1 DEVEREAUX AVENUE #1I
CITY OF SALEM, MASSACHUSE l-fS
BOARD OF HEALTH
004 120 WASHINGTON STREET,4"'FLOOR
TEL. (978) 741-1800
KINIBERLEY DRISCOL.L FAX(978) 745-0343
MAYOR NGer•:r.NUAUNf@.SAi.em COM
DAVID GRu.uNB U NI
AC'I'ING HI•:AI:;n I AG13NT
CERTIFICATE OF FITNESS
CERTIFICATE #361-09
DATE ISSUED: 7/31/2009
Property Located at: 1 Devereaux Avenue UNIT# 1
Owner/Agent: Ellen Talkowsky
Address: 3 Devereaux Avenue
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 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 BO OF HEALTH
I
DAVID GREEN AIGE
_
ACTING HEALTH T COD EN ORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
t 120 WASHINGTON STREET,4'"FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR . ocR17,etN13ALJMRSA1.EM.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."
c� FEE: $50.00
PROPERTY LOCATED AT eq v4 tN e, UNIT# /
IS T DISIGNATED AS RIGHT LEFT FRONT OR BAC PLEASE CIRCLE ONE
OWNER/LESSER en I� ` AIj AGER/AGENT
NO P.O. BOX ����� e� �- \ I
ADDRESS � ADDRESS I (�G/l4 014�/
CITY, STATE, IP �Qi✓' CITY, STATE,ZIPRESIDENCE PH �BUSINESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. 2. 3. hi✓t^1 4. " Soa►n 5. �✓� ���
K pd"" 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
EIIfS�PAYABLE AT THE TIME OF INSPECTION �1
APPLICANT'S SIGNATURE Od6�� �� � 07 _L DATE �y
Inspectors use only
Date on initial inspection: 31/01 Date of reinspection
Date of issuance of certificate: Date fee paid: 7 131 o
Type of unit: Dwelling Other Check#_t3_3 Check date:— 7/3
Notes:
")w Isy k ,Gv hh
Code Enforcement ector