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HOLLY STREET f rpND City of Salem, Massachusetts f us N. 10 Board of Health 120 Washington Street, 4th Floor, Salem, P«�PgbC�O18eetth MA 01970 e. Protect. 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-16-361 DATE ISSUED: 9/30/2016 Property Located at: 18 HOLLY STREET UNIT#2 Owner/Agent: Henry Vancelette Address: 20 Holly Street City/Town: Salem, MA 01970 Zip Code: 24 Hour Phone:(978) 745-9897 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. Jeff y Ejv� Larry Ramdin, MPH, REHS, CHO HEALTH AGENT SANITARIAN CITY OF SALEM, MASSACHUSETTS v BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR SAL TEL. (978)741-1800 FAX(978)745-0343 KIMBERLEY DRISCOLL h'amdin@salem.com ' MAYOR LARRY RAMllDJ,RS/RENS,CIiO,CP-FS HL'ALTH 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 8 Z6tY�% Y/_ UNIT# Z IS THIS UNIT DISIGNATED AtRIGH LEFT FRONT OR BA PLEASE CIRCLE ONE OWNER/LESSER /Xlwir . Y L MANAGERIAGENT NO P.O. BOX T- ADDRESS ADDRESS �D / T CITY, STATE,ZIPp� er/ CITY, STATE,ZIP RESIDENCE PHONE BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: `/ ,(1 ROOM USE: 1 2 � 3 A 4 5. /a'f0;*^� 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_ nom • U� DATE ' -'L/' l+G 0 Inspectors use only Date on initial inspection:Q 2(J , Date of reinspection:O /2�/ LV Date of issuance of certificate:�4�2�/� Date fee paid: 0 y/ 2nz / T- Type of unit: Dwellin V 'Other Check# y2�8 Check date: 2 Notes: Sc,e A+la C ement b? ctor Irfspectiodof ri grdize'd Date 0!�Z21/Time r NameAddress 2Q S p� Owner 0at), Tel. No. 9 !d-7YJ-q?j7 Type of Inspection_GP-r 1' i'tn4e, o F !'r Ima Inspector JG e p ( ' ) Remarks and Violations are listed below: t C n / (� I r IA MCj"K(je- le"U h ks� be, 4 -f I a 1-0,Q-4 /nnt oyl vnoM P.n�rQncP. t t v rn YoO V. Yl 0 G YOU Q2 r a Y 0. t j n i r�,, n w $� ✓ Yn Q n�rQnrP hpp0. o rn St YeCYI Kcna r @y YP� aCe scfeen. � r Report Received by: Z U�zvrX.r-f/�/ { "`oNniT"�d4 City of Salem, Massachusetts n LJ m Board of Health > 9' 120 Washington Street, 4th Floor, Salem, Public Health MA01970 Prevent Promote. Protect. 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-15-197 DATE ISSUED: 7/30/2015 Property Located at: 2 HODGES COURT UNIT#1 Owner/Agent: Gerald Wilkens Address: 18 Savoy Road City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(978) 7444760 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 SANITARIAN �Y CITY OF SALEM, MASSACHUSETTS IAJ r - BOARD OF HEALTH I t ,3 00' 120 WASHINGTON STREET,4"i FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR LRAMDIN@SN.,FM.00M LARRY RAMDIN,RS/REMS,CI I0,C114S H 2.AL 17-I AGI�:,M, 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: $50.0/0 c ,( PROPERTY LOCATED AT Z ]`YOGI rr2 S G? - �Szj_elu I Wlq7D UNIT# 1 IS THIS UNIT DISIGNATEI1 D AS1 IG1BACK LEFT FRONT OR PLEASE CIRCLE ONE OWNER/LESSER 1�1 �n 4aP-eT W l J Kens MANAGER/AGENT &5 NO P.O. BOX / -� ADDRESS 1,6 v/v Rd ADDRESS CITY, STATE,ZIP SQ' Q n� CITY, STATE, ZIP RESIDENCE PHONE 975? 2441 ,d BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOMUSE: 1.Liyii9ri 2. 6. 1j7. 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 SIGNATURES/ DATE "Z- 7 S� Inspectors use only Date on initial inspection: PD 1,/2_gl2DIr Date of reinspection: Date of issuance of certificate' D7�L9�2oZs Date fee paid: 07/29/Z015- Type of unit: Dwelling Other Check#-'->09 3 Check date: 07zz&)b14_ Notes: co le,'eC+nYS, ✓o-Irna {-erbAse,me.v1f S +allSi Co / br9 ment InX ectorI _'cy7 1 rt x a-_ r . •s --•. .. _ b � .. .. ��.toNOIT �v a � n CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel: (978)741-1800 05/16/2001 Fax:(978)740-9705 Regina Wharff 2A Holly Street Salem, MA 01970 PROPERTY LOCATED AT 2 Holly Street UNIT # 2 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 hoursareMonday thru Wednesday from 8:00 a.m. - 4:00 p.m. Thursday 6:00 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. R THE BOARyD�O .HEALTH REPLY TO Joanne Scott, MPH,RS,CHO PABLO VALDEZ HEALTH AGENT CODE ENFORCEMENT INSPECTOR ga.1T�a� n � 71 a °'ONE CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS, CHO NINE NORTH STREET HEALTH AGENT p9/11/2000 Tel:(978) 741-1800 Fax: (978) 740-9705 Mark Rogers 3 1/2 Holly Street Salem, MA 01970 PROPERTY LOCATED AT 3 Holly Street UNIT # 2 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. qR THE BOARHEA TH D REPLY TO Joanne Scott, MPH,RS,CHO PABLO VALDEZ HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS o m BOARD OF HEALTH s 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 W W W.SALEM.COM Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO Mayor HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#601-06 DATE ISSUED: 12/7/2006 Property Located at: 4 Holly Street UNIT# 1 Owner/Agent: Elvin Rodriguez Address: 4 Holly Street#2 Cityrrown: Salem, MA Zip Code: 01970 24 Hour Phone: 781-389-5844 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 a6ANNE SCOTT, MPH, RS, CHO k C �6J�'/rif79 HEALTH AGENT CODE ENFO CEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS /) n BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR 1�C� a SALEM, MA 01970 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 II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT u N O \\ � S)- e- UNIT# \ IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER'iA V\ N R,06(_ \5` -2-MANAGER/AGENT No P.O. Box . No P.O. Box ADDRESS `\ \��\ y S� Y �� a ADDRESS CITY CITY ��SS RESIDENCE PHONE _BUSINESS PHONE (24 HRS.nti3�q-S�y`1 BUSINESS PHONEoboe TOTAL NUMBER OF ROOMS: L5 ROOM USE: 1.R�c4Y�l�YY12.11y ',Ag� �`�\t°a r�oM 4 \, 90 5. 6. 7.-8.— THERE . 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. q APPLICANTS SIGNATURE �C._ ." ✓ �_ _ t DATE INSPECTORS USE ONLY DATE OF INITIAL INSPECTION /b-7-14415 DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE:-a a DATE FEE PAID:_��' TYPE OF UNIT: DWELLING(�OTHER_ CHECK # _CHECK DATE NOTES: CODE FORCEMENT INSPECTOR 9/28/98 CITY OF SALEM9 MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 -"� TEL. 978-74 1-1800 FAX 978-745-0343 KIMBERLEY DRISCOLL JSCOTT@SALEM.COM MAYOR JOANNE SCOTT HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#620-07 DATE ISSUED: 12/18/2007 Property Located at: 4 Holly Street UNIT#3rd floor Owner/Agent: Elvin Rodriguez Address: 4 Holly Street 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 JIANNE T, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON 'STREET, 4TH FLOOR �r SALEM, MA 01970 TEL. 978-741-1800 • ,4 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO Kimberley Driscoll HEALTH AGENT Mayor 1 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 �, H�1 \\ S\ UNIT# IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE \�i J Rev �e 2. OWNER/LESSER — �_MANAGER/AGENT No P.O.Boxy SYC��.} �NoP.O.Box ADDRESS ` j ADDRESS CITY \� RESIDENCE PHONEQ� BUSINESS PHONE {24 HRS) BUSINESS PHONE_ _ TOTAL NUMBER OF ROOMS: 1 ROOM USE: THERE IS A TWENTY-FIVE($25.00)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SA M HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. n ^ � APPLICANTS SIGNATURE DATE _ NJ SPECjORS USE ONLY 1 D E O I TIAL IN E I _'l 'v DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: ._DATE FEE PAID:_L ~�? TYPE OF UNIT: DWELLI OTHER— CHECK# CHECK DATE NOTES:----- CODE OTES: _—_CODE ENFORCEMENT INSPECTOR 9(28198 CITY OF SALEM, MASSACHUSETTS BOARD OF HFALTH 12O WASHINGTON STRFEr,4'''I�LOO]) TEL (978)741-'1800 KIMBERLFY DRISC:OLL FAX (978) 745-0343 MAYOR Irain&n s, em.com L/tII,IY RAMI7I N,1tS f7t F.LiS,C(i0,C3'-iTS H r.v:rrr Ac,F.N r CERTIFICATE OF FITNESS CERTIFICATE#192-11 DATE ISSUED:6/15/2011 Property Located at: 5 Holly Street UNIT# 1L Owner/Agent: Sparta Realty Address: 241 Lafayette Street 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 .Y � /I�I LARRY RAMDIN HEALTH AGENT CODE ENFORCEMENT INSPECTOR I a_ 15() wl) ( w 111 \1 I 11 120 P\(;'i0\ S I R I I.1, 4 11 ( )( )k (978) 74 1-1800 KIMBFIZLF.), DRISCOLL (978) 45-0343 I w S I I \R1 \x 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 sr PROPERTY LOCATED AT S I UNIT4 —I-LIS IS TH IS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK, PLEASE CIRCLE ONE OWNER/LESSER &OP&Jn P 9"L —MANAGER/ AGENT NO P.O. BOX ADDRESS Q41 LQ-( iyo 4Me) S-E ADDRESS CITY, STATE, zip S- Pftvim MA 01-7 _CITY, STATE, ZIP RESIDENCE PHONE BUSINESS PHONE (24HRS) BUSINESS PHONE 7&-.)Lfq 017 TOTAL NUMBER OF ROOMS:— ROOM USE: 1. LIQ 2. 3. 4. 5. be- 6. 7. 8. 9. to. 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 Inspectors use only Date on initial inspection: 10 Date of reinspection:_ Date of issuance of certificate: Date fee paid: Type of unit: Dwelling Other Check 4 22516!2 Check date: g -) �94 Notes: A de On orcermnaentInspector r' € o.� CITY OF SALEM, MASSACHUSETTS �t a 11OARDrn. HEm:rH y� 120 WASHINGI N Srar.H:Er 4... Pi.()()R 17a.. (978) 741-1800 KI.,MBERLEY DRISCOLL FAx (978) 745-0343 MAYOR IUIONiNBns'yI r%i.CODI JANE rDIONNE, SENAORSANTT. RIAN 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. 6 In the event it is necessary that said inspection be done in my/out absence. 1/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 4 during said inspection. Tenant/Lessee Owner/Le sor S it k7)-LW QST St'gWM Address Address 51-- Address on unit to be inspected Date 1 CITY OF SALEM, MASSACHUSETTS r + BOARD OF HEALTH 120 WASHINGTON STREET,4`"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR IMANCIN19SAI I°M COM JANI I'MANCIN I- - -- - - AC'T'ING Hi;,Aj.fl-1 AGBN,r CERTIFICATE OF FITNESS CERTIFICATE # 137-09 DATE ISSUED: 3/12/2009 Property Located at: 5 Holly Street UNIT#2 Owner/Agent: Sparta Realty Address: 241 Lafayette Street 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 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 OF HEALTH 2 -4 kETMANCINI ACTING HEALTH AGENT CODEENFORCEMENT-INSPECTOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 137 ,09 120 WASHINGTON STREET,4"`FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR io1oNNE(a�Syu.EM COM JANET DIONNE, SENIOR SANITARIAN 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 LL. j (Sr - 0tta) -r7L UNIT# IS IS THIS UNIT DISIGNATED AS RIGHT LEFT'FRONT OR BACK PLEASE CIRCLE ONE OWNER/LESSER PPR PC�LTil MANAGER/AGENT NO P.O.BOX �} ADDRESS C�� l �yCQ.I/,e I I�(�i r ADDRESS CITY,STATE,ZIP ��1 Y I CITY, STATE,ZIP RESIDENCE PHONE BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1. eR 2. JSR 3. `l � 4. L)C— 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 OF INSPEC\T,IgNr� APPLICANT'S SIGNATURE (��(( DATE Inspectors use only Date on initial inspection: 3' Z- D Q Date of reinspection: Date of issuance of certificate: 3 \Z.-d S Date fee paid: 3- ) 2--a3 Type of unit: Dwelling v'-� Other Check#1 $ 1 '40 Check date: *3 -0--o S Notes: Code En orcement Ii Spector CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 WWW.SALEM.COM Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO Mayor HEALTH AGENT 2/6/06 Steven & Heidi Polemanakos 241 Lafayette Street Salem, MA 01970 PROPERTY LOCATED AT 5 Holly Street Unit 2L 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 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. to 7:00 p.m. and Friday 8:00 a.m.— 12:00 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 tenant's entire utility bills retroactive to the date of initial occupancy in cases in which cross-metering has been proven to exist. r the Board of He th Reply to Joanne Scott MPH, RS, CHO Pablo Valdez Health Agent Code Enforcement Inspector � o vg '� °- CERT.# 110-01 FEE $25.00 DATE: 03/02/2001 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tel: (978)741-1800 Fax:(978)740-9705 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 6 Holly Street UNIT #: 2 OWNER/AGENT: John & Bertha Cappuccio ADDRESS: 49 Orchard Street CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-8635 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. OR THE OF HEALTH , JOANNE SCOTT MPH RS CHO v HEALTH AGENT CODE ENFORCEMENT INSPECTOR i 6 01 n M 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 :iT • UNIT# Z IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER C Ll'O MANAGER/AGENT No P.O. Box No P.O. Box ADDRESS 0 !z c-/A ,�, E' n 57ADDRESS �1 CITY RESIDENCE PHONE 7V1�1-576- ?Z BUSINESS PHONE (24 HRS.) BUSINESS PHONE TOTAL NUMBER OF ROOMS:_ ROOM USE: 2. �— ✓ 3._:4. j 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 SPECTO S ONLY DATE OF INITIAL INSPECTION 3 -a' `p ( DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: 'd " DATE FEE PAID: 3 - TYPE OF UNIT: DWELLINq/V OTHER_ CHECK# Sod 4 y CHECK DATE NOTES: J CODE ENFORCEMENT INSPECTOR 9/28/98 v���oNU(T CERT.# 383-99 FEE $25.00 DATE: 07/23/99 ��MINB CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Fax:(978)740-9705 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 8 Holly Street UNIT #: 1 OWNER/AGENT: Richard Harvey ADDRESS: 8 Holly Street - CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-1377 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 DOSS 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 OF HEALTH JOANNE SCOTT, MPH,RS,CHO /V/ HEALTH AGENT CODE ENFORCEMENT INSPECTOR 6 &, CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,OHO 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 �GGr, S �GE� UNIT#/ IS THIS UNIT DESIGNATED A IG EFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER gIaAiea YgkM,( _MANAGER/AGENT _ No P.O. BoxNo P.O. Box �r ADDRESS-f !6Y 5 (-- ADDRESS_ 't Y � CITY_ CITY V S RESIDENCE PHONE t/- �✓?_ 77 .,.._BUSINESS PHONE (24 HRS.) BUSINESS PHONE TOTAL NUMBER OF ROOMS:_._.,.___ ROOM USE: 1. f 1'rl 2_612—d' lkW6v 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. q `•APPLICANTS SIGNATURE S XV DATE_ s ;Y INSPECTORS USE ONLY DATE OF INITIAL INSPECTION - =`t. _DATE OF REINSPECTION _ DATE OF ISSUANCE OF CERTIFICATE?�oZ 5 l 4 DATE FEE PAID:Z �- 's --q 9 TYPE OF UNIT: DWELLING OTHER_._ CHECK#_CHECK DATE 7_1_2e` -,5�5 NOTES:--- CODE OTES: _CODE ENFORCEMENT INSPECTOR 9/28/98 4 6 111F a CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 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 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 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. T/ ESS r; OWNER/LESSOR �W�t UTA- `� ADDRESS f,D,DRESS �� ADDRESS OF UNIT TO BE INSPECTED CERT.# 555-97 3 R FEE $25.00 DATE: 08/14/97 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 9 Holly Street UNIT #: 1 OWNER/AGENT: Matthew M. & Valentina D.M. Burbank ADDRESS: 9 Holly Street CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 740-0492 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 HEALTH DEPARTMENT 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 THE BOARD O�� / 96 V �Ay/ ' z A JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR i p CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tei:(508)741-1800 APPLICATION FOR GERTIFICTE OF FITNESS Fax:(508)740-9705 IN ACCORDANCE WITH STATE SANITARY'CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT � UNIT I ' OWNER/LESSER 1 1 f < I �J _[Lr�404 J/ AVMANAGER/AGENT ADDRESS Ll VJ 4. �TGj� ADDRESS CITY �J� �1� `; t • t ' ► 7o CITY RESIDENCE PHONEEO .GI d (/ Z� BUSINESS PHONE (24 HRS.) BUSINESS PHONE 12 . o/ a 7 TOTAL NUMBER OF ROOMS: Z ROOM USE: 1.�'L+.j_2. 11V�� uv 3. `7✓V�00/J 4 . 5tl�2i0,1/7 5 o 1_6. D�V�, ,.7. 8. THERE IS A TWENTY-FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK OR HONEY ORDER TO THE CITY OF SALEM HP.ALTR DEPARTME THIS F S PAYABLE AT THE TIRE OF INSPECTION APPLICANTS SIGNATURE-� DATE INSPECTORS USE ONLY DATE OF INITIAL INSPECTION: f' DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: C. l GATE FEE PAID: 9' —/I(-, �} TYPE OF UNIT: DWELLING—�- OTHER NOTES ' '� 1✓ 6 w�. L� CODE ENFORCEMENT INSPECTOR L CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH " 3{ 120 WASHINGTON STREET, 4TH FLOOR o SALEM, MA 01970 9�A TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. UISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#580-05 DATE ISSUED: 9/19/05 Property Located at: 11 Holly Street UNIT# 1 Front Owner/Agent: Bruce Whear Address: P.O. Box 8291 City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-8219 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 r JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR SCIP . 12 05 lo: 211a Jeanne Scott Salem DOH 978 '745 0343 P. 1 CITY OF SALEM, MASSA C"USETT1,; SCARD 0F r- EAi Tl i 20 WAS H.I NOTON STrqc.E� 4111 FLG1)Fi 5 A 1,r NIA 0 1 370 TEL 978,74 FAX 978-745-0343 17 u5ovlcz' jpl .JOANNE SCOTT, NIPH, R5. Ch() MAYOR HEALTH AGLN' APPLICATION FOR CERTIFICATE OF i"ITHFSS IN ACCORDANCE.WITH STATE SANITARY CODE, GHAPTUI 11, 105 Cf,-IR 410,000 "KNIMUM STANDARDS FITNFSS FOR HUMAN H'61'r'ATi3IT'. qJ PROPERTY LOCATED AT-, UNIT f IS PHIS UNIT DESIGNATED AS RIGHT PLEASE CIRCLE ONE oWNER,L.ESSFI1 AQ(y� No P.O.8 No P.O.,Box ADDRESS- ADDRE -US'11NES$ PHONIC HIR".1, rsuslNEs7 PHONE TOTAL NUMBER OF ROOMS: 1-100ki US� 2,_ 3, 4 THERE IS A TWENTY-FIVE($25.00)D F 1 'ABL - YCHECKORMONEY ORDER TO THE CITY QrSAI TH A MIEN ' .III$ IS PAYABLE AT THE TIME OF MSPrC,110 APPLICAN TIS SiGINAI WA7J7,("IF IN!f'IAL !NSPF.0 11 DATE OF!SSUANOE OF CERTIFICATE: r J,2,oAbA7F FEE PAID: TPE OF UNF: DWELLIN' THER— CHFCrK#3A_9 H F O rES:__ _�L� KDATE ., N ................ C E M F N T I N S P E C 0 R CERT-� 13-97 eY e FEE $25 CO '. DATE: 01/14/97 . Ati x - / CIT- OF:SALER BOARD OF HEALTH ' '_ Salem; Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS;CHO - - - . . INE NORTH STREET HEALTH AGENT Fel:(508)741-1800 Fax:(508)740-9705 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 11 Holly Street UNIT � 2 OWNER/AGENT: Bruce Whear ADDRESS: P.O. Box 8291 CITY/TOVeN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-8219 AN INSPECTION OF YOUR VACANT DWELLING/ROOMING UNIT AT 'rHE AlBOVE ADD=S HAS BEENAPPROVED AND IS IN COMPLIANCE WITH 105 CMR 410,000: MASSACHUS='s STATE SANITARY CODE, CHAPTER II, °MINIMUM STANDARDS OF FITNESS FOE HUMAN H'--STATION" . THEREFORE, THIS. CERTIFICATE IS ISSUED BY THE CODE ENFORCEMENT DIVISI:CN OF THE SALEM HEALTH DEPARTMENT AND THE UNIT MAY NOW BE RENTED AND/©R OCCUPI'. MAXIMUM NUMBER OF OCCUPANTS, BASED ON 105 CMR 410.000': MASSACHUSETTS STATE - SANITARY CODE, CHAPTER II, "MINIMUM STANDARDS OF. FITNESS Fess. HUMAN H?'ITATION" . SECTION 410 .400 (B) : DWELLING UNIT (X) AND 410.410 (C) : MOMING UN---- MINIMUM N-MINIMUM SQUARE FOOTAGE FOR SLEEPING PURPOSES: NOTE: THIS APPROVAL DOES NOT CERTIFY COMPS,IANCE WITH THE STATE LEAD ]AW FOR OCCUPANTS UNDER 6 YEARS OF AGE. ,FOR THE BOARD OF HEALTH day JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFClRCEMENT IIC-PECTOR ��ad a'•. b 5,'fi�T1�a'�i' '�'� sC` ! O fa ,`' .� Hv .. p tY 'tri*k� v '�p�4 i �F r-_ i �s r '`Ly..«, +t• iF 0.2 ! \ 4 e. [ - •� -S` aty�" 114111, { ���� � ' . `3..vM.�' h `.i" F i♦ r.. a t k'+ t s. r y Gam '" '� �" '� '" r G17YtOf� SALEM, BC�A�D OF,'HEALT9:1` f'�'' _�'�"`�•✓� s z ' Salem;Ma'ssachuaett�01970=3928 , JOANNE SCOTT,MPH;RS,CHO - - _ . - NINE NORTH STREET '„f.HEALTH AGENT" , : . . Tel:(508)741-1800 APPLICATION`FOR C?:RTIFICTE OF'FITNESS ;Fax:(508)740-9705 TN ACCORDANCE WITH STATE SANITARY:CODE„CHAPTER II; 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT UNIT € OWNER/LESSER (f / n / MANAGER/AGENT ADDRESS_ ADDRESS C-ITY S 4 ��!2 CITY RESIDENCE PH-01M BUSINESS PHONE (24 HRS.) f;(F(? BUSINESS PHONE TOTAL NUMBER OF ROOMS. ROOM USE: I. 0)P C( 2. /J.��_3. �l� 4. s.�c�ot"G GS G. 7. THERE IS A'TWEHTY-Fm (25.00) DOLLAIR.FEE, PAY BY CHECK OR MONEY ORDER TO THE CITY OF SALEM HEALTHDEPARTME THIS IS ABLE AT THE TIME OF INSPECTION APPLICANTS SIGNATURE DATE F — / INSPECTORSUSEONLY DATE OF INITIAL INSPECTION: ` — z DATE OF REINSPECTION _ DATE OF ISSUANCE OF CERTIFICATE:__/,/ q 7 DATE FEE PAID: TYPE OF UNIT: DWELLING OTHER— NOTES: — L CODE ENFORCEMENT INSPECTOR a7 ¢ CITY OF SALEM, MASSACHUSETTS . BOARD OF HEALTH lu 120 WASHINGTON STREET,4".FLOOR PublicHealth Yrevem.Vromom.Yr"r<t. TEL. (978) 741-1800 FAK(978) 745-0343 KIMBERLEY DRISCOLL kamdin@salem.com MAYOR Id\ItRS'Rr\b'IDIN,RS/RriFIS,CI-10,CP-1;5 HEALTIi AGENT CERTIFICATE OF FITNESS CERTIFICATE#243-13 DATE ISSUED: 7/25/2013 Property Located at: 12 Holly Street UNIT# 1 Owner/Agent: John Karedis Address: 345 Locust Street City/Town: Danvers, MA Zip Code: 01923 24 Hour Phone: 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 LRA'MDIN VV HEALTH AGENT SANITARIAN le CITY OF SALEM MASSACHUSETTS J BOARD OFHEALTH 120 WASHINGTON STREET,e FLOOR PubBeH TEL.(978)741-1800 FAX(918)745-0343 KIMBERLEY DRISCOLL lramdin@salem.com MAYOR 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 "M mmm STANDARDS OF FITNESS FOR HUMAN HABITATION" FEE: $50.00 PROPERTY LOCATED AT �Z- b l� UNIT#- IS THIS VW DISM LEFT tRONT ORB CB,PLEASE CIRCLE ONE OWNER/LESSER iT0 J717 S MANAGER/AGENT NO P.O.BOX ADDRESS 31 L o cr c S-} St ADDRESS CIIY, STATE,ZIP Do(-Y1V60S M A n (q',?,3 CITY, STATE ZIP RESIDENCE PHONE c(7 f qq P 2 BUSINESS PHONE(24ERS) BUSINESS PHONE H? j!— 7 Ll q— 3 y Z TOTAL NUMBER OF ROOMS: 6 ROOMUSE: 1.4,l chen 2.Gt )414 �. 3, 4. 3PvIYa21m 5. 3Po4,wry 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 7AYLE AT THE TIME OF INSPECTION APPLICANT'S SIGNATURECE DATE ? Inspectors use only Date on initial inspection: i�O� 3 Date of reinspection Date of issuance of certificate:_ Date fee paid: Type ot: Dwellin�_Other Check# Check date: NotHaw es: U {' f Code Arfbie&nent Inspector C CITY OF SALEM, MASSACHUSETTS „ m BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 Fax 978-745-0343 W W W.SALEM.COM Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO Mayor HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#53-06 DATE ISSUED: 2/14/06 Property Located at: 14A Holly Street UNIT# 1 Owner/Agent: Rosemary Diskin Address: 18 Appaloosa Lane City/Town: Hamilton, MA Zip Code: 01982 24 Hour Phone: 777-2000 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 IP' 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 HEALTH AGENT CODE ENFORCEMENT INSPECTOR 't CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • • 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 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 "MINIMUM STANDARDS OF FITNESS FORHUMANHABITATION". / � � / j PROPERTY LOCATED AT ��ii �2f�"�_._UNIT# IS THIS UNIT DESIGNA D A IG�@'�T)LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER / S m' 71 " / NAM AGER/AGENT No P.O. Box ,�/ / No P.O. Box ADDRESS / m*z L✓��� 'ADDRESS CITY 1J719_14 'M N —CITY—M/'9— Q/7 ITYMqQ/7V RESIDENCE PHONE 6 Z�l�' BUSINESS 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-DEP RTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION.j APPLICANTS SIGNATUR '�-z z , _DATE INSPECTORS USE ONLY DATE OF INITIAL INSPECTION 9 - I LI— O 4' DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: [ -_b[=DATE FEE PAID:. TYPE OF UNIT: DWELLING1 ZOTHER_ CHECK # ba 5 7 CHECK DATE.2_4,V-_—Q-1/1 NOTES: _. CODE ENFORCEMENT INSPECTOR 9/28/98 fi �I a 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 05/21/2002 Rosemary Simcox 18 Appaloosa Lane Hamilton, MA 01982 PROPERTY LOCATED AT 14 Holly Street UNIT # Right 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 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 BOAR HEALTH REPLY TO oanne Sco t, MPH,RS,CHO PABLO VALDEZ Health Agent CODE ENFORCEMENT INSPECTOR CERT.# 733-97 FEE $25.00 14 R DATE: 02/23/98 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Fax:(978)740-9705 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 16 Holly Street UNIT #: 2 OWNER/AGENT: Lucille C. Nadeau ADDRESS: 12 Brown Street CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-2461 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 HEALTH DEPARTMENT 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 THE BOARD OF HEALTH JO/ANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR 3 5! CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHQ NINE NORTH STREET HEALTH AGENT Tei:(508)741-1800 APPLICATION FOR CERTIFICTE OF FITNESS Fax:(508)740-9705 IN ACCORDANCE WITH STATE SANITARY! CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT zzal `` � � �.' UNIT /_�_ OWNER/LESSER to as O t Y fQ Qom) MANAGER/AGENT ADDRESS tADDRESS CITY_ /14 7 0 CITY RESIDENCE PHONELa 4 U BUSINESS PHONE (24 MRS.) BUSINESS PHONE ri TOTAL NUMBER OF, .R�O-O�M�S- ROOM USE: i. � � 1-2.�ty P�fCh 3 �U__ 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 HISS PAYABLE AT THE TIME OF INSPECTION APPLICANTS SIGNATURE (I p n`Q �Cl SXR f W DATE L INSPECTORS USE ONLY TI DATE OF INITIAL INSPECTION:Lp_:-� n - 9 '? DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE:_, -�Z_?-� S DATE FEE PAID: TYPE OF UNIT: DWELLING OTHER ^_ (� NOTES : � � �, f ' /S CODE ENFORCEMENT INSPECTOR r CITY OF SALEM, MASSACHUSETTS BOARD of HEALTH 120 WAsHmToN STREET,4"'FLooR TEL. (978)741-1800 KIMBERI..EY DRISCOLL FAX(978)745-0343 MAYOR tM;R10-WBAUN Li AWIR LOM DAviD GREENBAum ACIING HEALm i AGENT CERTIFICATE OF FITNESS CERTIFICATE#325-09 DATE ISSUED:7/17/2009 Property Located at: 18 Holly Street UNIT# Owner/Agent: Henry Yancelette Address: 20 Holly Street City/Town: Salem,MA Zip Code: 01970 24 Hour Phone: 745-9897 An inspection of your vacant DwellingfRooming Unit at the above address has been approved and is in compliance with 105 CMR 410.000: Massachusetts State Sanitary Code, Chapter tl" 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 fi there is a valid Certificate of Occupancy. FO THE BO D OF HEALTH !DA ID NB UM �— ACTING HEALTH AGENT ClDE NFORCEMENT INSPECTOR lk . q CITY OF SALEM, MASSACHUSETTS J BOARD OF HEALTH 120 WASHINGTON STREET,4..FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGRITNBAUNI&AI.EM.COM DAVID GREENBAUM, ACTING HEAL'T'H 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 If UNIT# IS THIS UNIT DISIGNA AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE OWNER/LESSER/yty W —MANAGER/AGENT NO P.O. BOX a ADDRESS 1;0 6)1 LA ADDRESS r � v CITY, STATE,ZIP J, CITY, STATE, ZIP RESIDENCE PHONE �2k– y. USINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1. 2. 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 IS PAYABLE �AT�THE TIME OF INSPECTION APPLICANT'S SIGNATURE r��J.L///. //l�1'/�' DATE 1p�q Inspectors use only Date on initial inspections ) �/U 1 Date of reinspection: Date of issuance of certificate: CI Date fee paid: Type of unit: Dwelling Other Check#Check date: 1-7G 1 Notes: n( . too 1 Code Enforcement sp ct L • CITY OF SALEM, MASSACHUSETTS BOARD OF HEAL'T'H 120 WASHINGTON STREET,4°i FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR - DGRL+L'NBAUM@SALEM.COM DAVID GREENBAUM, 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. e-2�J Tenant/Le e Owner sor cs u.ys� �p� o .2 �t Address Address Address on unit to be inspected Date r � � CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,41°FLOOR TEL. (978) 741-1800 I IMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR rcarcN�snuMCn�sncrM coni DAVID GRF%NBAUM ACTING HEMAii AGL;NT CERTIFICATE OF FITNESS CERTIFICATE#307-09 DATE ISSUED: 7/10/2009 Property Located at: 18 Holly Street UNIT#2 Owner/Agent: Henry Vancelette Address: 20 Holly Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-9897 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 IP' 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 HEALTH D D GR ENBAUM ACTING HEALTH AGENT CO E FORCEMENTINSPECTOR CITY OF SALEM, MASSACHUSETTS J BOARD OF HEALTH 120 WASHINGTON STREET,4...FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DG1tEENBAUM@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 /cP UNIT# 2 - IS THIS UNIT��,DI//SIGNAT AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE OWNER/LESSEx /��/ � Vet, � MANAGER/AGENT NO P.O. BOX ADDRESS _25 —ADDRESS CITY, STATE, ZIP XJ iy��� c i CITY, STATE,ZIP RESIDENCE PHONE27f- 7,S-9 9'7 BUSINESS PHONE (24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1.0a- 2 gjd- 3-,elk,4 dli✓-�iwh 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 I,SS PAYABLE AT THE TIME OFF INNSSPECTION APPLICANT'S SIGNATURE �1t. cl �i'�:[� GGGLB/ DATE Inspectors use only Date on initial inspection: //Old Date of reinspection: Date of issuance of certificate: /G I Date fee paid: _ Type of unit: Dwelling V Other Check# _Check Notes: . OMQ- WO(JOIK)S W(n4 �j tj/t.-_�PA/1G C-eDla A OU Code Enforcement Inspe IQp CITY OF SALEM, MASSACHUSETTS BOARD OF HFAL'rlI 120 W�15HINC°TON STREET,4...FLOOR WMBBRLEYDRISCOLL IL'L. (978) 741-1800 MAYOR FAX(978) 745-0343 lramdin salem.com 1..ARRY RA Nil)IN,RS/It SI IS,(1110,CP-1+ti HI',Al..'l,l'I A(iF,N r CERTIFICATE OF FITNESS CERTIFICATE#347-11 DATE ISSUED: 9/22/2011 Property Located at: 20 Holly Street UNIT#2 Owner/Agent: Henry Vancelette Address: 20 Holly Street CityfTown: Salem, MA Zip Code: 01970 24 Hour Phone: 745-9897 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 issuano= 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 LARR RXAMDIN HEALTH AGENT CODE ENFO)tQtMENT INSPECTOR • CITY OF SALEM, MASSACHUSETTS C��c BOARD OF HEALTH 120 WASHINGTON STREET,41..FLOOR If,EL. (978) 741-1800 IiIMBERL Y DRISCOLL FAX(978) 745-0343 MAYOR LRANIDINOU SALF,%L(OM LARRY RANIDIN,11S/RI?1 fS,(j 10,CP-FS HI;AI:rtIAGr•.Nr 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, FEE: $50.00 PROPERTY LOCATED AT �0 /I` Sy good W-0-tr UNIT# �- IS THIS UNIT DISIGNA ED AS RIGHT LEFT FRONf OR BACK,PLEASE CIRCLE ONE OWNER/LESSER� &����, - E MANAGER/AGENT NO P.O. BOX ADDRESS 20 ffeLLy ST ADDRESS CITY, STATE,ZIP S,¢,c EM CITY, STATE,ZIP NA 0/ J 10 RESIDENCE PHONE 9?� J}S- 9S'9y BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS:_ ROOM USE: 1. 2. 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 IS PAYABLE AT THE TIME OF INSPECTION APPLICANT'S SIGNATURE 'U DATE f ZZ-// O Inspectors use only Date on initial inspection: Date of reinspection: Date of issuance of certificate- o !1 Date fee paid: cI as 11 Type of unit: DwellingL�Other Check# -3 Opl- Check date: I/ Notes: C-7kL ode Enfor ment Inspector � - 0011 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR p13lth rre.ev.rmmm .rrotec, TEL. (978) 741-1800 Fax(978) 745-0343 KIMBERLEY DRISCOLL lramdinna,salem.com - _ LARRYRriMDIN,RS/RF:I-IS,CI 10,C13-FSMAYOR FNT CERTIFICATE OF FITNESS CERTIFICATE#412-13 DATE ISSUED: 11/18/2013 Property Located at: 20 Holly Street UNIT#3 Owner/Agent: Henry Vancelette Address: 20 Holly Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-9897 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 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 LARRY AMDIN HEALTH AGENT SANITARIAN is PAS CITY OF SALEM, MASSACHUSETTS //�' /�Z BOARD OF HEALTH v 120 WASHINGTON STREET 4"'FLOOR Ptd icHealth f Prevent.Promote.Protect. TEL. (978) 741-1800 FAX(978)745-0343 KIMBERLEY DRISCOLL lramdirl@salem.com MAYOR LARRY]L\NIl)IN,RS/REHI S,CIO,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 2 4& UNIT# 3 ,L IS THIS UNIT DISIGNATEDIAS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE OWNER/LESSER, '�l �/GQw�KsP� MANAGER/AGENT /�,� ADDRESS 90 � X. ADDRESSreJ��j ?� 9L -- pp � ,,,, CITY, STATE,ZIP. YM CITY, STATE,ZIP irjx� 09 RESIDENCE PHONE'?V"Ws'" BUSINESS PHONE(24HRS) BUSINESS PHONE '4k TOTAL NUMBER OF ROOMS: ROOM USE: 1. 2. 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 ISS PAYABLE AT THE TIME OF INSPECTION APPLICANT'S SIGNATURE DATE ( Inspectors use only Date on initial inspection: (�1 I�I�3 Date of reinspection: Date of issuance of certificate: Date fee paid: Type of unit: Dwelling Other Check# Check date: Notes: 0 CoteTuA&elnent Inspector