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MARLBOROUGH ROAD MARLBOROUGH ROAD City of Salem, Massachusetts W PN I& Aff Board of Health �.�u_�}� 120 Washington Street, 4th Floor, Salem, Prevent,(9 MA 01970 Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, REHS,CHO Mayor health@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE#: GHL-16-376 DATE ISSUED: 10/4/2016 Property Located at: 81 MARLBOROUGH ROAD UNIT# Owner/Agent: Gloria Villanueva Address: 43A Western Avenue City/Town: Lynn, MA Zip Code: 01904 24 Hour Phone:(781) 608-1106 Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division 3, 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 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. Note: This approval does not certify compliance with the state lead law for occupants under 6 years of age. yB r y Larry Ramdin, MPH, REHS, CHO HEALTH AGENT /// SANITA CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH IV 120 WASHINGTON STREET,4°'FLOOR PullliCHC81th Prevent.Promote.Protect. TEL. (978) 741-1800 FAX (978) 745-0343 KIMBERLEY DRISCOLL Iramdin&salem.com MAYOR LARRY R.AMDIN,RS/REHS,CHO,CP-FS HEAL:I7i AGENT Cs �oriaV(IIIar)�eva�� �' y��oo�Cow� 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: $$550.00 /� PROPERTY LOCATED AT U/l�Uv/// //GU LL �G7/�� m�`" UNIT# nIS THIS UNIT1D'ISIIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE OWNER/LESSER U I0'C i4 V� ` 1QnUQV 0" MANAGER/AGENT NO P.O. BOX nn ADDRESS( f3fi C V4-4-r/J ADDRESS CITY, STATE,ZIP` 17 CITY, STATE, ZIP RESIDENCE PHONE V1 h O P 1210 0 BUSINESS PHONE(24HRS) BUSINESS PHONE G/r7 '799- J � TOTAL NUMBER OF ROOMS:_ ROOM USE: 1. 2. 3. 4. 6. 7. 8. 9. 10. THERE IS A FIFTY($50)DOLLAR FEE,P ABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEEIS P Y E AT THE TIME OF INSPECTION / APPLICANT'S SIGNA'T'URE DATE Inspectors use only / Date on initial inspection / 20.Z6 Date of reinspection: Date of issuance of certificate: Date fee paidl&IO3/2 D Type of unit: Dwelling Otfher Check#�� Check date: Wo312g426 I�SeM Notes: e Sn,n �le ke ker fmr nwJ s hvw bn-44u;q Code n cey ent Inspectp CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET 4".FLOOR pllbllCHC811t1 f Prevent.Promote.Protect. TEL. (978) 741-1800 Fax (978) 745-0343 KIMBERLEY DRISCOLL Iramdin@salem.com LARRY RS/12131-15,C1 10,CP-I+S HEA1,77I AGENT' 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. /dMc.� Ctin Tenan essee Owner/Lessor 1 #OLVk (,C—eg Address Address Address on unit to be inspected Date Updated 523/11 City of Salem, Massachusetts Board of Health n 120 Washington Street, 4th Floor, Salem, Publ>LCHealth MA 01970 Prevent.Promote. Protect Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, REHS, CHO Mayor health@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE #: GHL-17-7 DATE ISSUED: 1/10/2017 Property Located at: 173 MARLBOROUGH ROAD UNIT# Owner/Agent: Ben Sylvanowicz Address: 80 Jackman Street City/Town: Georgetown, Ma Zip Code: 01833 24 Hour Phone:(978) 352-8201 Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division 3, 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 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. Note: This approval does not certify compliance with the state lead law for occupants under 6 years of age. e� . ja Larry Ramdin, MPH, REHS, CHO HEALTH AGENT SANITARIAN h CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL (978)741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR LRAMDIN&ALEM.COM LARRY RAMDIN,RS/RHHS,CHO,CP-FS 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 s� _ PROPERTY LOCATED AT d y \� UNIT# IS THIS UHIT DISIGNAT,/ESD AS GHT LEND FRONT R A�PLEASE CI(R�CLE ONE a,� OWNER/LESSENO P.O.Box (R� �P, V� 5 ( V OW � I GAGE AGE� ADDRESS V ��r� �� ADDRESS tj M CITY, STATE,ZIP R JQx CPTY,STATE,ZIPWS5 U 3 3 RESIDENCE PHONE�' SC ' �SZ ° 201 BUSINESS PHONE(24HRS)-or� 1 ? BUSINESS PHONE Co UuA�'� r a V � Zi 0,y\clCea-, dGd �e� TOTAL NUMBER OF ROOMS: ROOMUSE: 1. F I` ( 2. 3. 4. 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 PAYABTHE TIME OF INSPECTION APPLICANT'S SIGNATURE /n � � % DATE—I ' � f f � \1 Ins tors use only 1 I Date on initial inspection: Date of reinspection: Date of issuance of certificate: { (o Date fee paid: a Type of unit: Dwelling Other Check#Check date: d Notes: Code)nfocceme t Inspector R CITY OF SALEM, MASSACHUSETTS lu BOARD OF HEALTH 120 WASHINGTON STREET,4`"FLOOR PubliCHea Ith r.<.�m.rumrt .r.oioc. TEL. (978)741-1800 Fax (978) 745-0343 KIMBERLEYDRISCOLL lramdin ,salem.com L,ViRY RAbNIN,RS/Ri:FIS,C1 10,CP-FS MAYOR Hr''.tu,LI-1 r1G13N"f CERTIFICATE OF FITNESS CERTIFICATE#305-14 DATE ISSUED: 9/19/2014 Property Located at: 173 Marlborough Road UNIT# Owner/Agent: Ben Sylvanowicz Address: 80 Jackson Street City/Town: Georgetwon, MA Zip Code: 01833 24 Hour Phone: 978-352-8201 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 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 e. �/l LARRAMDIN f� HEALTH AGENT SANITAR R CITY OF SALEM, MASSACHUSETTS BOARD or HE-LTH 120 WASHINGTON S'tREF„'T, 4”'FLUOR TEL. (978)741-1800 I TAIPERLEY DRISCOLL Rex (978) 745-0343 M.-�YOR LKAMDIN4SALETa COM t LARRY Ri ibtllIlV,RS f RTGTs,ci io,cP-Ps HE,AUM A3I;Nr - Application for Certificate of Fitness IN ACCORDANCE WITH STATE SANITARY CODE,CHAPTER 11, 105 CMR 410.000 "MNIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" -U ( -7 q FEE: $50.00 Le M tk4 A PROPERTY LOCATED AT ` t 3 r v ti ^ � �"�d � � � �� UNi IT# IS THIS UNIT DISIGNATED AS RIGHT LEFT'FRONT OR BAC PLEASE CIRCLE ONNE� OWNER/LESSER �2 f,N �a``', V&. A I)VVV MANAGERIAGENT 1nyike6 k` o ADDRESS © Q G�(1R J�I� ADDRESS CITY, STATE,ZII' V r� Q` /} !CITY, STATE,ZIP RESIDENCE PHONE"jR, l �2 V� BUSINESS PHONE(24HRS) BUSINESS PHONE �j TOTAL NUMBER OF ROOMS: J ROOM USE: 1. Qac 1--VM /S-C� 3, D- ' . 4. L7- 5. �tjr.L tJ 6. 7. 8. 9. 10. THERE IS A FIFTY($54)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH TIES FEE IS P ABLE AT THE TIME OF INSPECTION APPLICANT'S SIGNATURE DATE__ nI Inspectors use only Date on initial inspection: 1'A—A Date of reinspection: Date of issuance of certificate:, !9 ' r Date fee paid: Type of unit: Dwelling Other Check#Z2' )5 _Check date: Notes: 1 Z7 ode Enforcement Inspector e CITY OF SALEM, MASSACHUSETTS e BOARD OF HEALTH 120 WASHINGTON STREET,4'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL Fax(978) 745-0343 MAYOR DGRB3NBAUMQSA1jEM.COM DAVID GRF.ENBAUM ACTING HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#543-09 DATE ISSUED: 10/23/2009 Property Located at: 186 Marlborough Road UNIT# 1 Owner/Agent: Marie Gagnon Address: 8 Cleary lane City/Town: Topsfield, MA Zip Code: 01983 24 Hour Phone: 978-887-8856 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 kdR (� ACTING HEALTH AGENT CODE FORCEMENT INSPECTOR ¢¢ CITY OF SALEM, MASSACHUSETTS i a BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978)741-1800 J KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR Isco ri(_@SAI c M.COM JOANNE SCOTT, HEALTH AGENT ClIe {� 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 \ 8 b 1-�w2�u ovCrw 1L� UNIT#�_ IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE OWNER/LESSER 'tAvaQZL MANAGER/AGENT NO P.O. BOX ADDRESS—% C_4..�--+ 1-N ADDRESS CITY, STATE, ZIP—daST-�, %--Ar p1y8 3 CITY, STATE,ZIP RESIDENCE PHONE $ 88 —88s BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: l.f$f-J> 2. Qo > 3. )=Vm►h14--4 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 _ DATE1 012;3)D4 Inspectors use only Date on initial inspection: 110\'a31 u'�t Date of reinspection: Date of issuance of certificate: f D I d 310 1 Date fee paid: I0 Id 7 6 -7 Type of unit: Dwelling�bther Check#_10_515 Check date: /0 37o 4 Notes: Code En c merit Inspector YAry CITY OF SALEM MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR ' .-; ]SCOT1 SALEM.COM JOANNE SCOTT, HEALTH AGENT 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 iny/oiif 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. < r Tenant/Lessee Owner/Lessor Address Address -- Address on unit to be inspected Date HP Fax Series 900 Fax History Report for Plain Paper Fax/Copier Joanne Scott Salem BOH 978 745 0343 - Oct 27 2009 1;07pm Last Fax Date Time Twe Identification, Duration Pages - es It Oct 27 1:06pm Sent 919788877692 1:09 2 OK Result: OK - black and white fax City of Salem, Massachusetts n Board of Health 120 Washington Street, 4th Floor, Salem, PtibHCHealth MA 01970 Prevent. Pnomnte.Pretext. Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, RENS,CHo Mayor health@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE #: GHL-17-242 DATE ISSUED: 8/10/2017 Property Located at: 186 MARLBOROUGH ROAD UNIT#2 Owner/Agent: Michael Shea Address: 186 Marlborough Road City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division 3, 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 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. Note: This approval does not certify compliance with the state lead law for occupants under 6 years of age. Larry Ramdin, MPH, REHS, CHO HEALTH AGENT SANITARIAN Se� fcGet cow CIJ CITY OF SALEM, NWSACHUSETFS BOARD Of HEALTH 120 WASHINGTON STREET,4"FLOOR TEL(978)742-1800 KIMBFALFY DRISCOLL FAR(978)745-0343 MAYOR IwMnna@ ALEM.alM LARRY RAMDIN,RS/RF..HS,CHO,CP-PS - HEaTHAGENT Application for Certificate of Fitness IN ACCQRDANCE WTI'H STATE SANITARY CODE,CHAFI'ER 11, 105 CMR 410.00 -1 NI1�flI1M STANDARDS OF FITNESS FOR HUMAN HABITATION" / FEE: $50.00 PROPERTY LOCATED AT �� �cV( �oy w t� �o c. S VNTT# '- IS 1S THIS UHIT DI.SIGNATED AS RIGHT LEFr FRONT OR BA PLEASE CIRCLE ONE OWNER/LF.SCSrR ` r- I C 5 MANAGER/AGENT . NO PD.box ADDRESS�Q �° ((`�v f_ya ( ADDRESS QTY,STATE,ZIP Jt��!�C� (11 A 61 01:70 crrY,STATE ZB' . RESIDENCE PHONE t 7 S7 '32'�-?BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: 9 I ROOM USE: 1. 2^ 3. 4. 5. 6. 7. S. 9. 10. THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS Y AT THE TIME OF INSPECTION APPLICANT'S SIGNATURE DATE }p� i lnsnectors use only Date on initial inspection: I lJ I Date of reinspectio ^ Date of issuance of certificate: Date fee paid Type Of unit: DweI in&._,_Other Check ZF Check date: Notes: Code Enforcement Inspector i City of Salem, Massachusettslu Board of Health 120 Washington Street, 4th Floor, Salem, PublicHealth t MA 01970 Prevent. Promote. Protect. Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, REHS, CHO Mayor Iramdin@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE#: GHL-15-82 DATE ISSUED: 5/28/2015 Property Located at: 186-b1dg2 MARLBOROUGH ROAD UNIT#2 Owner/Agent: Marie Gagnon Address: 8 Cleary Lane City/Town: Topsfield, MA Zip Code: 01983 24 Hour Phone:(978) 884-8856 Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division 3, 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 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 Larry Ramdin, MPH, REHS, CHO HEALTH AGENT SANITARIAN r CITY OF SALEM, MASSACHUSETTS - 0 BOARD OF HEALTH 120 WASHINGTON STREET,4 FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGRIT..NBAUMnSALC'.M.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 k%b-O C > UNIT# 3- IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE OWNER/LESSER M Csac, MANAGER/AGENT NO P.O. BOX ADDRESS Clb ADDRESS CITY, STATE, ZIP 14%3 CITY, STATE,ZIP RESIDENCE PHONE 9­19�— 216-1 BUSINESS PHONE (24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS:__ ROOM USE: 1. 1231-� 2. 7 3. LV 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 S 1y Il S I f Inspectors use only Date on initial inspection: �I 3�V� Date of reinspection: Date of issuance of certificate: Date fee paid: Type of unit: Dwelling Other Check# Lf�CJ"9 Check date: Notes: Code i-nfo• ement Inspector CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH > 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# 318-07 DATE ISSUED: 7/16/2007 Property Located at: 192 Marlborough Road UNIT# 1 Owner/Agent: Marie Gagnon Address: 16 Lockwood Lane City/Town: Topsfeld, MA Zip Code: 01983 24 Hour Phone: 978-887-8406 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. FO CARD HEALTH JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • • 120 WASHINGTON STREET, 4TH FLOOR RECEIVED SALEM, MA01970 TEL. 978-741-1800 FAX 978-745-0343 _ WL 16 2001 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO - CITY OF SALEM MAYOR HEALTH AGENT BOARD OF HEALTH 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 UNIT#fg6JSC ) IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER l` '--%4c J MANAGER/AGENT No P.O. Box No P.O. Box ADDRESS\b ADDRESS CITY apses=mss 7 CITY RESIDENCE PHONE BUSINESS PHONE (24 HRS.) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 0. 7z 1� 2. 33>;n 5.3£9 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. D APPLICANTS SIGNATURE INSPECTORS USE ONLY DATE OF INITIAL INSPECTION 7-[� fi I DATE OF REINSPECTION DATE OF ISSUANCE OF CERTI FICATE:7,14C DATE FEE PAID: TYPE OF UNIT: DWELLING/ OTHER_ CHECK# 77/7 CHECK DATE NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98