4 DEVEREAUX AVENUE #2 City of Salem, Massachusetts
t3
Board of Health
120 Washington Street, 4th Floor, Salem,
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-17-383
DATE ISSUED: 11!9/2017
Property Located at: 4 DEVEREAUX STREET UNIT#2
Owner/Agent: Beverlie Mcswiggin
Address: 30 Japonica Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(978)979-2784
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 li"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.
LarryRamdin, MPH, REHS, CHO
HEALTH AGENT SANITARIAN
r-
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASU NG ON STREET,4"'FLOOR
TEL (978)741-1800
ICOOE RLF,Y DRISCOLL FAX(978)745-0343
MAYOR IHAMD .a)M
LARRY RAMDIN,RS/REBS,CHO,CP-PS '
HEALTH AGENT
Application for Certificate of FIMIM
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 _ST#_ _
is TIM DNIT D15IGNATED AS RIGA'LFF[FRONT OR BA CL PLEASECIRCLE ONE
OWNEMMSER_ ,-- l .gr`i•PMck7k-64YP7 MANAGER/AGE T :� �l e-t�-I—
NOP.O.BOX��
ADDRESS�c,�QyL i C_R �� ADDRESS ��Aq
CITY,STATE,23P 9 1 m CITY,STATE ZIl' W d� ?U
RESIDENCE PHONE BUSINESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ROOM USE: 2. 3. 4. 5.
9. 10.
THERE IS A F117fY($50)DOLLAR FEB,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE IS PAYABLE AT THE TIME F INSPEMON
APPLICANT'S SIGNATURE DATE J
Inspectors use my
Date on initial inspection: Date of reinspection:
Date of issuance of certificate: 11 � Date fee paid:
Type of unit Dwelling -Other-Check# )' `� Check date:
Notes:
Code Eirlbrceuent Inspector
F
CITY OF SALEM, MASSACHUSETTS
o ; BOARD OF HEALTH
s 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAx 978-745-0343
Kimberley Driscoll WWW.SALEM.COM
Mayor JOANNE Sco-r-r, MPH, RS, CHO
HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE# 163-07
DATE ISSUED: 4/2/2007
Property Located at: 4 Devereaux Street UNIT#2
Owner/Agent: Beverlie McSwiggin
Address: 30 Japonica Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-979-2784
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 If'
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
qv-o,�
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CTTy OF SALEM, MASSACHUSETTS 11p �
BOARD OF HEALTH
• 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
JOANNE SCOTT, MPH, RS, CHO
Kimberley Driscoll HEALTH AGENT
Mayor
If APPLICATION FOR CERTIFICATE OF FITNESS
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNtE�S,S"FOR HUMAN HABITATION'.
PROPERTY LOCATED AT /% ar�P.ZQXC
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER� MANAGER/AGENT
Na P.O. Box - No P.O.Box i
ADDRESS / ___ADDRESS
CITY_ ((// CITY j`c _
RESIDENCE PHONE#_LO�_BUSINESS PHONE (24 HRS.) �j�
BUSINESS PHONE____
TOTAL NUMBER OF ROOMS:_
ROOM USE: 1. 42. _3. K._4. __
:-
5-K ,&--
. K6. _7.` 8. __
THERE IS A TWENTY-FIVE(525.00) 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 DATE 7
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION__y__",�-.._ 'D_t -_DATE OF REINSPECTION-_____
DATE OF ISSUANCE:. OF CERTIFICATE � -r} �� _ _DATE FEE PAID
TYPE OF UNIT: DNELLII OTHER_- -, CHECK # . CHECK DATE
NOTES:
CODE ENFORCEMENT INSPECTOR 9/23/98