LYME STREET LYME STREET
a
A
�a
ceIT
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET
HEALTH AGENT Tel: (978)741-1800
03/01/2001 Fax: (978)740-9705
William A. Cunningham, III
1 Lyme Street
Salem, MA 01970
PROPERTY LOCATED AT 1 Lyme Street UNIT # 1
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.
FOR THE BOARD OF HEALTH REPLY TO
oanne Sco tt, M�O PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
1
-I
CERT.# 721-97
° FEE $25.00
X11. �F DATE: 10/22/97
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: 1 Lyme Street UNIT #: 1
OWNER/AGENT: William A. Cunninaham. III
ADDRESS: 1 Lyme Street
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-1056
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
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT,MPH,RS,CHO
HEALTH AGENT NINE NORTH STREET
Tel:(508)741-1800
APPLICATION FOR CERTIFICTE OF FITNESS Fax:(508)740-9705
IN ACCORDANCE WITH STATE SANITARY:CODE, CHAPTER II, 105 CMR 4 )0.000 "MINIMUM
STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED Al., cS 1 , UNIT #__�_
OWNER/LESSER �J(!�f 1�tm_ �/7�i f/79 AGER/AGENT
ADDRESS J �f ��J , d/ ADDRESS
CITY �� �� CITY _
RESIDENCE PRONE BUSINESS PHONE (24 HRS.)
BUSINESS PRONE
TOTAL NUMBER OF ROOMS: -3 j
ROOM USE: !, i ,�y✓I 2.
5. 6. 7. 8.
THERE IS A TWENTY-FIVE (25.00) DOLLAR FEE, PAYABLE B CHECK OR MONEY ORDER TO THE
CITY OF SALEM' HEALTH DEPARTMENT THIS FEE AYAB AT THE TUC OF INSPECTION
APPLICANTS SIGNATURE DATE_ -ZJ/
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION: 7 DATE OF REINSPECTION_
DATE OF ISSUANCE OF CERTIFICATE: `` -1 »f-7 DATE FEE PAID:fp
TYPE OF UNIT: DWELLING OTHER
NOTES:
CODE ENFORCEMENT INSPECTOR
3 -
mr�
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 Cit; 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.
TENANT/LESSEE OWNER/LESSOR
ADDRESS -— — — --- ADDRESS -- —--
ADDRESS OF UNIT TO BE INSPECTED
DATE
�, ��j
v
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH, RS;CHO NINE NORTH STREET
HEALTH AGENT Tel:(978)741-1800
Date: 10/15/97 Fax:(978)740-9705
William A. Cunningham, III
1 Lyme Street
Salem, MA 01970
PROPERTY LOCATED AT 1 Lyme Street UNIT # 1
Dear Sir/Madam:
It has come to our attention, that you may be considering renting a dwelling unit
at the above address.
It is incumbent upon you as owner(s) to contact the City of Salem Health Department
to apply for a CERTIFICATE OF FITNESS before any vacant dwelling unit is rented or
occupied, or to notify us of your intent for this unit.
Each dwelling unit must be inspected and certified by the Salem Health Department
prior to allowing occupancy in accordance with Chapter 111, Sections 127A and 127B, of
the Massachusetts General Laws, 105 CMR 400.00; State Sanitary Code, Chapter 1: General
Administrative Procedures and 105 CMR 410.000; State Sanitary Code, Chapter 11: Minimum
Standards of Fitness for Human Habitation, and in accordance_with Chapter 11, Article
XIII of the City of Salem Code of Ordiances, Section 2-334, Certificate of Fitness.
There is a twenty-five (25) dollar fee payable by check, or money order to the City
of Salem Health Department. This fee is payable at the time of inspection. Inspection
will not be performed without receipt of payment.
Failure to comply with this procedure, will result in a fine of twenty (20) dollars
per day for every day that the dwelling unit is occupied without approval of the Code
Enforcement Division of the Salem Health Department.
Contact this department within 24 hours of receipt of this notice. (508) 741-1800
Monday thru Wednesday from 8:00 a.m. - 4:00 p.m. Thursday 8:00 a.m. - 7 :00 p.m. or
Friday 8:00 a.m. to noon to schedule an appointment for an inspection.
SEE ENCLOSED SECTION 105 CMR 410.354 METERING OF GAS & ELECTRICITY.
Very truly yours,
FOR THE BOARD OF HEALTH REPLY TO
Joanne Scott, MPH,RS,CHO PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
t
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
s 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
Fax 978-745-0343
Kimberley Driscoll WWW.SALEM.COM
Mayor JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#288-07
DATE ISSUED: 6/27/2007
Property Located at: 4 Lyme Street UNIT# 1
Owner/Agent: Robert Barnard
Address: 249 Green Street
City/Town: Marblehead, MA Zip Code: 01945 24 Hour Phone: 745-0518
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 oneY ear 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 � GLS "" A'
J ANNE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SAL
\EM, MASSACHUSETTS
001
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR TT
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 AT1 . _ _UNIT#1
IS THIS UNIT DESIGNATED AS RIGHEFT FRONT BACK PLEASE C CLE ONE
OWNER/LESSER )vr n6tCMANAGER/AGENT 6(5
No P.O. Box / No P.O. Box �Q
'1 ADDRESS C9 tAetoN ADDRESS
CITY V V , CITY
RESIDENCE PHONE_ BUSINESS PHONE (24 HRS) /
BUSINESS PHONE i
TOTAL NUMBER OF ROOMS: ` n
ROOM USE: 1._ �
5. 6. 7 8.
THERE IS A TWENTY-FIVE($25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY
ORDER TO THE CITY OF SA HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE
TIME OF INSPECTION.
APPLICANTS SIGNATURE DATE_ � �c
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION -2_7:7U 7 DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATEDATE FEE PAID:_ _
TYPE OF UNIT: DWELI_In�_OTHERCHECK @1_ _�_8 CHECK DATE �5'_ _7
NOTES
CODE ENFORCEMENT INSPECTOR 9/28/98
CITY OF SALEM, MASSACHUSETTS
• - 1.� s BOARD OF HEALTH
120 WASHINGTON STREET,4."FLOOR
TEL. (978) 741-1800
KIMBLRLEY DRISCOLL Fax(978) 745-0343
MAYOR ucxr±eNBAUMQSAI,l=M.coM
DAVID GRUMNBAUM
Ac,rlNG Hl.AI:H-1.AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#380-09
DATE ISSUED: 8/11/2009
Property Located at: 4 Lyme Street UNIT#2
Owner/Agent: Robert Barnard
Address: 249 Green Street
City/Town: Marblehead, MA Zip Code: 01945 24 Hour Phone: 745-0518
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
I �
DAVI GBAUM �
ACTING HEALTH AGENT COQgtNFORCE1M5NT INSPECTOR
f
• CITY OF SALEM, MASSACHUSETTS
NO-09
BOARD OF HEALTH
120 WASHINGTON STREET,4°i FLOOR
TEL. (978) 741-1800
KiMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR DQR[ii?NBAUM@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 UNIT#
Is T
HIS
UUNIT DIISIG ATED AS RIGHT LEFT FRONT OR BACK.PLE C/IIRCLE ONE
OWNER/LESSER L MANAGER/AGENT Vi.li
NO P.O. BOX
ADDRESS )ghq� 6' 1r� /' ADDRESS
CITY, STATE,ZIP 1 Y� Ipplle ()/q% r CITY, STATE, ZIP //�%�} GLI
RESIDENCE PHONE J&- BUSINESS PHONE(24HRS) / /`�ys
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
� �r
ROOM USE: I. v l / 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 DATE
Inspectors use only
Date on initial inspection: /6/C Date of reinspection: -Un
Date of issuance of certificate: Date fee paid:
Type of unit: Dwelling�0ther Check# S-,jr Check date:
N es:L9 Ji Lom &aw dooci-: CL I2 I t c1 + k- ' HA4 WV114vw
cAurr crib leitz3f kkt sink IS GrczcKe /IYI I's �Cu � corner
�k bcu. o; ptckm Sink nRecls be re�5rovte�; a I e SfoNe
Cod orcement Inspector h-Prf� hOrt i fbki j �_ 'y a"d bedroom -d�esn IOC A
[r� in anz bad G m NkA5 '00 tob`�c s QPLU (ry93 hCt jlwm/
WlndoW keels scXe�n.
Vein _czU cwvre6ed 6utbLq6In aha ge; l,�u stilt besr� i
co
CITY OF SALEM, MASSACHUSETTS
vQ� BOARD OF HEALTH
3a _ 120 WASHINGTON STREET, 4TH FLOOR
a 1 SALEM, MA 01970
s TEL. 978-741-1800
FAX 978-745-0343
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO -
MAYOR HEALTH AGENT
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 Cit;• 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 [hat 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.
TENANT/LESSEE. 0' ER/i FSSOR
ADD Ri[ SS ADDRESS
C52
ADIIRE° OF UNIT TO BE INSPECTED
CITY OF SALEM, MASSACHUSETTS IV
BOARD OF HEALTH
120 WASHINGTON STREET,4".FLOOR PablicHeaIth
Prevent.Promote,Pana,.
TEL. (978) 741-1800 Fax(978) 745-0343
KIMBERLEY DRISCOLL Itamdin@salem.com salem.com LARRY RANIDIN,RS/IU l IS,CI IO,CI'-FS
MAYOR Hi"\Ln I AGEN'I,
CERTIFICATE OF FITNESS
CERTIFICATE#295-14
DATE ISSUED: 9/2/2014
Property Located at: 4 Lyme Street UNIT#3
Owner/Agent: Robert Barnard
Address: P.O. Box 52
City/Town: Salem, MA Zip Code: 01970 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 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
WH
DIN
NT SANITARIAN
g- �
o s„1 2 ( .)C, ;'r '+ J .E�t�.. ��1 �t�'`'� 1t lT i.i_�,.'i i -�'*> ��1J�
miDIP-S'
1
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"
FEE: $50.00
PROPERTY LOCATED AT )J J-q Yh 2 12J_ UNIT#2--
TS THIS t1NI1'DISIGNATED AS RIGHT LEFT FRONT OR BACK.PLEASE CIRCLE ONE
OWNER/LESSER 9O6Z(J �G(/(/Y1 /�tG, MANAGER/AGENT
NO P.O.BOX ;n
ADDRESSO � V'� � Z ADDRESS
CFTY,STATE,ZIP 0 lg7t ]TY,STATE,ZIP
RESIDENCE PHONE BUSINESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: /
ROOM USE: LIQ PAAV1 2. (- r/WIL-"l 3. ✓-WWT t 4.6 41;q No-�.
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 FE(E� IS PAYABLE AT THE TIME OF INSPECTION
APPLICANT'S SIGNATURE "I U V DATE
Inspectors use only
Date on initial inspection: EIWDate of reinspection:
Date of issuance of certificate: Date fee paid:
Type of unit: Dwelling Other Check# . (°_Check date:
Notes:
Co t or ement Inspector
1.7...14 i lit 'S.\: 1, S.v "T' �... . ,s ! ...
e d ,
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. Uwe 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.
Tenan-/Lessee Owner/Lessor
y l q t/QJ 3
Address VAddress
4 -e K2,;� #3
Address on unit to be inspected
u,
Date
Updated 5/23/11
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEAL:ni
120 WASHINGTON STREET,4°.FLOOR
TEL (978) 741-1800
Ii1MBERLEY DRTSCOLL Fax (978) 745-0343
MAYOR Icamdiii(@salem.com
LARRY RANIDIN,RS/RFI IS,(1110,CP-FS
HN;AI:I'I I AGIiN'I
CERTIFICATE OF FITNESS
CERTIFICATE#393-11
DATE ISSUED: 10/13/2011
Property Located at: 4 1/2 Lyme Street UNIT# 1
Owner/Agent: Robert Barnard
Address: P.O. Box 52
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.
I-FOR THE BOARD OF HEALTH
L 1
LARRY RAMDIN
HEALTH AGENT CODE ORCEMENT INSPECTOR
i
y
� • CI"I`1' OF SALEM, MASSACHUSETTS IA'
� � ) 13OARD OF HF\U11
120 W SHING i ON S W-T,T 4'" FLOOR J
TFi.. (978) 741-1800
KINMERL@:Y DRISCOLL FAA (978) 745-0343
MAYOR LRAiNDIN&A EN.(OM
1.mo,RVVMDIN,RS/RH IS,O 1O,(T-1'S
Fdl:,AI:II I 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
PROPERTY LOCATED AT Y/2 //y1 � cSUNIT# One
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER db-e, `f' Y OL X1/1,&-V-1 MANAGER/AGENT
NO P.O. BOX (jJ ,II c �v y y z
ADDRESS 1UI (! C ADDRESS
CITY, STATE,ZIP c c,(`et-fq m 4 ® (q 7 U CITY, STATE,ZIP
RESIDENCE PHONE nn l BUSINESS PHONE(24HRS)
BUSINESS PHONE -C �ap ! �d3 S7 Sl/o
TOTAL NUMBER OF ROOMS:—6
ROOM USE: l,r/Wul'" 2. k2 YU(1k11 3. U 4. 5.
6. aJ-eA 1 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 / atl DATE
Inspectors use only
Date on initial inspection: loh-3�l Date of reinspection: _
Date of issuance of certificate:_ ID��3 / 1 Date fee paid: 0 / I t I
Type of unit: Dwelling ✓Other Check# Check date: /of ,fib/
Notes: JAMdOW L U (fmmdows
ode Enfo cement Inspector
0
CITY OF SALEM, MASSACHUSETTS
ae BOARD OF HEALTH
120 WASHINGTON STREET,4`..FLOOR
TEL. (978) 741-1800
1QMBERLL•Y DRISCOLL FAX (978) 745-0343
MAYOR 1.RAMD1N(@SAI.CM.(70M
LARRY RAMI)IN,RS/RFI IS,CI 10,CP-FS
HFAI:nIAGFN'r
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 Owner/Lessor
/L
A dr s Address
Address on unit to be inspected
Lo11��
Date
Updated 523/11
v � Y
L N
/ .p
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT 11/29/99 Tel:(978)741.1800
Fax:(978)740-9705
Kathleen Perry
14 Lyme Street
Salem, MA 01970
PROPERTY LOCATED AT 14 Lyme Street UNIT # House
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
I 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.
FOR THE BOARD OF HEALTH REPLY TO
i
gj!an�nett, M O PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR