MAPLE STREET MAPLE STREET
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CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT Tel:(978)741-1800
01/13/2000 Fax:(978)740-9705
Norma Jaremsek c/o Robert Jaremsek
58 Western Avenue
Essex, MA 01929
PROPERTY LOCATED AT 7 Maple 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
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 BOARD REPLY TO
oanne Sco MPH,RS,CHO PABLO VALDEZ
Health Agent CODE ENFORCEMENT INSPECTOR
i
• + CITY Or SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,401 FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAx(978) 745-0343
MAYOR 1)GRR13NBAUM(7a SALCM.(7OM
D,\vu)GRvF.NBAUIS,RS
ACTING HhAJXIi AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#503-10
DATE ISSUED: 10/25/2010
Property Located at: 11 Maple Avenue UNIT#2
Owner/Agent: Gary Pierce
Address: 9 Oakview Avenue
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 744-6571
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 GREENBAUM, RS Ge
ACTING HEALTH AGENT CODgkNFORCEMENT INSPECTOR
+ CITY OF SALEM, MASSACHUSETTS y
BOARD OF HEAUrH
120 WASHINGTON STREET,4°1 FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX (978) 745-0343
MAYOR IJ(;RFL.N13AUM SA1E%4.COM
DAVID GREENBAum,RS I,
- ACTING HEAL`fI-I 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: $5000 -
PROPERTY LOCATED AT // XllIp e //4f UNIT# 2--
IS
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE
OWNER/LESSER / 7/Er C£ MANAGER/AGENT
NO P.O. BOX
ADDRESS 9 r✓'vs1kdlEu/ 111le ADDRESS
CITY, STATE,ZIP � 4C ,# ! CITY, STATE, ZIP
RESIDENCE PHONE if 7`>`y 4'-"1 BUSINESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ROOM USE: L;�ed 2.L/I/,•" 3. &I7`1tIJ 4. ZiA1 %� 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: oI a (I C) Date of reinspection:
T
Date of issuance of certificate: // Date fee paid:
Type of unit: Dwelling-----Other Check(# �l P Check date: LG AZ_7�f 16'A
Notes: IC P �Cd r WD/ 10 ��?r�P�zrl CG ODC I -�6f ck,4 d'. f d �
(I fl" - I ',�'Pf•
C e nforcementInspector