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HERSEY STREET City of Salem, Massachusetts 9 Board of Health A Aem 120 Washington Street, 4th Floor Salem, PubliCHealth no MA 01970 P«>e. . P Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, RENS, CHO Mayor health@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE#: GHL-17-229 DATE ISSUED: 8/2/2017 Property Located at: 3 HERSEY STREET UNIT#1 Owner/Agent: Leo Cullen Address: 9 Old Coach Road City/Town: Norfolk, MA Zip Code: 02056 24 Hour Phone: 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. Note: This approval does not certify compliance with the state lead law for occupants under 6 years of age. Larry Ramdin, MPH, RENS, CHO HEALTH AGENT SANITARIAN wT pry A 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 30 "1 WP IS THIS UNIT DISI /� kkAInGNA D AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE OWNER/LESSER--LPO, I 11 A`�.V I I1 MANAGE AGENT ADDRESS q 0I3 llmph ADDRESSAid PA CITY, STATE,ZIP (Tf v l MA_7 06(0 CITY, STATE,ZIP UI 'I D l 1�, 1M14 Da U5 � RESIDENCE PHONE �0 �—I Ra3 �q oZ. ) BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1. L1Vinp N 2. 'FQi \) V1a 3. ki I k \ 4. MW 5. 9W 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 DATE21 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 Release In accordance with Massachusetts General Laws Chapter 111; Code of Massachusetts Regulations 410.000 et. Seq. ; Code Chapter II and Article XIII of the Ci of Salem Ordinance undersigned owner/lessor and State Sanitary p ry gn tenant/lessee of a unit of residential property,hereby authorize the Salem Board of Health or its authorized agents to P PertY� Y g 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. TenanbUssee Own r/L.e sor l//j` w Mom 41 —&W4* Address Address 3 , &DM MA ® ?b Address on unif to be inspected U� ?0I Date Updated 5/23/11 • �pNDITq City of Salem, Massachusetts V Board of Health �y����� ���� MA 01970 120 Washington Street, 4th Floor, Salem, prevent, Promote. pi Air41 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-15-107 DATE ISSUED: 6/5/2015 Property Located at: 3 HERSEY STREET UNIT#1 Owner/Agent: Leo Cullen Address: 3 Hersey Street#2 City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(508) 4462712 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 SANITA IAN 1 CITY OF SALEM, MASSACIIUSETTS ( � BO IM Or HLALTIi 120 WASHINGTON STRI3FT,4:`FLOOR Trl_.. (978) 741-1800 KIMBERLEY DRISCOLL FAX (978) 745-0343 TvLwOR LRAMI)INnSAL M.Cobr LARRY RANIMN,RS/REAS,CHO,CP-FS I-IEAI.TH AGFNT. 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 HerS o S+- UNrr#--I- IS THIS UNITED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE OWNER/LESSER Lev T Cu11f,. MANAGER/AGENT I eo ; 6&JI v. NO P.O.BOX �y ADDRESS 3 ADDRESS CITY, STATE, ZIP i, /41 A ()IG 7-0 CITY, STATE,ZIP RESIDENCE PHONE2n8' 41.16 ^.2'� I GL. BUSINESS PHONE(24HRS) S07-4L( to'.2-7I :. TOTAL NUMBER OF ROOMS: T ROOM USE: 1.LI'u! .g AM 2. Uuu•j, Ra,3. KJfC 4. 5. 'JI 6. gN�o, 7. (�w� Kng 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 PAPA LE AT THE IME OF INSPECTION APPLICANT'S SIGNATUREDATE S A 6 SIS Inspectors use only Date on initial inspection: � Date of reinspection: Date of issuance of certificate: 111 Date fee paid: l� Type of unit: Dwelling Other Check#Check date: Notes: 4f e o ce entInspector o �� ooNo q, 5 9 City of Salem, Massachusetts Board of Health s 120 Washington Street, 4th Floor, Salem, y.�O MA 01970 Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, RENS, CHO Mayor health@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE#: GHL-16-241 DATE ISSUED: 7/14/2016 Property Located at: 3 HERSEY STREET UNIT#2 Owner/Agent: Leo Cullen Address: 3 Hersey Street#2 City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(508)446-2712 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 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 OFF HEALTH Larry Ramdin, MPH, REHS, CHO HEALTH AGENT S: I�D Jdnk0, SANITARIAN OTY O� S LEM, MASSACHUSETTS Irl BoAR I)OF 11i nLi H \tiul�c,rcm )ixi:ea,4"'FLOOR T'rl,. (978)741-1800 KIMBERLEY DRISCOLL F:\x (978) 745-0343 MAYORRAMD1N1 dSAr Fm CONI LARRY RA.NIDIV,RS/Rt'.IIS,CHO,CP-FS HEALll AGI?NT Application for Certificate of Fitness IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" n , , -EFEE:: $�5�0.00 2 y� PROPERTY LOCATED AT—, Jrd tM I l��� c Y91 �JM1�l7 D`qIT# IS THIS UNITIllI_SiGNnATEUS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE OWNER/LESSER LP./.�nc°�1_1U7 �/ F MANAGER/AGENT ADDRESS Ct 01,A l�_©C(\� I V- A N -ADDRESS CITY, STATE,ZIP )C3'�jT-O 1 k , V"A 0906 fa CITY, STATE,ZIP RESIDENCE PHONE BUSINESS PHONE(24HRS)598 BUSINESS PHONE TOTAL NUMBER OF ROOMS: `A n1n ROOM USE: 1. Lhll A6 2. XA 3. ltkj, 4. Vsxf 15. bQ� 6. Pi Pa 1 7. R)O}�n 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 YABLE A THE TIME OF INSPECTION APPLICANT'S SIGNATURE S DATE-7/ jj1jU- Inspectors use only Date on initial inspection: Date of reinspection: Date of issuance of certificate: - l0 Date fee paid: ' III 1Lb Type of unit: Dwelling�(_Other Check#Check date: I I I I I' Notes: �L,— (--� 3 , liDl� ,�� Code Enforcement Inspector i; NO. 1t>S 3 DATE -7/0" lD RECEIVED FROM ,u01ly Cullen i PC L�j C, Cola 00 DOLLARS ` Car 4 c�� �nns5 In ()eJ -)() Account Total $ 6000 °° t Amount Paid $ " 8 S.Ifvl1'nt� h; Balance Due $ -- —'-- Signature , Inspection of 3 Date Time //;?0fity? Name_ M 1 Cu 1 Gt'1 Address LII((a —pa, �P- Owner /'� In Tel. No.(Q Type of Inspection C(2!- !/�'Ca /,4 OP 77 D C Inspector ( * ) Remarks and Violations are listed below: /M (Mp Wa aco au Aepla,r or oluo a4jllct',. - o svIruAir d i vh e n j�a ctb—+ - /e S C'ab, n ►- , 110(fS� )akec-eoT se t - C ra LKS byIRS f�oc�O1p cc.s an Oil c/ �Ure (,i ti{ If and CUct l(S r LSIY1pU 4-)Q .0 Of G/f-kcA O VJ e-a S?'1Q ClI ec n 009 LC - ios C0702 1+01(? in 4-,)r)4 br?d moM ,SU-P en . PPQ(a e P S�vr en `o b5e,YvC-.e) CO KY--P-c4 J 1 ► ti 1 I L.7n U vin q ✓ oom / �',iM.fWuc! Q-2i nd(IAD Y)of I incr (7�' — S U t Jhea 0j 2&l On i/ ifad Q VJ$QAl COYYP -7 [/L1 I � la ( I Ivle� in Coate iose+ hlcheo osei- h iP5 b moven q es + er, b,,,�� nCI AD esu (-,61 Sur�,(05 Ck" smoo -h and C1UfGhle LA Lo Son x-,k e� oVJsa&V-ed b r-1-0 &�CJ -1 . 1L4I1(,p _ CC-I7POr rti r2 inSYOP( h',�hn u)hen 0l I repafC5 0 No -F ro ole 1'n L;L) dihIn rI Y00o l 6nreci- . PIQ C e n1j 0 66 " 0112 �P t rl LI u n ct rt;0vm . o"bS Co r e -7hyll & (- No 9noKP e Aq//Lk) Pear e0ioss., / hs tl ,s>no�e cre.k bb v �0�1 17/y Report Received bvN // r CITY OF SALEM, MASSACHUSETTS ` r BOARD O['HEALTH 120 WASHINGTON STREET,4...FLOOR TEL (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR uGIZ@P:NI3AUNI@r ALtiM.COM DAVID GRu I3NBAum,RS ACPING HEA1-LHA(,,I3N'r CERTIFICATE OF FITNESS CERTIFICATE#163-11 DATE ISSUED: 5/20/2011 Property Located at: 8 Hersey Street UNIT#2 Owner/Agent: Michael Chandler Address: 8 Hersey Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-4580 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 AL4"-) d Z�k - DAVID GREENBAUM, RS ACTING HEALTH AGENT CODE ENFORCEMENT INSPECTOR CM7 OF SALEM, MASSACHUSE-FrS BOARD or, HE,}LTI f J-20 W\S1[ING I'W\ �I m+�'I,41" 111,0OR Th.I­ (978) 741-1800 1 (9 18) 745-0343 iN4AYORyt�N] lAl.COM L) \\ 1D(;R,FENBAum,RS ACTIN(-, Hi-­\i,,i+i AGLM 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 S/ IJNIT4 IS THIS UNIT DISIGNATEDrAS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLEONE OWNER/LESSER Z -m MANAGER/AGENT-- NO P.Q.BOX P7— ADDRESS -ADDRESS— CITY, STATE,ZIP IT/ CITY, STATE,ZIP 'T RESIDENCE PHONE Z�� 7 BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS:– ROOM USE: 1. 1 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 TON APPLICANT'S SIGNATURE DATE C Inspectors use only Date on initial inspection:— Aq� 0 1 Date of reinspection: Date of issuance of certificate:— �-h 0 f I Date fee paid: L4�kdd// Type of unit: Dwelling_I- Other_,—Check#--P-"—Check date: Notes: C ent Inspector CITY OF SALEM, MASSACHUSETTS BOARD OF H&-kLTH 120 WASHINGTON STREET,4FLOOR TEL. (978) 741-1800 KIMBLRLLY DRISCOLL FAX(978) 745-0343 MAYOR DGIM]".NBAUMCreel M1EM.COM DAviD GRID I NB wM,RS ACTING HP?Al Al I AG[?NT Facsimile Transmittal To: C 1 C (' )J 1e\ L-LA ' )( t�P�UL� C6�,A-q Fax # RE: Date : �H Page(s): including this cover# Message: CL4t7 PP LkL o 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 TRANSMISSION VERIFICATION REPORT TIME : 05/25/2011 21:51 NAME : FAX : 9787450343 TEL : 9787411800 SER. # : 000BON341991 DATEJIME 05/25 21:50 FAX NO./NAME 919782825640 DURATION 00: 00: 34 PAGE(S) 02 RESULT OK MODE STANDARD ECM I n ` CITY OF SALEM, MASSACHUSETTS BOARD OF HI,ILTH 120 WASHINGTON STREET,4"'FLOOR JUMBERLEY DRISCOLL TEL. (978) 741-1800 MAYOR F'A\ (978) 745-0343 lramclin salcm.com LARRY RiAMDIN,RS/RFI-IS,CI 10,(Y-FS Hvm:I'II A(`iFN'1' CERTIFICATE OF FITNESS CERTIFICATE #221-11 DATE ISSUED: 7/13/2011 Property Located at: 8 Hersey Street UNIT#3 Owner/Agent: Michael Chandler Address: 8 Hersey Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-4580 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 HEALTH AGENT CODE ORCEMENT INSPECTOR f-. CITY OF SALEM, MASSACHUSETTSI`1/ - a - BOARD OF HEALTH 120 WASHINGTON STREET,4p.FLOOR TE:L. (978) 741-1800 IQMBERLEY DRISCOLL FAx (978) 745-0343 MAYOR LRANIDIN(Cl�SAIENIX70M LARRY RAMI)IN,RS/RIiHS,CI 10,CP-I5 HFAI.I1-I 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 F/Z� �f UNIT# IS THIS UNIT DISIGNATLfb AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE OWNER/LESSER /L1 / �i'�/f/I�LF��MANAGER/AGENT ADDRESS �`7 [J�S� I/ S`� [� ADDRESS � CITY, STATE, ZIP 2F// ��4`` /� q� cITY, STATE,ZIP RESIDENCE PHONE USINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS:- ROOM USE: 1. Y 2. 7- � e&3. /eZI 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 AT THE E 0 INSPEC N f APPLICANT'S SIGNATURE DATE lInspectors 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: 7 Notes: ( f ll. 0l\ ,Anti Code nforce ent Inspector CITY OF SALEM, MASSACHUSETTS '� • BOARD OF HEALI'[-I 120 WASHINGTON STREET,4".FLOOR TEL. (978) 741-1800 I IMBERLEY DRISCOLI. FAX(978) 745-0343 MAYOR cae:eNlsAUM7a nl.ltal.a>a� DAVID GRl?.E''.NB,N um,RS ACl'IN(- HI;AllI-I AG HNT CERTIFICATE OF FITNESS CERTIFICATE #433-10 DATE ISSUED: 9/8/2010 Property Located at: 20 Hersey Street UNIT# 1 Owner/Agent: Marie Barron Address: 3 Peppercorn Lane City/Town: Andover, MA Zip Code: 01810 24 Hour Phone: 978-886-9857 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 DAIDV GR'EENBAUwl,IRS ACTING HEALTH AGENT CODE ENP15RCEMENT INSPECTOR i CITY OF SALEM, MASSACHUSETTS 3 J ' BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGREENBAU [((ALEM.COAI DA\qD GREENBAum,RS 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." 1 FEE: $50.00 PROPERTY LOCATED AT Rersu1 ST • �K( �x t kA DIgl Zt> UNIT# IS THIS UNIT DISIGNAT AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE AI OWNER/LESSER 1" AM003 PKoP�;es LLC-MANAGER/AGENT MARIc &kPPo/J NO P.O. BOX ADDRESS-3- PEPPE_k(IIDOW CAU0 ADDRESS CITY, STATE, ZIP CITY, STATE,ZIP RESIDENCE PHONE-91&- 4-70 - 42>6`1 BUSINESS PHONE (24HRS)��� - 5$6 - R gS'j BUSINESS PHONE dftLE TOTAL NUMBER OF ROOMS: ROOM USE: 1. 41Z1iQ5J 2, 1J+ 3.L\V l u6 4. IDI UI uta 5. IJP 6. lbelp 7. 136-0 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 DATE9 -9 - 1 D Inspectors use only Date on initial inspection: o 110 I Date of reinspection Date of issuance of certificate: �0 Date fee paid: I i 1� qO Type of unit: Dwelling_�_ZOther Check#Check date: //O Notes: 0e q no— [/VG�fit/� jur(\- yP 6-r WC40-, Code Enforcement Inspector f �ND � City of Salem, Massachusetts 10 ,{ 3 IN:0- a Board of Health 120 Washington Street, 4th Floor, Salem, PUb1iCHealth MA 01970 P,c,c.,. Promote. Protect, Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, REHS, CHO Mayor health@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE#: GHL-17-181 DATE ISSUED: 6/28/2017 Property Located at: 20 HERSEY STREET UNIT#2 Owner/Agent: Derek Brown Address: 22 Rustic Lane City/Town: Reading, MA Zip Code: 01867 24 Hour Phone: 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. Note: This approval does not certify compliance with the state lead law for occupants under 6 years of age. Larry Ramdin, MPH, REHS, CHO HEALTH AGENT SANITARIAN r ' CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4°'FLOOR TEL (978)741-1800 IGNBERLFLY DRISCOLL FAX(978) 745-0343 MAYOR LRAAroIN@SACEM.CIM LARRY RAMDIN,RS/RENS,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 1() � C Se J est { UNITO is THIS tlNrr DISIGNA ED AS RIGHT LEFT FRONT OR BAA PLEASE CIRCLE ONE OWNER/LESSER e-,� Al, Q r-6 wn MANAGER/AGENT NO P.O.BOX ADDRESS ;Za V-S4i C I���— ADDRESS CITY,STATE,ZB' l`tea cJ /1 C�(�ln� CITY,STATE,Zi RESIDENCE PHONED a BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: C9 ROOM USE: 1. �< j 2. �� 3. 4. L`v �aw5. 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 lI DATE Inspectors use only Date on initial inspectiokbAti-fnI I Date of reinspectio Date of issuance of certificate: Date fee paid: Type of unit: Dwelling Other Check LA Check date: Notes: Cade Enforcement Inspector is CITY OF SALEM, MASSACHUSETTS t a BOARD OF Hr�i,,ni 120 WASHINGTON STREET,4T"FLOOR TEL. (978) 741-1800 KIM3ERLEY DRISCOLL FAX(978) 745-0343 MAYOR DCR1ar,N Au�7n w,Ilna.conl DAVID GR FJ;;NI3A U V1,RS A(-,'CIN(; W,m:CH AGI:N'I' CERTIFICATE OF FITNESS CERTIFICATE #431-10 DATE ISSUED: 9/8/2000 Property Located at: 20 Hersey Street UNIT#2 Owner/Agent: Marie Barron Address: 3 Peppercorn Lane CityfTown: Andover, MA Zip Code: 01810 24 Hour Phone: 978-886-9857 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 DAVID GREENBAUM, RS ACTING HEALTH AGENT COD FORCE MENT INSPECTOR • + CITY OF SALEM, MASSACHUSETTS i BOARD OF HEALTFI 120 WASHINGTONSTREET,4."FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR ucaceNisnu�rrs� .COSI DAVID GREENBAUM,RS 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." ' I FEE: $50.00 PROPERTY LOCATED AT c�O �eI S L. S At t�K RA L91 t -7 a UNIT# a 1� IS THIS UNIT DISIGNAT AS RIGHT LEFT FRONT OR BACK PLE�AASE CIRCLE/SONE OWNER/LESSER_I l 61iKKOAJ PROP(✓ T- -5 LU MANAGER/AGENT "LI�KtG 9A( OA) No sox ADDRESS—3 lh��� ��� r ^ ,W e ADDRESS CITY, STATE,ZIP AtJOD WX CITY, STATE,ZIP MA 0116i O RESIDENCE PHONEq 1S- LF7o - 4-4;�g7 BUSINESS PHONE (24HRS) O n$- 05(o -g eS -1 BUSINESS PHONE S Kntc- TOTAL NUMBER OF ROOMS:— ROOM OOMS:ROOM USE: 1. KrGt-k-_-1J 2. 6ATR 3. Lt0iut7 4. lll46)& 5. 4 lJ 6. 1° t> 7. 6&50 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 p Inspectors use only Date on initial inspection: 0/U Date of reinspection- Date of issuance of certificate: Cf q110 Date fee paid: 0 Type of unit: Dwelling ✓Othereck# /003 Check date: 9 8��D Notes: U C t�6`�/l \ VI reiglooL Ufb ab(/u�2 Ttoue_ add CWbi� Smo rrd e�n� L Currenfil GCtn+ Code Enforcement Inspector CERT.# 717-99 3 6p R FEE $25.00 DATE: 12/02/99 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(976)741-1800 Fax:(978)740-9705 CERTIFICATE OF FITNESS - PROPERTY LOCATED AT: 5 Hersey Street UNIT #: 1 OWNER/AGENT: Raymond Sobocinski ADDRESS: 5 Hersey Street CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-8769 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 0HEALTH JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR ti 3 � 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 II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". A PROPERTY LOCATED AT S �Z Se'+1 S `� q4 UNIT# IS THIS UNIT DESIGNATED ASIR GHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER - 1 0 00e_k At k l MANAGER/AGENT No P.O. Box No P.O. Box ADDRESS ADDRESS CITY C5,4 CITY RESIDENCE PHONE NI 971-9 BUSINESS PHONE (24 HRS.) -- BUSINESS PHONE `— TOTAL NUMBER OF ROOMS: ROOM USE: 1. ✓2. 9�3. '- 4. ✓ 5.�6. 7. 8. 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 SIGNATU u v DATE___/ I SP S USE 0 LY DATE OF INITIAL INSPECTION 'L f DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE .X f DATE FEE PAID: 1.,2- — 2— TYPE OF UNIT: DWELLING/ OTHER_ CHECK# .S'8 S 8 CHECK DATE NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 v� Ilk s CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT 11/23/99 Tel:(978)741-1800 Fax:(978)740-9705 Raymond & Genevieve Sobocinski 5 Hersey Street Salem, MA 01970 PROPERTY LOCATED AT 5 Hersey 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 the 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 One Week 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. 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 eo exist. FOR THE BOARD OF HEALTH REPLY TO Joanne Sco t, MHO PABLO VALDEZ HEALTH AGENT CODE ENFORCEMENT INSPECTOR f CITY OF SALEM, MASSACHUSETTS S BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR c SALEM, MA 01970 .� TEL. 978-741-1800 FAX 978-745-0343 JOANNE MPH RS CHO STANLEY J. USOVICZ, JR. SCOTT, , MAYOR HEALTH AGENT June 11, 2003 Joseph Kobos 6 Hersey Street Salem, MA 01970 PROPERTY LOCATED 6 Hersey 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. For the Board of Health Reply to Joa�t MPH, RS, CHO Pablo Valdez Health Agent Code Enforcement Inspector o ry CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 93 120 WASHINGTON STREET, 4TH FLOOR r c SALEM, MA 01970 . ? CITY OF SALEM, MASSACHUSE'I"I'S BOARD OF HEALTH 120 WASHINGTON STREET 4"'FLOOR PabUcHealth 1'r[ennl.Yfnmu,e.Pfnlrcl. TEL,. (978) 741-1800 FAX (978) 745-0343 I IMBERI.EY DRISCOLL ti'anidin(Da salel°n.com T ARR)7 R,ANIUIN,RS/ItI{I IS,CI 10,(T-RS MAYOR 1-11: I:CI])\(;];,N I' CERTIFICATE OF FITNESS CERTIFICATE #320-12 DATE ISSUED: 8/3/2012 Property Located at: 8 Hersey Street UNIT#3 Owner/Agent: Michael Chandler Address: 8 Hersey Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-4580 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 LAWIS RAMDIN HEALTH AGENT ' CITY OF SALEM, MASSACHUSETTS BOARD OF HEALfFI 2pgy 120 WASHINGTON STREET,4°1 FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR LIZA nxN(�s vr:sN[.co [ LARRY RANMIN,RS/RE11S,CI 10,C11-6S HvAF.;nf 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 /7Gy�`�y 1'� UNIT# 3 IS THIS UNIT DISIGNATED A RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE OWNER/LESSER C/�,e?�b'I�C �1L MANAGER/AGENT NO P.O. BOX A ADDRESS !fX 41 qf� ADDRESS CITY, STATE,ZIP -514L LL�)i /�Pf/ /d CITY, STATE, ZIP RESIDENCE PHONE�&Y_%�,f XJYd BUSINESS PHONE(24HRS) BUSINESSPHONE TOTAL NUMBER OF ROOMS: l- 3. ej /� 4..��E ROOM USE: 1.ff/��� 2. ,d5. 6. 8. 9. 10. THERE IS A FIFTY ($50)DOLLAR FEE,PAYABLE BY CHECK 04 MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE IS PAYABLE A E OF SPEC I APPLICANT'S SIGNATURE Y"IDATI!i5p 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: Co rcement Inspector o CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 CERT-4 277-02 TEL. 978-741-1800 FEE $25.00 Bc7,yplg D Fax 978-745-0343 ATE: 05/23/2002 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 10 Hersey Street UNIT #: 3 OWNER/AGENT: Rita Bailey _ ADDRESS: 10 Hersey Street CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-1389 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 O/F HEALTH JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CE N INSPEC OR o CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 3 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 ,pB9 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 �AL UNIT# IS THIS UNIT DESIGNATED AS RIGHT LEFT FR T BACK PLEASE CIRCLE ONE OWNER/LESSER MANAGER/AGENT No P.O. Box No P.O. Box ADDRESS ADDRESS CITY 44n CITY RESIDENCE PHON ? USINESS PHONE (24 HRS.) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1. 2. 3. 4. 5. 6.-7.-8. 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 INSPECTORS USE ONLY DATE OF INITIAL INSPECTION S%>-3 `Z" DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE:S 'a 3 -0 I-DATE FEE PAID: S a- 3 'a -- TYPE OF UNIT: DWELLINGOTHER_ CHECK# 17S a CHECK DATES 'r� -3 a L NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 i S • ,. y o CITY OF SALEM, MASSACHUSETTS BOARD 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 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 t'} e Cit; of. Salem Ordinance, undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Sall-m Board of Health or its author— ized 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/our absence, !/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. TE1,1A. f/LESSEE OWNER/L5'SSOR ADDRESS ADDRESS P A -- ADDRESS U-n, TO E iNSPFCfED ` l .good -- UAiE ca CITY OF SALEM, MASSACHUSETTS vQ' BOARD 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 05/09/2002 Hersey Street Realty Trust 10 Hersey Street Salem, MA 01970 PROPERTY LOCATED AT 10 Hersey Street UNIT # 3 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 the 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 One Week 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. 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 eo exist. FOR THE BOARD OF HEALTH REPLY TO oanne Scott, MPH,RS,CHO PABLO VALDEZ HEALTH AGENT CODE ENFORCEMENT INSPECTOR u CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 3 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 CERT.# 134-03 FEE $25.00 TEL. 978-741-1800 DATE: 03/27/2003 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 11 Hersey Street UNIT #: Bottom Rear OWNER/AGENT: Sam Allen ADDRESS: 97 Columbus Avenue CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-1580 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 NOR BUILDING RELATED CODES. FOR MORE INFORMATION CALL 978-741-1800 . FOR THE BOARD OF HEALTH JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR JUL 26 '99 10: 33 AM SALEM HEALTH +5087409705 Page 2 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 II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT t 2�Z _S�.<.__ UNIT#_�f IS THIS UNIT DESIGNATED AS RIGHT LEFT FRO PLEASE CIRCLE ONE OWNER/LESSERI�. � MANAGER/AGENT--__ No P.O. Box No P.O.Box ADDRESS_.r-! 7_�G CIN S.4c CITY__., _ RESIDENCE PHONE �� )�s�'�/J._BUSINESS PHONE (24 HRS_) _____ BUSINESS PHONE_.. . . _ . . .._ TOTAL NUMBER OF ROOMS: _.,. ROOM USE: 1.__ THERE IS A TWENTY-FIVE($25.00)DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. APPLICANTS SIGNATURE DATE. 35 . INSPECTORS USE ONLY / DATEQF INITIAL IN$pECTION�Ta -0 �._-DATE OF REINSPECTION____., DATE OF ISSUANCE OF CERTIFICATE:3.,,,>'7.7:�DATE FEE PAID: TYPE OF UNIT: DWELLING(Z CHECK#. �P_b CHECK DATE NOTES:_ CODE ENFORCEMENT INSPECTOR 9/28/98 i �,e,oxnrr - CERT.# 86-02 ga FEE $25.00 'i�,��'➢NB>iDATE: 02/20/2002 "h? 9q , CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 019,70- JOANNE SCOTT, MPH, RS,CHO 120 Washington Street HEALTH AGENT Tel: (978)741-1800 Fax (978)745-0343 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 11 Hersey Street UNIT #: lot Floor Front OWNER/AGENT: Sam Allen ADDRESS: 97 Columbus Avenue CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-1580 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" . I THEREFORE, THIS CERTIFICATE IS ISSUED BY THE CODE ENFORCEMENT DIVISION OF THE SALEM BOARD OF HEALTH AMD 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 THESTATELEAD LAW FOR OCCUPANTS UNDER 6 YEARS OF AGE. FOR MORE INFORMATION CALL 978-741-1800 . i FOR THE BOARD OF HEALTH JOANNE SCOTT, MPH,RS,CHO - HEALTH AGENT CODE ENFORCEMENT INSPECTOR I I i i i L Fein 19 02 11 . 32a Joanne Scozz Salem BOH 978 740 9705 P. 2 CITY OF SALEM, MASSACFIUSFETTS BOApp OF HEALTH �v • • 120 WASHINGTON STPEeT, 4TH FLOOR SALEM, MA 01870 TEL. 979-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JN. JOANNE SCOTT, MPH, RS, CHO MAT'OP HEALTH AGENT APPLICATION FOR CERTIFICATE OF FITNESS IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR UMAN HABITATION". PROPERTY LOCATED AT (- UNIT#— y IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER � MANA(E;MAGFNT-_, No P.O. Box / / NO P.O.Box ESS... _. RESIDENCE P14ONGZ,f , BUSINESS PHONF (24 HRS) _ BUSINESS TOTAL NUMBER OF ROOMS: ROOM USE: i THERE IS A TWENTY-FIVE(525.00)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 !"" _„DATES fr% � (L{,EECTORS USE ONLY / DATE OF INITIAL INSPECTION L'DATE OF REINSPECTION,, _ DATE OF ISSUANCE OF CERTIFICATE:;. v "o?r DATE FEE PAID:_.7, :: l't -Q TYPE OF UNIT: DWELLINGI(OTHER_ CHECK# S�Q `I CHECK DATE _2 !0 4,0 NOTES:, CODE ENFORCEMENT INSPECTOR 9!28!98 �ONOIT vQ� s Rpm CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970- 02/21/2002 JOANNE SCOTT, MPH, RS,CHO 120 Washington Street — 4`" Floor HEALTH AGENT Tel # (978)-741-1800 Sam Allen & James Flynn 97 Columbus Avenue Fax # (978)-745-0343 Salem, MA 01970 PROPERTY LOCATED AT 11 Hersey Street UNIT # 1L -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 andcertified 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. R THE BOARD 0HEALTH REPLY TO oanne Sco t, MPH 0 PABLO VALDEZ Health Agent CODE ENFORCEMENT INSPECTOR II` CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TFL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGItEI3NBAUM@SALBM.COM DAVID GRFENBAUM ACTING HEALTH AGF�NT CERTIFICATE OF FITNESS CERTIFICATE#561-09 DATE ISSUED: 10/28/2009 Property Located at: 11 Hersey Street UNIT#2nd floor Owner/Agent: Sam Allen Address: 97 Columbus Avenue 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, Chapter ll" 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 I D 1R E/BAW ACTING HEALTH HEALTH AGENT CODE E ORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS �j�f s ` BOARD OF HEALTH 120 WAM IINGTON STREET,4°i FLOOR TEI.. (978) 741-1800 KIMBLRLEY DRISCOLL FAx(978) 745-0343 MAYOR _)GRLEN13eu�.f&AL 1nM.COM DAVID GREENBAUM, ACTING HEALTII AGENT Application pp for o 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 r PROPERTY LOCATED AT` r f`�A UNIT#-r d +/oo✓, IS THIS UNIT DIISIGNATE RIGHT LEFT FRONT BACK, LEASE CIRCLE ONE `� w 1 OWNER/LESSER � II-Q,M1r) MANAGER/AGENT . NO P.O. BOXC �1 C ADDRESS �� `C7)l�V� 6, A ✓p 'SC CO ADDRESS �— r CITY, STATE, ZIP �eE (GI 7 O CITY, STATE, ZIP RESIDENCE PHONE' _1r4-~)LIS'" / G-SG BUSINESS PHONE(24HRS) BUSINESS PHONE ':Z6 � - TOTAL NUMBER OF ROOMS: 1. ROOM USE: 1 0-c-i 0 ^ 2 L V;rw�c . 33 ,a won 04_,C� 6_N- -`- 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 A//T'��THE ,�TIME OF INSPECTION APPLICANT'S SIGNATURE �i C i�.1L��—^ DATE-1 D/J-Cf)(39 Inspectors use onlv Date on initial inspection: (b a E161 Date of reinspection: Date of issuance of certificate: %DLaI Slo q Date fee paid: /G/015 Type of unit: Dwelling V Other Check"# J Check date: 16 dJ /) q Notes: %o-tx 6i a h i t/i(i��c oft GQ- C q bon m o6 OXIb d ecofo ' Qui S f(A �OOM1' ',I brGQmn' �— Code Enforcem Inspector CITY OF SALEM, MASSACHUSETTS ' BOARD OF HEAL11-1 120 WASHINGTON STREET,411' FLOOR TF-L. (978) 741-1800 IQMBERLLY DRISCOLL FAX(978) 745-0343 MAYOR DGRarNBAONdnDSA[1N.COM DA\TID GREF..NB.AUM, ACTTNG HE,u TH 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. 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. t T ant/Lessee Owner/Lessor Address Address Address on unit a inspected Date e �o CITY OF SALEMo MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR f o SALEM, MA 01970 mss. TEL. 978-741-1800 dam' FAX 978-745-0343 KIMBERLEY DRISCOLL JSCOTT@SALEM.COM MAYOR JOANNE SCOTT HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#281-08 DATE ISSUED:6/13/2008 Property Located at: 11 Hersey Street UNIT#Top Floor Owner/Agent: Sam Allen Address: 97 Columbus Avenue 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, 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 J NNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFO CE ENT IN CTOR A7..' �z l ANT , CITY OF SALEM, MASSACHUSETTS , ^ i + iINGT OF HEAE1'H 120 WASHINGTON STREET,4"'FLOOR C � TEL. (978)741-1800 'e<;:•h1,;Yibi,,iii.i,,i L/111J1.1J1.1, FAX(`//8) /45-0343 MAYOR ISCOTr SALEM.COM yyyy�. "p .r.5 A)iieu�rvS bi.�il i, x .HEALTH AGENT � t � tC ,4— .. i Application for Certificate of Fitness rnT AtIfInorNArir•c 1lnmU CmA= CAwirrAnv O�TNU OuAD=D it lnc SAM AlA non "MINIMUM STANDARDS OF FITNESS FOR HUMA HABITATION." — -, PR(IPFRTV l.ACATFn ATIiNTT# 1 Ol '1 ' AlE AS MUH1H1 LU I MON:1'URBACK,rLLASE CIRCLE ONE l OWNER/LESSER H15UN1XVO' MANAGER/AGENT ADDRESS Fr l ADDRESS CITY wSTATE,ZIP s9�Pjn� �� L'l� �D CITY.STATE.ZIP RESIDENCE PHONE �,�� S l���BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: S ;, ROOM USE: 1. 2. 3. 4. p� Y. IU. THERE IS A TWENTY-FIVE($25)DO LAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF . , vr.a....u. vv�.w v. .a.�u u. ..uv u.. ..v.�. uu.v u... .......v. ...u......w.. APPLICANTS SIGNATU DATE Inspectors use only Date on initial insnection: nate ofreinsnection: / Date of issuance of certificate: 6 'k) ',F Date fee paid: Type of unit: Dwelling ✓ Other Check# (o- b Check date: "L-a S' vores: 3a l CR.nU�u� wcti9DU W) Code Enforceme Inspector ^arCITY OF SALEM, MASSACHUSETTS of d€ 15OAR0 OF 11EALLH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 I IV1DG1V..L.1 L1l1Jl.VLL 1'AA l`l/25) /47-UJ4J MAYOR ISCOTTe SALEM.COM JUS NiNr..JiIji 1, HEALTi-i AGENT Release In accordance with Massachusetts General Laws Chapter 111; Code of Massachusetts Regulations 410.000 et. Seq. ; State Sanitary Code Chapter TI and Article XIII of the City of Salem Ordinance, undersigned owner/lessor and .. tenant/IAecaa of a nnit of racidAntial nrnnnrtar hArahv anthnriva thu CalPm Rnard of IlAaIth nr ite anthnrivAd a MA to inspect the residence identified below in accordance with the aforementioned statutes,regulations and ordinances. .. in the.Pvant it is nnracean+that eaid in enantinn ha(Inns in my/net ahcPnr. IhvP Pvnraeely anthnrivrd the cama and fnr my/our successors and assigns hereby release and discharge the City of Salem, Salem Board of Health and its authorized agents from any lose or injury sustained of whatever nature and description occasioned by my/out absence der;na said inenPrtinn v c""'X"Z�— Tenant/Lessee Owner/L dd s Address ddress on unit o be inspected L tae late ` CITY OF SALEM, MASSACHUSETTS "$ BOARD OF HEALTH c t9€3 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978.741-1800 FAx 978-745.0343 KIMBERLEY r)RISCOLL JSCOTT@SALEM.COM MAYOR JOANNE SCOTT HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#104-08 DATE ISSUED: 3/6/2008 Property Located at: 16 Hersey Street UNIT# 1 Owner/Agent: Ana Sanchez Address: 16 Hersey Street#2 CitytTown: Salem, MA Zip Cade: 01970 24 Hour Phone: 978-210-1032 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 ,I JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR S; CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • • �. 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 w v 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 11, 105 CMR 410.000 � Q "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". SFJ'" PROPERTY LOCATED AT���/ �' 4'� 1 JT UNIT#_j IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNERILESSER N� V"f� CJ�r�✓r � MANAGER/AGENT No R P.O. Box � F. D No P.O. Box ADDRESS _jk )4 S ��11` ADDRESS CITY nn�� CITY y RESIDENCE PHO @ t -` s'BUSINESS PHONE (24 HRS.) 2SJ f(0 BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1 2JA . 1ov _094. L i N OOM 5. —6.-7.-8. 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 i —DATE INSPECTORS USE ONLY DATE OF INITIALDATE OF INITIAL INSPECTION . `— _01 —DATE OF REINSPECTION_ — DATE OF ISSUANCE OF CERTIFICATE: DATE FEE PAID:_ 7 TYPE OF UNIT: DWELLI _OTHER__ CHECK #�I D_CHECK DATE 7_'6 NOTES: - --------- - -- CODE ENFORCEMENT INSPECTOR 9/28/98 CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH - 120 WASHINGTON STREET,4"FLOOR TEL. (978) 741-1800 IC NI BERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGRBC.NBAUM@SAr.HM.CQM DAVID GREENBAUM ACTING HEALTH AGrNr CERTIFICATE OF FITNESS CERTIFICATE#567-09 DATE ISSUED: 11/4/2009 Property Located at: 16 Hersey Street UNIT#2 Owner/Agent: Ana Sanchez Address: 19 Williams Street City/Town: Lynn, MA Zip Code: 01902 24 Hour Phone: 978-210-1032 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 BOA D OF HEALTH A -- _ DAVID GREENBAUM ACTING HEALTH AGENT CODE ENFORCEMENT INSPECTOR • A. > CITY OF SALEM, MASSACHUSETTS ' BOARD OF HEALTH 120 N)VASI UNGTON STREET,4"'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGR EENBAUM6 SALEM.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 ?/ O�S F� S1( S� Z JEP M ,4 D t 7� UNIT# nnIS�TjH S UNIT DI,SIIG�N/Ay(D/,1AS RIGHT LEFT FRONT OR HACK,PLEASE CHICLE ONE OWNER/LESSER Y` 1" �� �" �l Tl� MANAGER/AGENT NO P.O.BOX bi' p y 1 A A �J 7 ADDRESS 9 � / l�h- �( ADDRESS CITY, STATE,ZIP eCi� 1Ut� CITY, STATE,ZIP 1 f RESIDENCE PHONErI 1 -��v`� S^2 BUSINESS PHONE(24HRS}Qq 7{TI BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1 t',- 2 Z/ 3. 4. 5. 6, 7, 8. 9, 10. THERE IS A FIFTY($50)DOLLAR FEE,P4YABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE IS AY LE T THE T E OF INSPECTION APPLICANT'S SIGNATURE DATE Inspectors use only Date on initial inspection:___ /o % Date of reinspection: -Date of issuance of certificate: 'I./ — Date fee paid: illqT61 — Type of unit: Dwelling UOther Check#__._/1 -1—Check date: 1/Iq G 1 Notes: burn dcwn kuu GVO?l at,i Up acv kn 1N Jb4J-(�-�s� Gr. -b(4 *( VJ I n SA�la �ir.. 16(r- I��� bt^U do-es 00- Code EEnnfo e�lnsp&to3 I CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH 120 WASHINGTON STREET,4u"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR MANCINI(RSALr M1I.COM JANE I'MANCINI AC'I"ING I-I'EAL'I'I:LAG13NT CERTIFICATE OF FITNESS CERTIFICATE#235-09 DATE ISSUED: 5/18/2009 Property Located at: 20 Hersey Street UNIT# 1 Owner/Agent: Marie Barron Address: 2 Peppercorn Lane City/Town: Andover, MA Zip Code: 01810 24 Hour Phone: 978-886-9857 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. FOQR(THyE]�,BOARD �O�F�HEALTH OW JANET MANCINI ACTING HEALTH AGENT CODE CEMENT INSPECTOR 41 nn CITY OF SALEM, MASSACHUSETTS . BOARD OF HEALTH 120 WASHINGTON STREET,4'"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR )DIONNE&ALeM.COM JANE'r DIONNE, 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 a'--' UNIT#- '� IS THIS UNIT DISIGNATED ARIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE OWNER/LESSER E'l14-kIekerJ MANAGER/AGENT NO P.O. BOX /� ADDRESS 3 rapjW12/ 0 CAuc ADDRESS U CITY, STATE, ZIP LmUCk— CITY, STATE, ZIP / rry� 0/b/O RESIDENCE PHONE BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: (9- -7 ROOM USE: 1. K'ft v2. rA'U i c.c/ 3. 1);A.) 4. &t fll 5. �C 6. ISc t( 7. 8. 9 10. THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE IS PAYABLE AT THE TIME OF INSPECTION APPLICANT'S SIGNATURE ' """ DATE S- -1 f Inspectors use only Date on initial inspection: J /l� I o ti Date of reinspection:: Date of issuance of certificate: VIA 16-1Date fee paid: S Il d l o(1 Type of unit: Dwelling ✓Other Check# �� (i1'S Check date: �//d /0 Notes: aa& gevq Code Enforcement hwector ?� CITY OF SALEM, MASSACHUSETTS IV BOARD OF I IEALfH 120 WASHINGTON STREET,4".FLOOR PublicHealth rre.em.r.omme.rmac,. TEL. (978) 741-1800 FAX(978) 745-0343 KIMBERLEY DRISCOLL lramdina,salcm.com LARRY ILvMDIN,RS/RN IS,(:1 10,CP—ISS MAYOR Idem eirAGr•Nr CERTIFICATE OF FITNESS CERTIFICATE#231-14 DATE ISSUED: 7/10/2014 Property Located at: 20 Hersey Street UNIT#2 Owner/Agent: Derek Brown Address: 815 A Broadway City/Town: Revere, MA Zip Code: 0215124 Hour Phone: 781-710-7618 Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division3, Section 705: Certificate of fitness of rented dwelling unit, apartment or tenement. An inspection of your vacant Dwelling/Rooming Unit at the above address has been approved and is in compliance with 105 CMR 410.000: Massachusetts State Sanitary Code, Chapter II" Minimum Standards of Fitness for Human Habitation". Therefore, this Certificate is issued by the Code Enforcement Division of the Salem Board of Health and the unit may now be rented and/or occupied. Maximum Number of occupants, must comply with 105 CMR 410.000. Certificate valid for one year from date of issuance or until the current tenant vacates, whichever is later. This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy. FOR THE BOARD OF HEALTH LARRY RAADIN HEALTH AGENT SANITARIAN { + H CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STRFET 4'"`FLOOR PUbHC$@elth r Prevent.Promote.Pratt". TEL. (978)741-1800 FAX(978)745-0343 KIMBERLEY DRISCOLL Iramdin@salem.com MAYOR LrvRRl'}i,�MI}IN,RS/RFItS,Ci IO,CP-VS HEAT;ri 1 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 ��� r S i S J E M 1"1 tIN1T# Z IS'I ID'S UNIT DISII�GNATED AS RIG T LEFC FRONT�IR BACK LEASE CIRCLE ONE OWNER/LESSER PC e e(L (2y N MANAGER/AGENT NO P.O. BOX ADDRESS _ P5 7 70z6ft b 4l/A(, n ADDRESS CITY, STATE,ZIP (�u� A i is R CITY, STATE,ZIP RESIDENCE PHONE ?/0 7tIL �2 BUSINESS PHONE(24HRS> BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1. 2. 3. 4. 5. (61 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 FEEIS PAY E AT TWE ON INSPECTION APPLICANT'S SIGNATURE� / tc DATE Inspectors use only Date on initial inspection: /�l 1 l q Date of reinspection: Date of issuance of certificate: Date fee paid: Type of unit: Dwelling Other Check# —Check date: �— Notes: Code n cement Inspector