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CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
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120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
-- TEL. 978-741-1800
FAX 978.745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#37-05
DATE ISSUED: 1/19/05
Property Located at: 10 Lynn Street UNIT# 1
Owner/Agent: Jospeh Galvin
Address: 15 Summit Street
City/Town: Somerville, MA Zip Code: 02144 24 Hour Phone:
An inspection of your vacant Dwelling/Rooming Unit at the above address has been approved and is in
compliance with 105 CMR410.000: 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 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.
FOR THE BOARD OF HEALTH
JOA NE�MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
� o CITY OF SALEM, MASSACHUSETTS
`! BOARD OF HEALTH
• • 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
_ FAX 978-745-0343
STANLEY LISOVICZ, 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 HABITATION".
PROPERTY LOCATED AT /t) L�tAJ J S�Iu+�I UNIT
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER04Q,K Gdvjf MANAGER/AGENT f
No P.O. Box ' ' No P.O. Box
ADDRESS IS S'#AVAV IT SQ- ADDRESS
CITY_ EcvAE(Luj")E #M OUVY CITY
RESIDENCE PHONE(!/]. L3-f'-F44-'7- BUSINESS PHONE (24 HRS.) VAW6L.
BUSINESS PHONE `^
TOTAL NUMBER OF ROOMS: S
ROOM USE: 1 ,340,QO--pM 2. lj>A A4.� 4.IAQ
5iy�i�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,SVIDATE /-V-oS
1 NSPECTORS
USE ONLY
DATE OF INITIAL INSPECTION J -/3 ° DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATq�4310 11 DATE FEE PAID:=o-
TYPE OF UNIT: DWELLINGV OTHER__ CHECK 41b 6 f_CHECK DATE,4—_
NOTES:
CODE ENFORCEMENT INSPECTOR 9/28/98
CITY OF SALEM, MASSACHUSETTS
a
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-74 1-1800 ..
FAX 978-745-0343
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
RELEASE
In accordance with Massachusetts General Laws Chapter 111 ; Code of Massachusetts
Regulations 410.000 et. seq. ; State Sanitary Code Chapter TT and Article %III 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 Chat said inspection be done in my/our absence , 1/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' ESS Ems ' OWNER/LESSOR
ADDRESS ADDRESS—
!0 kKh_
ADl?RESS iF UNIT To BE INSP CT
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D 'iE
CITY OF SALEM, MASSACHUSETTS
3 �. BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA O 1970
TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#36-05
DATE ISSUED: 1/19/05
Property Located at: 10 Lynn Street UNIT#2nd
Owner/Agent: Joseph Galvin
Address: 15 Summit Street
Cit /Town: Somerville, P MA Zi Code: 02144 24 Hour Phone:
Y
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
JO iNE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
• j 120 WASHINGTON STREET, 4TH FLOOR
i� 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 II, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT ZO Y► S UNIT#
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSERTc6ed G10AW40MANAGER/AGENT
No P.O. Box A No P.O. Box
ADDRESS_ iT SNraMnll ,T ADDRESS
CITY S�6LCAL I-d ry1A MVWCITY
RESIDENCE PHONE4/?_44b'*4w"" BUSINESS PHONE (24 HRS.)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:-7S
ROOM USE: ,1.966%% 2. 3. .v/ 4.'?WAOV N
5.,dt M/ . 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_��0 DATE � ' �"OS
INSPECTOR USE ONLY
DATE OF INITIAL INSPECTION —/3 y DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE:/-/3 DATE FEE PAID: >'
TYPE OF UNIT: DWELLINGTHER_ CHECK#/b b/ CHECK DATE S
NOTES:
CODE ENFORCEMENT INSPECTOR - 9/28/98
'•r CITY OF SALEM, MASSACHUSETTS
.i
a
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA O1970
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 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, I/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 aAeats
from any loss or injury sustained of whatever nature and description occasioned
by my/our absence during said inspection.
NAN' %LuS U — OWNER/iESSOR.
S --- --
ADDRESS ADDRESS—
ADDRESSOF UNIT TO BE I?;SRECTED
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