fax # Un - 9$3 - (J )-a
RE: .
Date :
Page(s): including this cover# Z
Message:
Board of Health News -----------------------------------------------------------For Your Information
OFFICE HOURS:
Monday, Tuesday, Wednesday 8:00 AM to 4:00 PM
Thursday 8:00 AM to 7:00 PM
Friday 8:00 AM to 12:00 NOON
y CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH lu
120 WASHINGTON STREET 41°FLOOR PI1�1CHC81t$
P)ev1"11 Pram"I¢.Pro,Cc,.
TEL. (978) 741-1800 Fax (978) 745-0343
KIMBERLEY DRISCOLI. Iramdin salem com
LARRY It\MDIN,RS/RFI-IS,CFIO,CP-FS
MAYOR HK;U;1'Lr AGf!N"I'
CERTIFICATE OF FITNESS
CERTIFICATE#290-14
DATE ISSUED: 8/27/2014
Property Located at: 10 Geneva Street UNIT#
Owner/Agent: Edith Metcalf
Address: 12 Geneva Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-578-0023
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 OFHEALTH
LA RAMDIN
HEALTH AGENT "SANITARIAN
J
CITY OF SALEM, MASSACHUSETTS BOARDol BOARD OF HEALTH120 WASHINGTON STREET,4'"FLOOR
TEL. (978)741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR LRAMI)iN&ALFM.COM
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 /0 aAmti� _l�- UAIIT#
IS THIS UNIT DISIUNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER MANAGER/AGENT gz- geal �
NO P.O.BOX
ADDRESS 2- O- 20 ADDRESS a-7 Q-jJ,7 l-
CrrY,STATE,ZIP S o Qa. /Yl4 61920 CITY,STATE,ZIP o
RESIDENCE PHONE BUSINESS PHONE(24HRS) C22Y) Sok 00'p-z
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ROOMUSE: 1. Lkin4gm, 2 +amino 3 k4a, 4 fSt.j6,No, 5 6tiem,,
7. A ,h.., 8. 9. 10.
If F
THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE IS P YABLE AT THE TIME OF INSPECTION
APPLICANT'S SIGNAT DATE oZ7 6 SL
Inspecto s use only
Date on initial inspection: r? t} Date of reinspection:
Date of issuance of certificate: Date fee paid:
Type of unit: Dwelling Other Check# Check date: I 1
Notes: G a J CO sN ,�
ode n cement Inspector
.1
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4:`"FLOOR
TEL. (978)741-1800
KIMBERLEY DRISCOLL FAx(978) 745-0343
MAYOR T.RAMDIN@SAI.EM COM
LARRY RAMDTN,RS/REHS,CHO,CP-FS
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 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. Uwe 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.
r
Tenant/Lessee Owne ssor
�y trete �J 'SL
Address Addres
Address on OR to be inspected
Date
Updated 5/23/11
_ `OND " City of Salem, Massachusetts lu
wY
Board of Health
120 Washington Street, 4th Floor, Salem, Public Health
MA 01970 Prevent. Promote. Protect.
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-15-275
DATE ISSUED: 9/3/2015
Property Located at: 17 GENEVA STREET UNIT#1
Owner/Agent: Ben Carlson
Address: 2 Leather Lane
City/Town: Beverly, MA Zip Code: 01915 24 Hour Phone:(781)820-5809
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 SANT ARIAN
i-
'�6 '' CITY OF SALEM MASSACHUSETTS
BOARD OF HF 1urtTi
`mac s� 120 WASHINGTON STREF-r,4"'FLoOR
TEL (978)741-1800
KIMBERLEY DRISCOLL FAX(978)745-0343
MAYOR T-RANIMN cd.SALENLcona
LARRY RAMDIN,1LS/RI14S,CHO,CP-PS
HEm xFi AGF.N'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 1 -7 6 c-n, /al UNIT#
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER U_^ C�IS o n MANAGER/AGENT 17 C�(Sen
NO P.O.BOX
ADDRESS_a ADDRESS
CITY, STATE,ZIP_ ITY, STATE, ZIP
RESIDENCE PHONE BUSINESS PHONE(24HRS)
BUSINESS PHONE Zo — 51(0 9
TOTAL NUMBER OF ROOMS:—
ROOM
OOMS:ROOM USE: 1._ 6,tA 2. aGUt 3.]y &,o,^ 4 L'v'^) rods
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 Z'1
Inspectors use only
Date on initial inspection: 694220/f.1 Date of reinspection:
Date of issuance of certificate: Date fee paid: 0qI0212O1S
Type of unit: Dwelling Other Check# 9 7 1 Check date: 09/02/201.5
Notes:
C d of cement IhWector
a
v CITY OF SALEM, MASSACHUSETTS
BOARD or He ir-rH
120 WAsenvGTON SI:RF}T,4�"FLOOR
TEL. (978)741-1800
KIMBERLEY DRISCOLL RAx(978) 745-0343
MAYOR 1,RAMQ1N asacsNccoNt
LARRY RANIDIN,RS/RE'HS,C.1 IO,CP-FS
E :n
Hw --t AGEN'r
Release
In accordance with Massachusetts General Laws Chapter 111; Code of Massachusetts Regulations 410.000 et. Seq. ;
State Sanitary Code Chapter H 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
7 - I k ( � rVf 619cJ,
Address Address
Address to
be inspected
Date
Updated 5/23/t I
CITY OF SALEM, MASSACHUSETTS
BOARD Or HEALTH
120 WASHINGTON STREET,4:"'FLOOR
Tr-L. (978) 741-1800
KIMI3F.IiL1 Y DRISCOLL FAX (978) 745-0343
MAYOR Lrimdin@salem.com
salem.com
LARRY RAMUIN,RS/RP,I1S,CI1(.),CP-FS
I-IFAi A I I AGP.N'l
CERTIFICATE OF FITNESS
CERTIFICATE #390-11
DATE ISSUED: 10/5/2011
Property Located at: 17 Geneva Street UNIT#A
Owner/Agent: Martin Hansberry
Address: 19 Geneva Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 617-571-0471
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
LA RY RAMDIN
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS 1A
BOARD OF HtAa�ll �96—
W
120 W vSHING1 ON STRE 4"' PLOOR
'Lr . (978) 741-1800
KIMI31-RLEY DRISCOLL F.\N (978) 745-0343
MAYOR I.R:U1DIN(a�SAiENIJ 0M
L.Amn,RAPfUIN,RS/RGI IS,CI 10,CI'-I;ti
I'll A(;FN'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"
FEE: $50.00
PROPERTY LOCATED AT ��7 6 e j4e Ute , UNIT#j
IS TH IS7 UNIT DISIGNATED AS RIGHT LEFT FRONT OR BBQ PLEASE CIRCLE O1NE
OWNER/LESSER t �0,wS��MANAGER/AGENT
NO P.O. BOX 1 \JR 5. '
ADDRESS 19 /mo o- 00 )6 ADDRESS 19 S�f A /toy 0X6
CITY, STATE, ZI�W Sn�&n. Aa P FF 01570—CITY, STATE,ZIP `q S e
RESIDENCE PHONESAO l) 93q O[Z'i BUSINESS PHONE(24HRS)
BUSINESS PHONE kl
TOTAL NUMBER OF ROOMS:__
ROOM USE: 1. 2. 3. 5.
6. 7. 8. 9. 10.
THERE IS A FIFTY($50)DOLLAR FEE,PAY LE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE ISS YAZLET THE TIME OF INSPECTION
APPLICANT'S SIGNATURE %"° DATE � 0 1 W&
Inspectors use only
Date on initial inspection: )okIll Date of reinspection: —�—
Date of issuance of certificate: /V S/ / Date fee paid:
Type of unit: Dwelling Other Check# Check date:
Notes:
C Enfor e hent Inspector
� COND$,t�
City of Salem, Massachusetts
On Board of Health
120 Washington Street, 4th Floor, Salem, PublicHea Ith
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-15-298
DATE ISSUED: 9/18/2015
Property Located at: 17 GENEVA STREET UNIT#2
Owner/Agent: Ben Carlson
Address: 2 Leather Lane
City/Town: Beverly, MA Zip Code: 01915 24 Hour Phone:(781) 820-5809
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
F�
Larry Ramdin, MPH, REHS, CHO
HEALTH AGENT SANITARIAN
i
'ti
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
n'
\\'u� 120 WASHINGTON STREET,4 FLOOR
TEL. (978)741-1800
KIMBERT.EY DRISCOLL Fax(978) 745-0343
MAYOR r.RAN1D1Ng_SA1.el\1.u0u
LARRY RANIDIN,R.S/REHS,CHO,CP-FS
HFALI'H.AGP,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"
FEE: $50.00
PROPERTY LOCATED AT 1 -7 Ge .t.-m SA(� UNIT# v`
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER 1&UN (&Y-15-11 MANAGER/AGENT
NO P.O.BOX 12 �'-�/ L�L
ADDRESS ADDRESS
CITY, STATE,ZIPS. MA D t ts' CITY, STATE,ZIP
RESIDENCE PHONE BUSINESS PHONE(24HRS)
BUSINESS PHONE -7g I - $26 - 5 Tp�}
TOTAL NUMBER OF ROOMS:
-r `
ROOM USE: 1. (3e-42. 3. �fw,r "4. U�11 5. �1'�1-..s
1
6. Xu -k 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 BLE AT THE TIME OF INSPECTION
APPLICANT'S SIGNATURE DATE
Inspectors use only
Date on initial inspection: 0!ja l'r Date of reinspection:
Date of issuance of certificate: Date fee paid:ngl2S�/2Lt1S
Type of unit: Dwellin Other Check#—W—Check date: 0111—L"01 S—
Notes:
C deC de n�cement pectorpector
CERT.# 249-96
FEE $25.00
DATE: 05/01/96
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: 17B Geneva Street UNIT #: B
OWNER/AGENT: John Hinch
ADDRESS: 51 Valley 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, CHAP'T'ER 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
I .�'i%�L'3�:;i-. .i moi+;,..-"M1-'6•,
y
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
z C2
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970.3928
JOANNE SCOTT,MPH,R5,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".
PROPERTY LOCATED AT 41::;,�taA 4 UNIT 1-6
OWNERfLESSER BffJt/ tfrl/Gs' MANAGER/AGENT
ADDRESS / L�il�t .� ADDRESS
CITY CITY
RESIDENCE PRONE BUSINESS PHONE (24 HRS.)
BUSINESS PHONE —
TOTAL NUMBER OF ROOMS: j
ROOM USE: 1._L,A- _2.�2��3. lr-- 4.
5. / /j 6. _7 8.
THERE IS A TWENTY-FIVE (25.00) DOLLAR FEE, RAYABLE BY CHECK OR MONEY ORDER TO THE
CITY OF SALEM HEALTH DE NT THIS FE P ABLE AT THE TIME OF INSPECTION
APPLICANTS SIGNA� DATE
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION: / DA'IF. OF REINSPECTION
------------
DATE OF ISSUANCE OF CERTIFIICATE: DATE FEE PAID: - (�
TYPE OF UNIT: DWELLING OTHER_
NOTES:
CODE ENFORCEMENT INSPECTOR
d DIN
City of Salem, Massachusetts
Board of Health
120 Washington Street, 4th Floor, Salem, Pu
PbliCIieea2th
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-15-277
DATE ISSUED: 9/3/2015
Property Located at: 19 GENEVA STREET UNIT#1
Owner/Agent: Ben Carlson
Address: 2 Leather Lane
City/Town: Beverly, MA Zip Code: 01915 24 Hour Phone:(781)820-5809
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
44
Larry Ramdin, MPH, RENS, CHO SANITA
HEALTH AGENT
CITY OF SALEM MASSACHUSETTS
BOARD OF HEALTH
120 WY ASHINGTON STREET,4"FLOOR
TT--L' (978)741-1800
KIMBERL EY DRISCOLL FAS(978)745-0343
MAYOR La,�nanr �s,�rr�tcon:
LARRY RAALDIN,P.S/RF.HS,CHO,CP-PS
HEALTI-t 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: $50.0:0_
PROPERTY LOCATED AT 9 � � fG� S trr� UNIT# I
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER f5tll MANAGER/AGENT
NO P.O.BOX
ADDRESS ADDRESS
CITY, STATE,ZIPS AAA Ot`1 T CITY, STATE, ZIP
RESIDENCE PHONE BUSINESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. 3--A 2. 13 ed` 3. i<<VcC 4. bo, rm,r\ 5. '`V
6. 1 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 P ABLE AT THE TIME OF INSPECTION
APPLICANT'S SIGNATURE DATE l l�
Inspectors use only
Date on initial inspection: 0"241015- Date of reinspection:
Date of issuance of certificate /Ow-=E Date fee paid: 0110212-01-5-
Type
1/02/20.15Type of unit: Dwelhng Other Check#_Check date: 6�42/201S—
Notes:
C d n cement Spector
,a
v ' CITY OF SALEM, MASSACHUSETTS
BOARD OF HF--LTH
120 WASHINGTON STREI r,e'FLOOR
TEL. (978)741-1800
KINMERLEY DRTSCOL.L FAx (978) 745-0343
MAYOR TR.V,01N( SAL6Rccomt
LARRY RANIDIN,RS/RENS,CHO,CT'-FS
HEAT;1'H AGL',N7'
Release
In accordance with Massachusetts General Laws Chapter 111; Code of Massachusetts Regulations 410.000 et. Seq. ;
State Sanitary Code Chapter H 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. Uwe 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 oEinjury-sustained of whatever nature and description occasioned by my/out absence
X
' gm.
� Owner/Lessor
r
Address pl9 Address
/9-2
Address on unit to be inspected
9/1�i5
Date
Updated 5/23/11
City of Salem, Massachusetts lu
Board of Health
120 ,,,Washington Street4th Floor, Salem, PublicHeaith
MA 01970 Prev<nt. 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-15-276
DATE ISSUED:9/3/2015
Property Located at: 19 GENEVA STREET UNIT#2
Owner/Agent: Ben Carlson
Address: 2 Leather Lane
City/Town: Beverly, MA Zip Code: 01915 24 Hour Phone:(781)820-5609
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 SANT' ARl IAN
HEALTH AGENT
CITY OF SALEM, MASSACHUSETTS
BOARD OFHFAI:rH
120 WASITINGTON STREET,4'FLOOR
TEL. (978)741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR LRAMD1Nn.SALfiM.00M
LARRY R,\MD1N,RS/RE TS,Ci-IO,C11-17S
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 SIY7;:4� UNrF# o�
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER 5-CA MANAGER/AGENT
NO P.O.BOX
ADDRESS ADDRESS
CITY,STATE,ZIP � 019 1 S CITY,STATE,ZIP
RESIDENCE PHONE BUSINESS PHONE(24HRS)
BUSINESS PHONE 7t ( S Zo— Sf10�
TOTAL NUMBER OF ROOMS: S
ROOM USE: 1. ge-A 2. i3CA 3. &,k 4.K,+r"/T1/5. v stn
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_ _r DATE Z It S
Inspectors use only
Date on initial inspection:_C)q/ /2.0 S Date of reinspection:
Date of issuance of certificate:0O Date fee paid: ql azz/n.
_OZ5-
Type of unit: Dwellin Other Check#Check dater OBJ/O 2/201S
Notes:
Coe Ifo ement IXector
F,
V c CITY OF SALEM, MASSACHUSETTS
BOARD OP HF,ILTH
120 W11SHdNGTON SPRF_ET,4"FLOOR
TEL. (978)741-1800
KINIBERLEY DRISCOLI, FAX(978)745-0343
Mt1YOR c.RANfDFN ) ALF.N[.Cona
LARRY RANDIN,RS/RFSHS,CHO,CP-FS
f—JrALr[-t 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 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. Uwe 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
G,64-e vq, -1 W-, (,e� lo--t- Px.we� A,vl G r 9 c�
Address Address
Address on unit to be inspected
y
Date
Updated 5/23/11
�ONWT
�9e��M11YE
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-
02/13/2002
JOANNE SCOTT, MPH, RS,CHO 120 Washington Street— 4th Floor
HEALTH AGENT Tel # (978)-741-1800
Tanin Sasaluxanon Fax# (978)-745-0343
24 Reed Road
Peabody, MA 01960
PROPERTY LOCATED AT 20 Geneva 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.
ganTne
HE BOARD OF EALTH REPLY TO
Scot MPH,RS 0 PABLO VALDEZ
Health Agent CODE ENFORCEMENT INSPECTOR
i�
CITY OF SALEM, MASSACHUSETTS
w
HEALTH AGENT
120 WASHINGTON STREET, 4TH FLOOR
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#374-07A
DATE ISSUED: 8/13/2007
Property Located at: 26 Geneva Street UNIT# 1
Owner/Agent: Arturo Caceres
Address: 15 Patton Road
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-1407
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.
FO T( D OF FjEALTH /��� r
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
r
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
• 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 rZC&-P (2) 10 dCS1SA__4:Y UNIT# I
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER d, v/LO CGYL-er(?JMANAGER/AGENT
No P.O. Box No P.O. Box
ADDRESS /S ADDRESS
CITY 5;>q �E e.t.t, CITY
RESIDENCE PHONE SO r BUSINESS PHONE (24 HRS.) __
BUSINESS PHONE t- 5�D&& S- ?j
TOTAL NUMBER OF ROOMS:_LI'f___
ROOM USE
5.------6 8.
THERE IS A TWENTY-FIVE (S25.00) 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_ / �/�p
INSPECTORS USE ONLY 7-
DATE OF INITIAL INSPECTION ._ `3b. - DATE OF REINSPEC71ON
DATE OF ISSUANCE OF CERTIFICATE: -V� DATE FEE PAID:<.-/3
TYPE OF UNIT. DWELLIN ' __.--OTHER --- CHECK : ��� _- CHECK DATE 15 ii 3
NOTES
CODE ENFORCEMENT INSPECTOR 9/28!98
1
+pp, CITY OF SALEM, MASSACHUSETTS
�L HEALTH AGENT
120 WASHINGTON STREET, 4TH FLOOR
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#374-07B
DATE ISSUED: 8/13/2007
Property Located at: 26 Geneva Street UNIT#2
Owner/Agent: Arturo Caceres
Address: 15 Patton Road
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-1407
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
� 1
JOANNE SCOTT, MPH, RS, CHO 9
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 0 1970
TEL. 978-741-1800
FAX 978-745-0343
JOANNE SCOTT, MPH, IRS, cHo
HEALTH AGENT
� Dh�0
;N8y0|
APPLICATION �
� �
/
|NACCORDANCE WITH STATE SANITARY CODE, CHAPTER ||` 105CMR 410.000
"MINIMUM STANDARDS OFFITNESS FOR HUMAN HAB|TAT0N"
�
PROPERTY LOCATED AT VN|T#_��
|STHIS UNIT DESIGNATED 4S RIGHT LEFT FRON BACK PLEASE CIRCLE ONE
OVVNER/LESSER _��ANA{�ER/A(�EN --_
NoP ^� ��ox ��oP.��. Box
A[)DRESS [5 aj,1,0t3ADDRESS____. -_-
�
QTY . -� � QTY_-______
RESIDENCE PH0NE /TVS|NESSPH()NE (24HRS )__________
�
BUSINESS PHONE
TOTAL NUMBER 0FRO0M8� �J
�-��'--7f---_
ROOM USE 1Lf'} _ 2 �} S _ 4 __��'J- __
5`.______8
THERE |S ATWENTY-FIVE(S25.00) DOLLAR FEE, PAYABLE BYCHECK 0RMONEY
ORDER TO THE CITY OF SALEM HEALTH EP RTMENTTH|SFEEISPAY4BLEATT6E
TIME OF INSPECTION.
APPLICANTS SIGNATURE _-�-____�----DATF__
NS,5{C[ORS USE ONLY
�
(y—| � -a DATE0FRE|NSPECT\0N
�}/�7�- _��_ _�
DATE OFISSUANCE 0FCERTIFICATE / } DATE FEE PAID _ { /
�
TYPE OFUNIT DYYELL|N�L/- OTHER CHECK , / / \* C|1ECKDKTE oCy--/'' /
NOTES__�
CODE ENFORCEMENT INSPECTOR
CERT.# 125-01
FEE $25.00
DATE: 03/09/2001
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: 28 Geneva Street UNIT #: 1
OWNER/AGENT: Arturo Caceres
ADDRESS: 15 Patton Road
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-1407
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
iI
i
w
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
Fu:(978)740-9705
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER It, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT Z �f Genco c._ c.4-_ UNIT#I
IS THIS UNIT DESIGNATED AS IGT LEFT FRONT BACK PLEASE CIRCLE ONE
1
OWNER/LESSER Y��-to v 6mc-Er4-% MANAGER/AGENT
No P.O. Box (_� � No P.O. Box
ADDRESS I S ca T�rJ �� ADDRESS
CITY CITY
RESIDENCE PHONE 74!�_ ) '-( C'1__ BUSINESS PHONE (24 HRS.)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: S
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 DATE - e-' I
Y
DATE OF INITIAL INSPECTION �� �f DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: d DATE FEE PAID: 3�
TYPE OF UNIT: DWELLING j HER_ CHECK# - _CHECK DATE
NOTES:
I _
CODE ENFORCEMENT INSPECTOR 9/28/98
h �
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT Tei:(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.
Ia 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.
TE?IAHT(LESSEE Eft/ e
ezv�4.tJ. Petr✓ i=re-5
ADDRESS ADDRESS )
AD[)ftESS OF UNIT TO BE INSPECTED
Mc( --
CITY OF SALEM,MASSACHUSETTS
BOARD oF"HEALTH
12O WASHINGTON STREET,4"'FLooR
"f a.. (978)741-1800
KIMBERLE,Y DRISCOLL FAX (978)745-0343
MAYOR 11;C0,17I' SAI.I M COM
JOANNE SCOTT,
HEALTH AGENT
CERTIFICATE OF FITtyESS
CERTIFICATE#345-08
PATE ISSUER 81`1008
Property Located at: 28 Geneva Street UNIT#2
Owner/Agent: Arturo Caceres
Address: 3532 Amaca Circle
Cityrrown: Orlando, FL Zip Code: 32837 24 Hour Phone, 978-590-6683
An inspection of your vacant DwellingCRooming 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 Cade Enforcement Division of the Salem Board of
Health and the unit may nowbe 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 O,FH�ALTH
aC�
J ANNE SCOTT MPH RS CHOW
HEALTH AGENT �'CVE ENFORCEMENT INSPECTOR
• CITY OF SALEM MASSACHUSETTS L
BOARD OF HEALTH r0LTA
120 WASHINGTON STREET,4"'FLOOR �: NO
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343 /
MAYOR tscol-r r�i SALUN.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 ?� U e&� 0_,1 a__ S f- UNIT# Z
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE
OWNER/LESSER RfUk3KS�N MANAGER/AGENT
NO P.O. BOX
ADDRESS I x,532 4NU-6_ . UK- ADDRESS
CITY, STATE,ZIP CITY, STATE,Zip--F _ 2i 2 g 3
RESIDENCE PHONE (40 2TO _2-1 '6--? BUSINESS PHONE(24HRS) !�)y scuO Co 6 K I
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:—" _
ROOM USE: 1. 2. 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 IS PAYABLE E'I`M F INSPECTION
APPLICANT'S SIGNATURE DATE
Inspcctors-use only
Date on initial inspection: /(j '®g Date of reinspection:
Date of issuance of certificate: Date fee paid:
Type of unit: Dwelling Other Check#_,903 l Check date: Ttl
Notes: Lljl�rooha kOlyt4SAC ww 6KLIIn
nforcement Inspector