2DEVEREAUX AVENUE ¢o CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
c
� :9 120 WASHINGTON STREET, 4TH FLOOR
\ o 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#492-05
DATE ISSUED: 8/4/05
'e."
Property Located at: 2 Devereaux Street'UN'T# 1
1
Owner/Agent: Beverly McSwiggin
Address: 30 Japonica Street
City/Town: Salem, MA Zip Cade: 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 BOARD OF HEALTH f
JOINE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
x 1 a CITY OF SALEM, h4ASSACHUSETTS
- • ..�5 BOARD OF HEALTH !
• • 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-74 1-1800
745-0343
FAx 978- (/
STANLEY OYICZ, .J R- ,JOANNE SCOTT, MPH, R5, CHO
I
MAYOR HEALTH AGENT
i
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 — clo r—�_UNIT . L
IS THIS UNIT DESIGNATED AS FIG-- TT
H � LEFT FRONT BACK PLEASE CIRCLE ONE
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( �/U/ /
OWNEWLESSER MANAGER AGENT
No P.O. Box No P.O.Box
ADDRESS �0 W011)� GIS- Sr`IADDRESS
CITY—j#
'. —_C1TYii .
RESIDENCE PHONEUSINFSS PHONE (24 HRS ),
BUSINESS PHONE
TOTAL.. NUMBER OFFF ROOMS
:
ROOM USE 1,,4A 2-�
THERE IS A TWENTY-FIVE(525.00) DOLt.AR FEE, PAYABLE BY CHECK OR MONEY
ORDER TO THE CITY OF SALEM HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE
TIME OF INSPECTION,
APPLICANTS SIGNATUR�_. _ DATE -
INSP CIOR5USCONLY
i
DATEIF INHJAL INSPFCTIQN"� ' Y DATE OF RIDNSPECT ION1
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DATE OF ISSUANCI- Ol- C'CRI1PIMATF -65 Dltik r FI E I':.ID - "L v T
IYM- OFUNITDWELt..ING ._..01HFR CHFCK1! tf )� Rl ( iHFCKDATL
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