251 Loring Ave, Unit3 tr+.
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON Smihm,4'"'FLOOR
TEL (978)741-1800
K]WBEIU,FY DRISCOLL FAX(978)745-0343
MAYOR I.RAMDJN@S&LEM CAM
LARRY RAMDIN,RS/RRHS,CHO,CP-PS
HEALTH AGINT
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 Z!V Zd2/Nt Ali ilxrr#�
IS TMS UNIT DLSIGNATRD AS RIGHT LEFT FRONT OR RACE.PLEASE CIRCLE ONE
OWNER/LESSER MANAGER/AGENT
NO P.O.BOIL
ADDRESS �Q /'£� 1�� ADDRESS
CITY,STATE,Z� <X_ I)) //! CITY,STATE,ZIP 01970
RESIDENCE PHONE / �g 7 5/'f cyJ/7BUSINESS PRONE(24BRS)��
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: /
ROOM USE: i /f/ ) 2Z1 tet" 3klAll ) 4 OG� 5.
6. 7. 8. 9. 10.
THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE IS PAY LE AT THE TIME OF INSPECTION
APPLICANT'S SIGNATURE DATE
j/1o /
Inspectors use only
Date on initial inspection: Date of reinspection:
Date of issuance of certificate: Date fee paid:
Type of unit Dwelling Other Check# Check date:
Notes:
Code Enforcement Inspector
City of Salem, Massachusetts
Board of Health
120 Washington Street, 4th Floor, Salem,0 pr
MA 01970
Kimberley Driscoii Tel. {978} 741-1800 Fax. (978} 745-0343 Larry Ramdin, MPH, REHS,CHO
Mayor health@salem.com Health Agent
CERTIFICATE OF FITNESS
CERTIFICATE* GHL-17-333
DATE ISSUED: 10/1012017
Property Located at: 251 LORING AVENUE UNIT#3
Owner/Agent: Gary Pierce
Address: 9 Oakview Avenue
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:
Pursuant to the requirements of City of Salem ordinance Chapter 2 Article €V 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.
Nate: This approval does not certify compliance with the state lead law for occupants under S years of age.
Larry Ramdin, MPH, RENS, CHO SANITARIAN ^
HEALTH AGENT