13 Palmer Street COF f
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
l120 WASHiNGt'ON STRLET,4°1 FLOOR
TEL. (978)741-1800
KIMBERLEY DRISCOLL FAX(978)745-0343
MAYOR JDIONNEnsALE WCON-1
JANETDIONNIi
ACTING HEAI;I1-I AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#484-08
DATE ISSUED: 9/23/2008
Property Located at: 13 Palmer Street UNIT# 1
Owner/Agent: Linda Locke
Address: 1 Pickering Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-5135
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 BOAFnIF HEALTH
aT DIONNE "
ACTING HEALTH AGENT COqANFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
s BOARD OF HEALTH
120 WASHINGTON STREET,4m FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR IDIONNEna MLE'M.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."
FEE: $50.00
PROPERTY LOCATED AT 3 r UNIT#--/
f
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE/
OWNER/LESSER 1 / li , �Bv (-,�_ MANAGER/AGENT /tel _- L0 0
/6Q—
NO P.O. BOX 1
ADDRESS �tF. /�� �Y ' ADDRESS SRS _
CITY, STATE,ZIP ��/I�i+ti /r} �j�7i2 CITY, STATE, ZIP
RESIDENCE PHONE 4)f —7V�i , 3J BUSINESS PHONE(24HRS).S�e a� `
BUSINESS PHONE IiV tr e— O -`
e
TOTAL NUMBER OF ROOMS: �i�
ROOM USE: 11-V ZA7 2. 4.,669 On 5.e Wll� -1
6BMAth 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 ABLE AT THE TIME OF INSPECTION
APPLICANT'S SIGNATURE DATE cai 3
Ins_nectors use only
Date on initial inspection: "i Date of reinspection:
Date of issuance of certificate: Date fee paid: e�
Type of unit: Dwelling Other Check# Check date: l I o� IDS
Notes: VJ< of on 111 �(1C1`�Y�QiYL in S 2 l�C �O �', Ji ,hCxt'.e--07', prove,f i .
Code orcement Inspector