0008 KOSCUISKO STREET co�1r CITY OF SALEM, MASSACHUSETTS
ver,
�. BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
a SALEM, MA 01970 CERT.# 346-02
z^i
s9p TEL. 978-741-1800 FEE $25.00 �
FAX 978-745-0343 DATE: 07/08/2002
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 8 Kosciusko Street UNIT #: 1
OWNER/AGENT: M. Nemirousky
ADDRESS: 8 Kosciusko Street
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 741-4883
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 OF HEALTH
JOANNE SCOTT, MPH,RS,CHO a®
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
co CITY OF SALEM, MASSACHUSETTS 0�.
�` '� BOARD OF HEALTH '
3 w 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
,pq� 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 H'A/BITA IOM'.
PROPERTY LOCATED AT 19
—_��C I �/ NIT#
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNEPJLESSER MANAGER/AGENT
No P.O. Box J�, o P.O. Box
ADDRESS 1C1/ �CI �S � � ADDRESS
CITY S AL erm CITY
RESIDENCE PHONE7� �G a.7 BUSINESS PHONE (24 HRS.)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:_l
ROOM USE: 1. 4 2. 3.
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�C�1-M l N�l�V/JiATE_ / f U t92
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION 7 - k-- 0' DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE:?-!Z i0 ' DATE FEE PAID: ? — 9 —D v
TYPE OF UNIT: DWELLING(/ OTHER_ CHECK# I O CHECK DATEZ�
NOTES: /I�
CODE ENFORCEMENT INSPECTOR 9/28/98
r a CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
e 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
06/13/2002
Michael & Yula Nemirousky
8 Kosciusko Street
Salem, MA 01970
PROPERTY LOCATED AT 8 Kosciusko Street UNIT # First Floor
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.
OR THE SO ,�fi' HEALTH REPLY TO
Joanne Scott, MPH,R�LS,CHO PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR