6 DEVEREAUX AVENUE #2 - , - City of Salem, Massachusetts 1111", PW
ML Aff
INLW
t 3.
Board of Health �i�'-
120 Washington Street, 4th Floor, Salem, PFP�1bUr-Promote.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-17-352
DATE ISSUED: 10/17/2017
Property Located at: 6 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 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
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STRr'.ET,4n'FwoR
TEL (978)741-1800
KIMBERLEY DRISCOLL FAX(978)745-0343
MAYOR LRAMDIN@SAIEM.CA)M
LARRY RAMOIN,RS/RF.HS,CHO,CP-PS .
HEALTHAGIWr
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 ATg t 1 P i/ 2 J P G ( �L C r h�t UNJT# a
IS THIS UNIT DISIGNATED AS RIGHT LERf FRONT OR BAC PLEASE OIRCLE ONE
OWNER/IMSERB&✓2.y'I' <- AGER/AGENT, I �P� &_k6, ,, 7
NO P.O.BOX.
ADDRESS 3 c O n �, S ADDRESS �
CITY,STATE,ZIP S P h1 ✓J'l CITY,STATE,ZIP •D 7/ 7 C
RmiDENCE PHONE22LI VY-1 0 a k BusINESS PHONE(24HRS) 9 70` C.'y —.2
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:_
ROOMUSE: 1 ��,`fC(ti 2 I ; h 3 L:'J Iss 4.L, 5. 1�' V`uo'.
6.bcJra w, 7.10gdro,.s,. Cj-__ 3 uK% 10.
THERE IS A FWff($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 �Q C ' DATES /
InsDecto use only
Date on initial inspection: Date of reinspection:
Date of issuance of certificate: Date fee paid:
Type of unit Dwellim Dwell' Other �� }��/�Check#_� Check date: P
Notes: LY i/6 � 1—Gl 0P,1C lkl I
Code Enforcement Inspector I
�t � K /V
t CITY OF SALEM, MAssACHUSErm
:1 BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR - CERT.# 500-03
SALEM, MA 01970
TEL. 978-741-1800 FEE $25.00
op FAX 978-745-0343 DATE: 10/1/03
STANLEY USOVICZ, JR, JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
f
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 6 DEVEREAUX STREET UNIT #: 2
OWNER/AGENT: . JOHN P. RILEY
ADDRESS: 30 JAPONICA STREET
CITY/TOWN: SALEM, MA ZIP CODE: 01970 24 HOUR PHONE: 978-744-1088
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 IT, "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, BASED ON 105 CMR 410.000: MASSACHUSETTS STATE
SANITARY CODE, CHAPTER II, "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" .
SECTION 410.400 (B) : DWELLING UNIT (X) AND 410.400 (C) : ROOMING UNIT
MINIMUM SQUARE FOOTAGE FOR SLEEPING PURPOSES: .
NOTE: THIS APPROVAL DOES NOT CERTIFY COMPLIANCE WITH THE STATE LEAD LAW FOR
OCCUPANTS UNDER 6 YEARS OF AGE NOR BUILDING RELATED CODES, FOR MORE
INFORMATION CALL 978-741-1800.
F4 TD OF HEALTH
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
f CITY OF SALEM, MASSACHUSETTS a3
BOARD OF HEALTH
• • 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-74 1-1 800
FAX 978-745-0343
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
APPLICATION FOR CERTIFICATE OF FITNESS
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATI09
PROPERTY LOCATED AT, ( —UNIT# 6i
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER MANAGER/AGENT ,�e6—
No P.O. Boxo P.O. Box
ADDRESS ��2��Q/tl��i/4 ADDRESS
CITY M4 CITY
RESIDENCE PHONE �/p�l'7!/J/�lO�jBUSINESS PHONE (24 HRS.)_
BUSINESS PHONE /�7�l
_�7� 7,/ `/aff
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. 2. 3. 1-4.
5. /r� aelcl
6. XJA 7. 8. /
04"rvk
THERE IS A TWENTY-FIVE($25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY
ORDER TO THE CITY OF SALEM HEALTH DEPA ENT THIS FEE IS PAYABLE AT THE
TIME OF INSPECTION.
APPLICANTS SIGNATURE a DATE
6;7LNSPECT0'RS_JSE ONVY
DATE OF INITIAL INSPECTION 9l a /-) DATE OF REINSPECTION N�i4
DATE OF ISSUANCE OF CERTIFICATE:_ y1dS-1e 2 DATE F�� ,AID: 6EI 3
TYPE OF UNIT: DWELLING VOTHER_ CHECK# -'W6-3 CHECK DATE?-_da-GS
NOTES: O•lr" �lo :AkA4/ 4- '-2y
COD N CEMENT SPECTOR 9/28/98