HATHORNE CRESCENT w
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CERT.# 309-01
FEE $25.00
DATE: 06/25/2001
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CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH, RS,CHO
HEALTH AGENT 120 Washington Street 4th floor
Tel: (978)741-1800
Fax: (978)745-0343
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 1-3 Hathorne Crescent UNIT #: 2
OWNER/AGENT: Helen Sienkiewicz
ADDRESS: 1 Hathorne Crescent
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-1175
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 .
/7 OR THE BOARD F HEALTH
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
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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 Tel:(978)741-1800
Fax:(978)740-9705
IN ACCORDANCE WITH STATE SANITARY CODE,CHAPTER 11, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR H AN HABITATION".
PROPERTY LOCATED AT Z— UNIT#
IS THIS UNIT DESIGNATED AS BIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER� MANAGERIAGENT
No P.O. Box No P.O. Box
ADDRESS ��&-_L--ADDRESS -
CITY Ce a CITY ?d
RESIDENCE PHONE ��`I ��7S BUSINESS PHONE (24 HRS.)
BUSINESS PHONE
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TOTAL NUMBER OF ROOMS: 5
ROOM USE: 1. 2. 3. ` 4
THERE IS A TWENTY-FIVE_($2500).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 SIGNATUREDATE 4 was
INSPECTORS USE t}MLY
DATE OF INITIAL INSPECTION -0 DATE OF REINSPECTION_
DATE OF ISSUANCE OF CERTIFICATE: a �-o ( DATE FEE PAID: E '� S~ 07
TYPE OF UNIT: DWELLINGj.ZOTHER_ CHECK#-f`„��CHECK DATE
NOTES-,_
CODE ENFORCEMENT INSPECTOR 9/28/98