Loading...
HIGHLAND STREET City of Salem, Massachusetts Wig Board of Health 120 Washington Street, 4th Floor, Salem, MA 01970 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-16-375 DATE ISSUED:9/30/2016 Property Located at: 51 HIGHLAND STREET UNIT#11- Owner/Agent: 1LOwner/Agent: JOHN STAVARIDIS Address: 51 Highland Street City/Town: SALEM, MA Zip Code: 01970 24 Hour Phone:(976)740-5656 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 it "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. e—� rey B s Larry Ramdin, MPH, REHS, CHO SANIT AN HEALTH AGENT On, OF SALEM, MASSACHUSETTS vi BOARD OF HEALTH 120 WASHINGTON STREL•T,4' FLOOR -ML (978)741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR RAA177tN R(R1SAi GU[OM 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" iiii FEE: $50.00 PROPERTY LOCATED AT i HI 11 UNIT# I IS TMS UNIT DIOGNATED AS RMUILW ER 6NT OR BACK.PLEASE CntCLE ONE OWNERAXSSE<�WU (( MANAGER/AGENT ADDRESS Hl`qh I Wj . ADDRESS CITY,STATE,21PMme,{�t/1!r CTTY,STATE,ZIP RESIDENCE PHONE c - 2�{D I BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OFA ROOMS: ROOM USE: I �t WW 2. 3. 4 S 6 7. 8. 9. I0. THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE P X AT THE TIME OF INSPECTION APPLICANT'S SIGNATURE DATE-40 1 Inspectors use only Date on initial inspection:C&Lql2o t7 Date of reinspection: Date of issuance of certificate: j6 Date fee paid:0q/291W Type of unit: Dwelling_ Other Check#2�� Cbeck date: Notes: Coe or ent Insp Mor R CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET 4'"FLOOR PRb�CHC81th STREET, Prevent.Promote.Protect. TEL. (978) 741-1800 Fax (978) 745-0343 KIMBERLEY DRISCOLL lram&ia salem.com MAYOR RS/IU-,I-IS,L,\RRY R,\MDIN,RS/IU-,I-IS,CIIO,CFS P- Hu,\Lt'il AGENT CERTIFICATE OF FITNESS CERTIFICATE #138-14 DATE ISSUED:4/30/2014 Property Located at: 25 Highland Street UNIT# 1 Owner/Agent: Bogdan Jucewicz Address: 12 Forest Road City/Town: Wakefield, MA Zip Code: 01880 24 Hour Phone: 978-314-9352 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 RAMDIN HEALTH AGENT SANITARIAN IU ® CITY OF SALEM, MASSACHUSETTS 136--) BOARD OF HEALTH 120 WASHINGTON STREET,4`"FLOOR PublicHealth Prevent Itromott.Pralect. TEL. (978) 741-1800 FAX(978)745-0343 KIMBERLEY DRISCOLL Iramdinna,salem.com MAYOR . ' LARRY IiAD1DIN,RS�RG:FIS,(1110,C11-C11-1;1',-F� HI?AI:PFI 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 2� L�l�?Al aI4 v/ S'f Salem, W UNIT# / IS THIS UNIT DISIGNA D AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE OWNER/LESSER 00601W LRUC& !�/t&ANAGER/AGENT ADDRESS 1 Z FO Prvr 7` RD ADDRESS CITY, STATE,ZIP W��r! CITY, STATE, ZIPS`�p�, RESIDENCE PHONE BUSINESS PHONE(24HRS) 979 311 / N35-2, BUSINESS PHONE TOTAL NUMBER OF ROOMS:- 6 r� ROOM USE: 1. SedP1`'0h 2. Se6l"0 B, &AW- 4. k'�4e,-5. 6. 6 7. 8. 9. 10. THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE IS PAYABLE AT THE TIME OF INSPECTION APPLICANT'S SIGNATURE DATE 3� Inspectors use only Date on initial inspection:3 O/14 Date of reinspection: Date of issuance of certificate: Date fee paid: Type of unit: Dwelling Other Check#Check date: 't Notes: Code nfAro iment Inspector 1 r CTIY OF SAI-E-W, NIASSACHUSEZU TS 1301Rt)Cllr F31 i]TH 1.20 W��srnNc rr�N Srxr rr,4"'1�LOOII ,,.��mo Tra;. (978)741-1800 F.tx (978) 745-0343 KIMBERLEY DRISCOLL Isantdixt a salem.coixt 1„\ItRY lttVlvlUIN,R$j AEil1S,(J 10,f;P-Ii5 MAYOR I-IFAI I n I A(d-,,N'I' CERTIFICATE:OF FITNESS CERTIFICATE#217-12 DATE ISSUED: 5/25/2012 Property Located at: 25 Highland Street UNIT#2 Owner/Agent: Bogdan Jucewicz Address: 25 Highland Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-316-9352 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 Occuparcy. FOR THE BOARD OF HEALTH LAR RAMDIN ,u HEALTH AGENT SANITARIAN CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4p.FLOOR TEL. (978) 74171800 a KINRIERL) Y DRISCOLL, FAX(978) 745-0343 MAYOR LRANIDIN(a S AIIN.COM Ln RRYRAMDIN RS/REf-IS,CIiO,CP-I'S I IPAIXJI AGI:�.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 l PROPERTY LOCATED AT �i/ �1� /0 /161 J � UNIT# 2 IS THIS UNIT DISIGNATELf AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE OWNER/LESSSER �© VON ,Tbele�t//�M�IAGER/AGENT ADDRESS 11-11-C717 10 6>/ J ADDRESS /J// CITY, STATE,ZIP_ _!, 4zc �� CITY, STATE,ZIP /y/ 7d ��/� 70 RESIDENCE PHONE BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER-OF ROOMS: //� / /J ROOM USE,./.?vpvo' 2. l�/1�C�Gt 34fII 4. J�IN1/G 5. 6. 7 8 9. 10. THERE IS A FIFTY($50)DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE IS PAYABLE AT THE TIME OF INSPECTION APPLICANT'S SIGNATURE DATE S Z F }-•+tt"'` 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 rcement Inspector f SAN "Q City of Salem, Massachusetts Board of Health 120 Washington Street, 4th Floor, Salem, PublicHea Ith MA01970 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-16-119 DATE ISSUED: 4/8/2016 Property Located at: 48 HIGHLAND AVENUE UNIT#1 Owner/Agent: George Hoxha Address: 52 Highland Avenue Cityrrown: Salem, MA Zip Code: 01970 24 Hour Phone:(978) 9446674 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 0, — Larry Ramdin, MPH, REHS, CHO HEALTH AGENT SANITARIAN * + CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR rn,snr�nemth me TEL. (978)741-1800 FAX(978)745-0343 KIMBERLEY DRISCOLL kamdin ,salem.com ' MAYOR LARRY RAMDIN,RS/REAS,CHO,CP-IS HEALIJ-]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 �k �0 (e UNIT# } IS THIS UNIT DISIGN TED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE OWNER/LESSERcor41_ x ti—Q- NO AGENT NO P.O. BOX ADDRESS E2 ``�; �. �1e (-\u e ADDRESS CITY,STATE,ZIP �..x ,w �/L� 1� _ CITY, STATE,ZIP y! Gt RESIDENCE PHONE �H�4 t f 1 Z 1 BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: I. l}c 2 c� 3 �_ 4 1 S 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-P-AYABL-E-AT TIMfi- INSPECTION APPLICANT'S SIGNA DATE U, Inspectors use only Date on initial inspection:.0 V-0.4 L Date of reinspection: Date of issuance of certificate: Q VQ"�21 ,_ Date fee paid:0Yj� f20Z Type of unit: Dwellin8�__Other Check#Check date: 0�j 12-0l Notes: y ems- reo ez x,K'F r,., I sfI rto s iw a WE7br4cem ,e pector I �Cn CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4°1 FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR INIANCINI[@SAIk3N1.IX)NI JANU I'MANCINI ACTING HEALI'FI AGI6N'I' CERTIFICATE OF FITNESS CERTIFICATE#617-08 DATE ISSUED: 12/2/2008 Property Located at: 51 Highland Street UNIT# 1R Owner/Agent: John Stavaridis Address: 51 Highland Street City/Town: Salem,MA Zip Code: 01970 24 Hour Phone: 978-979-1043 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 BOARPO HEALTH AR J4NET ACTING HEALTH AGENT CODE EN O CEME INSPECTOR CITY OF SALEM, MASSACHUSETTS • ♦ BOARD OF HEALTH �}QJ,� ' 120 WASHINGTON STREET,4"'FLOOR I 1��`' " TEL. (978) 741-1800 0 KIMBERLEY DRISCOLL FAX (978) 745-0343 MAYOR IDIONNE(C7�SALEM.COM JANET 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." 9� rL FEE: $50.00 n PROPERTY LOCATED AT H I q Y I�' (J I UNIT# IS THIS UNIT DI IGNATED RIGHT EFT FRONT OR BACK,PLEASE CIRCLE ONE OWNER/LESSERZIJn UIyVj0f4(S MANAGER/AGENT NO P.O.BOX i �y ADDRESS 5 t E I(T(�(I��I1nOp/l� ADDRESS CITY, STATE,ZIPq-�ppFyr I lri ©� I�I CITY, STATE,ZIP RESIDENCE PHONE USINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1. 2. N(/04n 3. 5. 6. 7. 8. 9. 10. THERE IS A FIFTY($50)DOLL EE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS F 'ISP Y THE TIME OF INSPECTION APPLICANT'S SIGNATURE DATE Inspectors use only Date on initial inspection: 1 .2- O Date of reinspection: Date of issuance of certificate: 1 L- L O Date fee paid: 1 Z 2- Type Type of unit: DwellingN! Other Check# Check date: I L- 7-- 6 F Notes: C Enforcement Inspector CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH 120 WASHINGTON STREET,4""FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR IutONNI,e SAI.EM.COM JANET DIONNE, ACTING 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. 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 Iner/Lessor 51 NiVI�� �uyl� Address Address 51 Niuln b 6)1'' 1R 'IAM IM A Address on unit to be inspected Date d�ONDiT� City of Salem, Massachusetts10 �. 9 Board of Health 120 Washington Street, 4th Floor, Salem, Public Health Prevent. Promote. Protect. MA 01970 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-15-309 DATE ISSUED: 9/25/2015 Property Located at: 51 HIGHLAND STREET UNIT#1L Owner/Agent: JOHN STAVARIDIS Address: 51 Highland Street City/Town: SALEM, MA Zip Code: 01970 24 Hour Phone:(978) 740-5658 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 ]] "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 U Larry Ramdin, MPH, REHS, CHO HEALTH AGENT ////SAN`lTARIAN/'� I CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4" FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOI-L FAx(978)745-0343 MAYOR txantpiN stiLeM.conl i LARRY RAMDIN,RS/RENS,010,(Y-FS i HRAun f AGENT 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" t ,�y din/� FEE: $50.00 PROPERTY LOCATED AT ,' �1� ��W 11V4 � L7ATIT# I L_ S THIS UNIT DIS CNATED AS O�1 T OR BACK PLEASE Cn2CLE ONE �A OWNERILESSER , 7A11,t 1�t MANAGER/AGENT NO P.O.BOX � J (_ ADDRESS 5t — _ ADDRESS CITY, STATE ZIP_ 1V--Vy�/I�t7_ �l�J/1 I t CITY,STATE,ZIP RESIDENCE FHONE f /U 7 th/` Cit11 1 BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1 2 b\A 9j 3.UW 1 4. 5. 6 7 8 9. 10. THERE IS A FIFTY($50)DOLLAR FEE,P ABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE LE T THE TIME OF INSPECTION APPLICANT'S SIGNADATE 2� IBJ Inspectors use only Date on initial inspection: W 2 l 4 nl2 Date of reinspection: Date of issuance of certificate:¢v2'f/�2EJZS� Date fee paid:O�IZ'{I20,1 S Type of unit:r Dwelling V'*� Other Check# J,9 3 Check date: D912_ J1 Notes: �t`�'U1Gn W1A ../ JOSt S4 46 d'g.a.&' Zr1jr_-,AdCee, � A 7Pll�� a.'1 flit 60-F Stn 'Oil )e rc� C e ' o ement In c;tor r CITY OF SALEM MASSACHUSETTS BOARD OF HEALTH s • $ 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#251-04 DATE ISSUED: 06/11/2004 Property Located at: 51 Highland Street UNIT#2 Owner/Agent: John Stavardis Address: 51 Highland Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-979-1043 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 JOANNE SCOTT, MPH, RS, CHO h HEALTH AGENT 41ww ENFORCEMENT INSPECT CITY OF SALEM, MASSACHUSETTS '� BOARD OF HEALTH • 120 WASHINGTON STREET, 4TH FLOOR ` SALEM, MA 01970 .yB. 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 II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT 51 H( dab nM Qt UNIT#2, IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER,,. l ( MANAGER/AGENT No P.O. Box . c No P.O. Box ADDRESS 5I I"I�;1hI l�� ADDRESS CITYSoAuy,\ CITY RESIDENCE PHONE BUSINESS PHONE (24 HRS.) BUSINESS PHONE TOTAL NUMBER OF ROOMS:_ ROOM USE: IW 2. 3. 4. LiV, '21VI) 5.1*ft, 6. 7. 8. THERE IS A TWENTY-FIVE($25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM ALTH TMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. APPLICANTS SIGNATU E DATE INSPECTORS USE ONLY DATE OF INITIAL INSPECTION 62 D DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: DATE FEE PAID:_6� TYPE OF UNIT: DWELLING_OTHER_ CHECK# /y_ CHECK DATE / z�/ NOTES: �/ CODE ENFORCEMENT INSPECTOR 9/28/98