HILLSIDE AVENUE CITY OF SALEM9 MASSACHUSETTS
3
BOARD OF HEALTH
" 120 WASHINGTON STREET, 4TH FLOOR
r o' SALEM, MA 01970
q"�mNsv�' TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#357-04
DATE ISSUED: 07/29/2004
Property Located at: 27 Hillside Avenue UNIT# House
Owner/Agent: Charlene Gagnon
Address: 37 Sagamore Drive
City/Town: Andover, MA Zip Code: 01810 24 Hour Phone: 475-6226
An inspection of yourvacant 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 yearfrom 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.
F R THE BOARD OF HEALTH (/'*�/O o�a�
JOANNE SCOTT, MPH, RS, CHO /
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
• i 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
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 aZ� t�tJ�Str� t 4yF . UNIT#_
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSERC� eAM 0461 DAI MANAGER/AGENT _
No P.O. Box No P.O. Box
ADDRESS 37 $i1_lVy r= P&__.__ADDRESS
CITY (anc�Ode4 _CITY t yY A
RESIDENCE PHONE 978•4Z a BUSINESS PHONE {24 HRS)_ r/
BUSINESS PHONE_ f
TOTAL NUMBER OF ROOMS:_._6___ J
ROOM USE: 1.� ' 2.. t�1�✓�/ 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.
APPLICANTS SIGNATURE 7 DATE -7 `-'.Qy
INS, CTORSUj E ONLY
DATE OF INITIAL INSPECTION :',- j I l DATE OF REINSPECTION _
DATE OF ISSUANCE OF CERTIFICATEI_f_d'�DATE FEE PAID: 'r
TYPE OF UNIT: DWELLING, OTHER_ CHECK# -3- _ICHECK
CHECK DATE 2!�
NOTES: _
CODE ENFORCEMENT INSPECTOR 9/28/98
I
o
w h
f? CITY OF Stv:.,EM, MASSACHUSETTS
BOARD OP HF\I,TH
120 WASHINGTON SPR=f,4' FLOORhublicHea Ith
Pr(v(ni.Prom n,c.Pro If UI.
Tat.. (978) 741-1800 FAX(978) 745-0343
KlMB RI:.F.Y DIUSCOL , b-amdln@salgm.colTl
LARRY R.ANII)1N,Itti/Rlil IS,Cl IO,(T-FS
MAYOR I-II{,V:111 A(;I'N I'
CERTIFICATE OF FITNESS
CERTIFICATE #367-12
DATE ISSUED: 9/20/2012
Property Located at: 29 Hillside Avenue UNIT#
Owner/Agent: Bruce Lessard
Address: 375 Merrimack Street#18
City/Town: Methuen, MA Zip Code: 01844 24 Hour Phone: 978-741-0482
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.
ORTHE BOA OF H�gLTH
LARRY RAMDIN
HEALTH AGENT SANITARIAN
Sep-20-2012 08:48 Li'i 3M TOUCH SYSTEMS 9786599071 il'I
09/18/2012 21:45 9787450343 PAGE 02
4
CITY OF SALEM,MAS"z;t1C1IiISE`I"I'S lu
BOARD OF HEAVrH v FtibUcHeatth
120 WASHINGTON STRM' ',4 FLOOR Protvn 1'rmmtm Fmieni.
TZL,(978)741-1800 PAN(978)745.0343
KmBI3,RLEYDRISCOLL isamclin nalem,c LAlk1WIIAJMVN,it8/lWfl8,CI°I0.C:1'-K5
MAYOR T418AL'rt•T AGE+NT
AppUcation for Certificate of Fitne$$
IN ACCORDANCE WIT14 STATE SANITAF:Y CODE, CPIAPTER 11, 105 CMR 410.000
"N01MUM STANDARDS OF FITNESS FOR HUMAN HABITATION"
ItEE:5,;90.00
PROPERTY LOCATED AT-22--ALL S I z� Vic-
IS
A 1!�
IS TM UNIT DXSXGNA.TIM A$&=I&EX11tQ1,T 0At BA,CK,RT MUZ GIRCLO ONE
OWNERILESSM BA//' SSAR D XMAGEi2/AC ENT _
NO P.O.BOX
ADDRESS 37 /V/
_fEI44K 57 *JR ,ADDRE
CITY, STATE,ZIP / MiyL�aj9#4 QIT,Y, STATL,ZAP
RESIDENCE T-IONE��ir-7U(—.Q rte_- .BTJSINFSSPHONE(24HRS)
BUSMSS Plzlm
TOTAL NV�MER OF ROOMS:_
ROOM USE; 1.Ll �.[1j( AK 3.kr kAil 4 5. `
b. 7. S. 2, , 10.
TXT IS A FT.=($50)DOLLAR FEE,PAWLB BY CTiW7 OR MONTJY ORDER TO TT-IE CrN OF SALMI
I
BOARD OF I-SALTH 17-118 FBM IS PAYABLE AT T.INIE OF INSUCfION
APFUCANT'S SIONATUO � ='Vp _DATFJAS
Incecto �use ot>ly (�
Date on inmetl impeetion: f 1 1$'�a _ Date of reinapeotiou: -I
Date of ieaueace of cerucate: _� Date foe paid:_
Type of unit; DwelU�ng Other Checkd s„` )LCheckdate:� f
Notoe: d Co ht O lJ , 101O- 1Oc.k�
�ffi' re(n5�ec��� -�,(I violc�,t'vns cz�r�ec�ft�C�
Zd�
cr ement Inepeotor