MEMORIAL DRIVE (002) MEMORIAL DRIVE
i
NaxwT CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
b 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-74 1-1800
FAX 978-745-0343
STANLEY LISOVICZ, JR. JOANNE SCOTT, MPH, RS. CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#232-04
DATE ISSUED: 05/28/2004
Property Located at: 51 Memorial Drive UNIT# House
Owner/Agent: Margaret Press
Address: 55 Memorial Drive
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-745-0285
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.
THE BOARD O HEALT,FORH
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT CpDE ENFORCE ENT INSP TOR
CITY OF SALEM, MASSACHUSETTS
0
BOARD OF HEALTH
• 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-74 1-1800
FAX 978-745-0343
STANLEY LISOVICZ, 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 FITNESSFORHUMAN HABITATION".
PROPERTY LOCATED AT ( 1 FLPrlA `/i Wy UNIT#
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER IAM'Q6 UI MANAGER/AGENT
No P.O. Box No P.O. Box
ADDRESS// gip"�A �,� ADDRESS
CITY �J�' �f CITY
RESIDENCE PHONE7CK-0r7ssS' BUSINESS PHONE (24 HRS.) em�i
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. 5AFM 2.
5. yVJN 6. 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.
APPLICANTS SIGNATURE C a DATE
INSP CTORS USE ONLY
DATE OF INITIAL INSPECTION, 5,/6 DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: DATE FEE PAID/-
TYPE OF UNIT: DWELLING _OTHER_ CHECK# 1W CHECK DATE_, 4
NOTES:
Al- A14
CODr ENFORCEMENT INS ECTOR 9/28/98