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NORTH STREET 200-300 NORTH STREET 200 — 300 b a _ y CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 W W W.SALEM.COM Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO Mayor HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE# 187-06 DATE ISSUED: 4/11/06 Property Located at: 202 North Street UNIT# 1 Owner/Agent: Denyce Deroche Address: 202 North Street 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 Ir' 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 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CrT Y OF SAID M M)C§ A tISE I a HOARD OF HEALTH 120 WASHINGTON STREETS 4TH FLOOR �� J SALEM,MA 01970 tiJ/�Al(••J� TEL. 978-741-1800 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 p, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION'. PROPERTY LOCATED ATC3 l(j rC�} _ UNIT N_ IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNERILESSER C(aMANAGER/AGENT_ _ NO P O.Box n G��ji,� No P.O.Box ADDRESS Box 11CY#'�1� t SII OADDRESS r CITY- �R ,O' i�t, h j CITY, RESIDENCE PHONE'�I'ILI rBUSINESS PHONE (24 HRS)__ BUSINESS PHONE TOTAL NUMBER OF ROOMS: ' r� n ROOM USE: 1. l 2._°�� g F-1�' WN_4. Ll\1 l�1 5--6 7-_. II _ THERE IS A TWENTY-FIE(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. II j APPIICANIS SIGNATURE INSPECTORS_USF ONLY III DATE OF INITIAL INSPECTION_t{ - / ( L' DATE OF REINSPECTIcON, DATE OF ISSUANCE OF CERTIFICATE, l f --C.GpAT[. f EE PAID t /� TYPE OF UNIT. DWELLI' OTHER CHECK t! / 07 0 iFCK DATE NOTES COL ENPOIWTMI'NI INS;Ill ClO4i u, l�idtt �27 CITY OF SAI,;EM, IVIASSACHUSL,1"TS BOARD OF HEALTH IV 120 WASHINGTON STREET,4."FLOOR PtibllCmH4!81th TEL. (978) 741-1800 Fax(978) 745-0343 KIMBERLEYDRISCOLL Itamdin@,salem.com MAYOR LARRY R-AMDIN,IiS/RP..I-IS,C1 10,CP-FS H[t,\i,n-r Ac aNT CERTIFICATE OF FITNESS CERTIFICATE#285-14 DATE ISSUED: 9/2/2014 Property Located at: 209 North Street UNIT# 1 Owner/Agent: Pamela Vath Address: 11 Duane Drive City/Town: North Reading, MA Zip Code: 01864 24 Hour Phone: 978-491-7252 Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division3, 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. FOR THE BOARD OF HEALTH LARFCORAMIDIN ((// HEALTH AGENT SANITARIAN L CITY OF SALEM, MASSACHUSETTS R; BOARD OF HEALTH ' 120 WASHINGTON STREET,4."FLOOR TEL. (978) 741-1800 w KIMBERLEY DRISCOLL FAX (978) 745-0343 MAYOR 1.RAMDIN(a),SAIa3M.00A1 LARRY RAMDIN,RS/RENS,CHO,CP-FS �D HI3Aun-f AGI.,NT 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 ACC PROPERTY LOCATED AT cZQ Z). I �1T-, ` /�[ UNIT# IS THIS UNIT //DISIG��N//ATE//D//AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE X77/ OWNER/LESSER OlayaJL,, MANAGER/AGENT SC7/YLP NO P.O.BOX ADDRESS /l �)UanA 0121 UP_ ADDRESS CITY, STATE,ZIP ipnLQ[� /2h—CITY, STATE,ZIP RESIDENCE PHONE ?'7 cr' BUSINESS PHONE(24HRS) BUSINESS PHONE 97Y �91 7o2Sc2 TOTAL NUMBER OFF ROOMS: / S ROOM USE: 1. -1j 1CMvi 2. h.J%spa 3. 4. 6. 7. 8. 9. 10. THERE IS A FIFTY($50)D AR FEE, YABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THI EE IS PAYA LE AT THE TIME F INSPECTION !� APPLICANT'S SIGNATU DATEo/D// Inspectors use only Date on initial inspection: a Date of reinspection: P / 1 � � Date of issuance of certificate: Date fee paid: Type of unit: Dwelling Other Check#Check date: Notes: O O J t f r Codment I&pector r "--k-. �v�� - i TRANSMISSION VERIFICATION REPORT TIME 09/03/2014 22: 02 NAME FAX 9787450343 TEL 9787411800 SER.# 000BON341991 DATEJIME 09/03 22:02 FAX NO. /NAME 919789220787 DURATION 00:00:29 PAGE(S) 01 RESULT OK MODE STANDARD ECM CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH s 120 WASHINGTON STREET, 4TH FLOOR I�o SALEM, MA O 1970 TEL. 978-741-1800 FAX 978-745-0343 KIMBERLEY DRISCOLL JSCOTT@SALEM.COM MAYOR JOANNE SCOTT HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#46-08 DATE ISSUED: 2/4/2008 Property Located at: 209 North Street UNIT#2 Owner/Agent: Pamela Vath Address: 11 Duane Drive City/Town: North Reading, MA Zip Code: 01864 24 Hour Phone: 978-491-7252 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 ll" 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. FO THE BOARD OF HEALTH r QUA c#,— JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, R5, CHO - Kimberley Driscoll HEALTH AGENT Mayor APPLICATION FOR CERTIFICATE OF FITNESS IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR gHUMAN HABITATION". PROPERTY LOCATED AT o2o9 /C �/-/LJt UNIT N o1 " IS THIS UNIT DES�NATEDAS RIGHT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER l� GL GL I�^) _MANAGER/AGENT No P.O. BoxNo P.O.Box ADDRESS 11 uQC1Q re 1Ve ADDRESSp ' CITY � cy—, CITY RESIDENCE PHONE d? od M BUSINESS PHONE (24 HRS.) BUSINESS PHONE 9 7S 119J 7a—C9 TOTAL NUMBER OF ROOMS: Q ROOM USE: 1._ .2. ._,2 4. /\ 5. 6. 7. 8. THERE IS A TWENTY-FIVE���??0 D(I LAS? Fr,-E, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM HEALT DEPARTM NT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. / APPLICANTS SIGNATUR _DATdD� INSPECTORS USE ONLY DATE OF INITIAL INSPECTION —0 DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE:24-_-=�b J�JDATE FEE PAID:_,_ TYPE OF UNIT: DWELLING OTHER CHECK # CH o� _ _-_ � _ ECK DATE , NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 I f __ { t , 1--- � � �. � � � �� �, . �. �� _• '. .. I City of Salem, Massachusetts Board of Health ! 120 Washington Street, 4th Floor, Salem, PubliCHealth MA 01970 Prevent.Promote, Protect. Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Remain, MPH, REHS, CHO Mayor health@salem.com Health Agent I CERTIFICATE OF FITNESS CERTIFICATE#: GHL-16.448 DATE ISSUED: 11/17/2016 Property Located at: 210 NORTH STREET UNIT#1 Owner/Agent: John Williams Address: 3 Cleveland Road I i City/Town: Salem, MA i Zip Code: 01970 24 Hour Phone:(978)745-9599 Pursuant to the requirements oflCity 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'. I 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. j i 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 cei ify compliance with the state lead law for occupants under 6 years of age. &effr sy Larry Ramdin, MPH, REHS, CHO HEALTH AGENT SANITARIAN • + CITY OF SALEM, MASSACHUS].I"I'S BOARD or HEALTH 120 WASHINGTON STREET,4T"FLOOR TEL. (978) 741-1800 VUMBERLEY DRISCOL L FAX(978) 745-0343 MAYOR LRAMDIN&SALF_M.COM I.ARRYRAMDIN,RS/RLHS,CHo,CP-FS FIEAT.,TH 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" FEE: $50.00 PROPERTY LOCATED AT Z�0 _J;;/ UNIT# l IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE OWNER/LESSER ;-7//" �l �+zs MANAGER/AGENT NO P.O.BOX / /' ADDRESS 3 (21 vP I, ADDRESS CITY, STATE,ZIP , ��Gc�_ /'lF� (57/y77 U CITY, STATE,ZIP RESIDENCE PHONEq 7Yf�J t S BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: �� ROOM USE: 1. 2. 3. 4. l� 5. J 6. 7. 8. 9. 10. THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR EY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE IS$ YA E A`T�TIM OF TION APPLICANT'S SIGNATURE SCJ ' DATE Inspectors use only Date on initial inspection:�l- /� kJ/ 4 b Date of reinspection: Date of issuance of certificate: Date fee paid:1 OV-2o1,E Type of unit: Dwelfin Other Check#Check date: 1--1 o Notes: C nfo ement Inst ctor FMiI� ' FAMILY MEDICINE ASSOCIATES LC) Uj 5 t�- , a,y mks G - A- 15 Railroad Avenue, Hamilton, MA 01982 phone: 978-468-7381 fax: 978-468-6020 www.fma.md / CONDiT,, City of Salem, Massachusetts 9 Board of Health 120 Washington Street, 4th Floor, Salem, Puth MA01970 Prevent. Promote. Protect. Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, RENS, CHO Mayor health@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE M GHL-16-449 DATE ISSUED: 11/17/2016 Property Located at: 210 NORTH STREET UNIT#2 Owner/Agent: John Williams Address: 3 Cleveland Road City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(978) 745-9599 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. � Y Larry Ramdin, MPH, REHS, CHO HEALTH AGENT SANITARIAN : CITY OF SAIJiM, MASSACHUSE'I"TS BOARD OF HEALTH 120 WASHINGTON STREET,4T"FLOOR TEL. (978) 741-1800 ICTn1BERLEY DIUSCOLL FAX(978) 745-0343 MAYOR LRAMDINC(6A1EM.00M LARRY RAMDIN,RS/REHS,CHO,CP-FS HEAL'm AGENT Application for Certificate of Fitness IN ACCORDANCE WITH STATE SANITARY CODE, C14APTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" h FEE: $50.00 PROPERTY LOCATED AT UNIT# IS THIS UNIT SIG D AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE OWNER/LESSER C1/( dt � ' YG MANAGER/AGENT NO P.O.BOX ADDRESS ADDRESS CITY, STATE,ZIP 1 7G . �S�� CITY, STATE,ZIP RESIDENCE PHONE //J' )��rT_BUSINESS PHONE (24HRS) BUSINESS PHONE ff / ;7 Z TOTAL NUMBER OF ROOMS: ROOM USE: 1. 2. 3. 4. 6. 7. 8. 9. 10. THERE IS A FIFTY($50)DOLLAR FEE,PA BLE BY R ' ONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE IS PA AT OF SPECTION APPLICANT'S SIGNATURE / DATE ` Inspectors use only Date on initial inspection: Date of reinspection: Date of issuance of certificate: .2-06 Date fee aid: Type of unit: Dwelling �Other Check#Check date: Notes: C n cement Inst ctor `O nom" City of Salem, Massachusetts 9 Board of Health 120 Washington Street, 4th Floor, Salem, PubliCHealth MA 01970 Prevent. Promote. Protect. Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, RENS, CHO Mayor health@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE #: GHL-16.450 DATE ISSUED: 11/17/2016 Property Located at: 210 NORTH STREET UNIT#3 Owner/Agent: John Williams Address: 3 Cleveland Road City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(978) 745-9599 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. J re Larry Ramdin, MPH, REHS, CHO HEALTH AGENT SANITARIAN : CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,47"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR LRAMD W&SALEM.COM LARRYRAMDtN,RS/RFHs,CHO,CP-FS 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" FEE:/$50.00 PROPERTY LOCATED AT UNIT# IS THIS UNIT DISIG D AS RIGHT LEFT FRONT OR BACKPLEASE CIRCLE ONE OWNER/LESSER MANAGER/AGENT NO P.O.BOX ADDRESS ADDRESS CITY, STATE,ZIP CITY, STATE,ZIP RESIDENCE PHONE BUSINESS PHONE (24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1. 2. 3. 4. 6. 7. 8. 9. 10. THERE IS A FIFTY($50)DOLLAR FEY,PAYABLE BY K OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE IS ABLE AT OF INSPECTION APPLICANT'S SIGNATURE 2DATE �177 q ¢jj - Inspectors use only Date on initial inspection: � ,1? (- Date of reinspection: Date of issuance of certificate: -��L� Date fee paid: 19L41 Type of unit: Dwelling_�Other Check#10-6—Check date: Z �� Notes: o orcemet14spec[or n CERT.# 191-01 o. FEE $25 .00 DATE: 04/23/2001 ��MINg CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tel: (978)741-1800 Fax: (978)740-9705 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 212 North Street UNIT #: 1 OWNER/AGENT: Jose & Eire Gonzalez ADDRESS: 212 North Street CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-4812 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, 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. FOR MORE INFORMATION CALL 978-741-1800 . FOR THE BOARD OF HEALTH 6 L&V JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR !' �,CONDIT ��YryMg CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT APPLICATION FOR CERTIFICATE OF FITNESS Tel:(978)741-1800 Fax:(978)740-9705 IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT_ v21.;�- 15;�7�Lh UNIT# 1 IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER ,t MANAGER/AGENT No P.O. Box�� �� No P.O. Box ADDRESS ADDRESS CITY CITY RESIDENCE PHONE 9�0° "7%j�gl�' BUSINESS PHONE (24 HRS.) BUSINESS PHONE TOTAL NUMBER//OF ROOMS: �f rrn" Ai ROOM USE: 1. 2. I7// mn 3.4_'tdrrm, 4, 5. 6.-7.-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 DATE eY�� � INSPECTORS USE ONLY DATE OF INITIAL INSPECTION �f-� 3- Q ( DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: -o DATE FEE PAID: TYPE OF UNIT: DWELLING/rOTHER_ CHECK# a 7 CHECK DATE ZJ 1 NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 �ONUIT� CERT.# 182-00 FEE $25 .00 M DATE: 03/09/2000 Hg�IMIN6 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS, CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Fax:(978)740-9705 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 217 North Street UNIT #: 2 OWNER/AGENT: Peter Scanaas ADDRESS: 217 North Street CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-2765 AN INSPECTION OF YOUR VACANT DWELLING/ROOMING UNIT AT THE ABOVE ADDRESS HAS BEEN APPROVED AND IS IN COMPLIANCE WITH 105 CMR 410 .000 : MASSACHUSETTS STATE SANITARY CODE, CHAPTER II, "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" . THEREFORE, THIS CERTIFICATE IS ISSUED BY THE CODE ENFORCEMENT DIVISION OF THE SALEM BOARD OF HEALTH AND THE UNIT MAY NOW BE RENTED AND/OR OCCUPIED. MAXIMUM NUMBER OF OCCUPANTS, BASED ON 105 CMR 410 .000 : MASSACHUSETTS STATE SANITARY CODE, CHAPTER II, "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" . SECTION 410 .400 (B) : DWELLING UNIT (X) AND 410.400 (C) : ROOMING UNIT ( ) MINIMUM SQUARE FOOTAGE FOR SLEEPING PURPOSES: . NOTE: THIS APPROVAL DOES NOT CERTIFY COMPLIANCE WITH THE STATE LEAD LAW FOR OCCUPANTS UNDER 6 YEARS OF AGE. FOR MORE INFORMATION CALL 978-741-1800 . FOR THE BOARD OF HEALTH JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR 0 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT APPLICATION FOR CERTIFICATE OF FITNESS Tef: (978)741-1800 IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000 Fax:(978)740-9705 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT � JJ e l ST UNIT#j�g IS,THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER Tt77J`C 6 SMMCAS MANAGER/AGENT S /9 M �-- No P.O. Box No P.O. Box ADDRESS ADDRESS RESIDENCE PHONE 245`o`Z 7 -D BUSINESS PHONE (24 HRS.) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1. �2. 5. ( 6. / 7. 8. THERE IS A TWENTY-FIVE($T25.00) 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- - =/y ATE 25;� INSPECTORS USE ONLY DATE OF INITIAL INSPECTION 3 DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE:. 04D DATE FEE PAID: 6va TYPE OF UNIT: DWELLING OTHER_ CHECK# Z 3 ? CHECK DATE � C�d NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 �+ e CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT 03/03/2000 Tel:(978)741-1800 Fax:(978)740-9705 Peter & Anastasia Scangas 217 North Street Salem, MA 01970 PROPERTY LOCATED AT 217 North Street UNIT # 2 Dear Sir/Madam: It has come to our attention, that you may be considering renting a dwelling unit at the above address. In accordance with Chapter 11, Article XIII of the City of Salem Code of Ordinances, Section 2-334, titled "Certificate of Fitness, " each dwelling unit must be inspected and certified prior to allowing occupancy. The inspection will be conducted in accordance with the State Sanitary Code, Chapter II: Minimum Standards of Fitness for Human Habitation. Please notify us if you do not intend to rent the unit. Please contact this department within One Week of receipt of this notice at 978-741-1800, to schedule an appointment for an inspection. Our office hours are Monday thru Wednesday from 8:00 a.m. - 4:00 p.m. Thursday 8:00 a.m. - 7:00 p.m. and Friday 8:00 a.m.- 4:00 p.m. A $25.00 check payable to the City of Salem is required for each unit inspected at the time of inspection. A property owner is required to pay gas and electricity for residential tenants if there is not a written letting agreement stating the tenant is responsible for those utilities and if the meter(s) records electricity and gas use which is not used exclusively by that tenant. The Department of Public Utilities has billed property owners for their tenants' entire utility bills retroactive to the date of initial occupancy in cases in which cross-metering has been proven eo exist. R THE BOARD 0 HEALTH REPLY TO Joanne Scott,- MPH,RS,CHO -PABLO VALDEZ - - HEALTH AGENT CODE ENFORCEMENT INSPECTOR i �I � ,.: vg�gONU1T ' CERT.# 85-99 FEE $25.00 DATE: 02/24/99 ���7MMg>l CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tel: (978)741-1800 Fax: (978)740-9705 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 217 North Street UNIT #: 3 OWNER/AGENT: Peter Scangae ADDRESS: 217 North Street CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-2765 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 HEALTH DEPARTMENT 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. FOR MORE INFORMATION CALL 978-741-1800 . FOR THE BOARD OF HEALTH q ANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR ill CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT APPLICATION FOR CERTIFICATE OF FITNESS Tee(978)741-1800 Fax:(978)740-9705 IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT 02/11 �D Apr Q57 UNIT# v IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER-?� S MANAGER/AGENT No P.O. Box No P.O. Box ADDRES,9�5?I _ ADDRESS_ CITY , CITY RESIDENCE PHONEBUSINESS PHONE (24 HRS.) BUSINESS PHONE i TOTAL NUMBER OF ROOMS: l0 ROOM USE: 1. y _ 2. rtl 3s&DR. 4.3 DJe. 51.• lQDd67 6. �r 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. / p� APPLICANTS SIGNATURE _ _DATE02 027— ! INSPECTORS Ud ONLY DATE OF INITIAL INSPECTION �1� t 4 DATE OF REINSPECTION DATE OF ISSUANCE OF CER14 (T.IFICATE:.'�'f -qf DATE FEE PAID: A '� � - f TYPE OF UNIT: DWELLING {1 OTHER_ CHECK #�w CHECK DATE .2 NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS, CHO NINE NORTH STREET HEALTH AGENT 02/17/99 Tel: (978)741-1800 Fax: (978)740-9705 Anastasia & Peter Scangas 217 North Street Salem, MA 01970 PROPERTY LOCATED AT 217 North Street UNIT # 3 Dear Sir/Madam: It has come to our attention, that you may be considering renting a dwelling unit at the above address. In accordance with Chapter 11, Article XIII of the City of .Salem Code of Ordinances, Section 2-334, titled "Certificate of Fitness, " each dwelling unit must be inspected and certified prior to allowing occupancy. The inspection will be conducted in accordance with the State Sanitary Code, Chapter II: Minimum Standards of Fitness for Human Habitation. Please notify us if you do not intend to rent the unit. Please contact this department within One Week of receipt of this notice at 978-741-1800, to schedule an appointment for an inspection. Our office hours are Monday thru Wednesday from 8:00 a.m. - 4 :00 p.m. Thursday 8:00 a.m. - 7 :00 p.m. and Friday 8:00 a.m. - 4:00 p.m. A $25.00 check payable to the City of Salem is required for each unit inspected at the time of inspection. A property owner is required to pay gas and electricity for residential tenants if there is not -a written letting agreement stating the tenant is responsible for those utilities and if the meter(s) records electricity and gas use which is not used exclusively by that tenant. The Department of Public Utilities has billed property owners for their tenants' entire utility bills retroactive to the date of initial occupancy in cases in which cross-metering has been proven eo exist. IaTHE BOARD OF EA T REPLY TO �� 5�, MPPABLO VALDEZ HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS • • BOARD OF HEALTH 120 WASHINGTON STREET,4°`FLOOR TEL. (978) 741-1800. IC NI BERLEY DRISCOLL FAx(978) 745-0343 MAYOR DGRBFNBAUM(@SAI,EM.CnM DAv)D GREENBAUM ACTING HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#572-09 DATE ISSUED: 11/2/2009 Property Located at: 235 North Street UNIT# 1 Owner/Agent: Alaide Corria Address: P.O. Box 52 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 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. FOF HEALTH 1 DAVID GREENBAUM ACTING HEALTH AGENT CODE ENF T PECTOR CITY OF SALEM, MASSACHUSETTS _. + : BOARD OF HEALTH 120 WASHINGTON STREET,4°i FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR D(AZLENI4AUMOSALEM.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." ?? FEE: $50.00 PROPERTY LOCATED AT CJ�S UNIT#_L IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE OWNER/LESSER AIc.6 d e MANAGER/AGENT NO P.O. BOX ADDRESS ADDRESS CITY, STATE,ZIPS cl 142 ,n p Vh �r CITY, STATE,ZIP RESIDENCE PHONE BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: I_6eJ ✓rw^', 2 h ed� 3.b.CsD KV�w% 4I�'n� Wu�+ 5 t fl 6. 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 IS PAYABLE AT THE TIME OF INSPECTION APPLICANT'S SIGNATURE vuctj Avl. DATE Inspectors use only Date on initial inspection: I /a /Q Date of reinspection- Date of issuance of certificate:� 114ki Date fee paid: I� y Type of unit: Dwelling �Uther Check# 9 D Check date: / d) k 9 Notes: Code Enfor 4ent Inspector / 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WAS'HING'TON STREET,4T°FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX (978) 745-0343 MAYOR DGR Er:NBAUM([I_SAJ EM.COM DAVID GRE FNBA U M,RS Al.TfNCi Hi]',Atxi-f AGG.N'T CERTIFICATE OF FITNESS CERTIFICATE #566-10 DATE ISSUED: 12/9/2010 Property Located at: 235 North Street UNIT#3 Owner/Agent: Alaide Correia Address: P.O. Box 52 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 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. FOR THE BOARD OF HEALTH D VID GREENBAUM, RS ACTING HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHLJSE'r- :S t3(I.vIzn(Ie Ht u.rx 120 WAST LING ON STRGI:T,4O' I'7,o IR KIMBI iRLEY DRISCOLL (978)741-1800 F,\x(978)745-0343 MAYOR lraindin a salcin.coin LARRY RANIDIN, RS/RI!I IS,010,01-11,' HP;;\l a'I I A(;I INT Facsimile Transmittal To: Fax # RE: Date : 4/6,/ Page(s): including this cover# Message: Board of Health News -- -- - — ------ --For Your Information OFFICE HOURS: Monday, Tuesday, Wednesday 8:00 AM to 4:00 PM Thursday 8:00 AM to 7:00 PM Friday 8:00 AM to 12:00 NOON L TRANSMISSION VERIFICATION REPORT TIME 01/29/2012 21:37 NAME FAX 9787450343 TEL 9787411800 SER. # 000BON341991 DATE,TIME 01129 21:36 FAX NO. /NAME 919784588237 DURATION 00: 00: 25 PAGE(S) 02 RESULT OK MODE STANDARD ECM A 0 � o p �� ------ �! /� �-- �,�;`"�' � , /. �--`� ..---'" r— CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON S'1RI3F_1",4°1 FIxIOIt TFL. (978) 741-1800 14MBERLEY DRISCOLL FAX(978) 745-0343 MAYOR COM DAVID GRCINBAumt,RS ACTING Hi^.AizI-i 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." FEE: $50.00 PROPERTY LOCATED AT U�� S� re UNIT# -3 IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE OWNER/LESSER �(�Cn i(� 'C ��r cti MANAGER/AGENT V" C cO \,( Y-e-r NOP'0. BOX ,(� ADRESS t7 f X S ADDRESS O , CITY, STATE,ZIP S m 1 wt VY1 A C) J CITY, STATE,ZIP S w( e-� RESIDENCE PHONE l BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS:—.5 ROOM USE: I A)a w u—A 2. 6o( WL 6. 7. S. 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 IS PAYABLE AT THE TIME OF INSPECTION\ APPLICANT'S SIGNATURE Y n Cl `� DATE / Z A O Inspectors use only Date on initial inspection: lall ! (] Date of reinspection: Date of issuance of certificate: /0 Date fee paid: Type of unit: Dwelling zOther Check#Check date: �a I Gl ITU Notes: -�()( JCIPA I''1 00 � rv,n day, Ac/ bUqk/ Co En rcement Inspector • CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TFL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR DGRFTNBAUMQSA1,Eb1.COM DAVID GRE,ENBAU\I,RS ACTING HF.AI;FH AGENT Release In accordance with Massachusetts General Laws Chapter 111; Code of Massachusetts Regulations 410.000 et. Seq. ; State Sanitary Code Chapter II and Article XIII of the City of Salem Ordinance, undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health or its authorized agents to inspect the residence identified below in accordance with the aforementioned statutes, regulations and ordinances. In the event it is necessary that said inspection be done in my/out absence. I/we expressly authorized the same and for my/our successors and assigns hereby release and discharge the City of Salem, Salem Board of Health and its authorized agents from any lose or injury sustained of whatever nature and description occasioned by my/out absence during said inspection. Tenant/Lessee Owner/Lessor Address Address Address on unit to be inspected Date CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH ' 120 WASHINGTON STREET,4""FLOOR TEL. (978) 741-1800 ICNEIERLE,Y DRISCOLL FAX(978) 745-0343 MAYOR ucal:r;NisnuniCn�sni.lsnc :omr D;\VID Giu;rNIi;\UA4 ACTING W,ALrn AGISN'f Facsimile I/'�� Transmittal To: Fax # / 7 - ,LV� RE: c�.� �/� yke,- Date Page(s): including this cover# Message: Board of Health News ---------------------------------------------------------------For Your Information OFFICE HOURS: Monday, Tuesday, Wednesday 8:00 AM to 4:00 PM Thursday 8:00 AM to 7:00 PM Friday 8:00 AM to 12:00 NOON T 19 TRANSMISSION VERIFICATION REPORT TIME : 12/12/2010 22:33 NAME : FAX : 9787450343 TEL : 9787411800 SER.# : 000BON341991 DATEJIME 12/12 22: 33 FAX NO./NAME 916175327642 DURATION 00:00:39 PAGE(S) 02 RESULT OK MODE STANDARD ECM i ,X o CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH m 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1 800 FAX 978-745-0343 STANLEY USOVICZ, JR. JO^'x.'111 .SCOTT. MPH. RF; MAYOR HEALTH AGENT 02/08/2002 Leonidas & Elizabeth Phillipedas 245 North Street Salem, MA 01970 PROPERTY LOCATED AT 245 North Street UNIT # 1 Dear Sir/Madam: It has come to our attention, that you may be considering renting a dwelling unit at -� !e above address. In accordance with Chapter 11, Article XIII of the City of Salem Code of Ordinances, Section 2-334, titled "Certificate of Fitness, " each dwelling unit must be inspected and certified prior to allowing occupancy. The inspection will be conducted in accordance with the State Sanitary Code, Chapter II: Minimum Standards of Fitness for Human Habitation. Please notify us if you do not intend to rent the unit. Please contact this department within One Week of receipt of this notice at 978-741-1800, to schedule an appointment for an inspection. Our office hours are Monday thru Wednesday from 8:00 a.m. - 4 :00 p.m. Thursday 8:00 a.m. - 7 : 00 p.m. and Friday 8:00 a.m. - 4 :00 p.m. - A $25.00 check payable to the City of Salem is required for each unit inspected at the time of inspection. A property owner is required to pay gas and electricity for residential tenants if there is not a written letting agreement stating the tenant is responsible for those utilities and if the meter(s) records electricity and gas use which is not used exclusively by that tenant. The Department of Public Utilities has billed property owners for their tenants' entire utility bills retroactive to the'date of initial occupancy in cases in which cross-metering has been proven eo exist. OR THE BOARD OF HEALTH REPLY TO Joanne Scott, MPH,RS,CHO PABLO VALDEZ HEALTH AGENT CODE ENFORCEMENT INSPECTOR I �y 1h CERT.# 40-98 w " FEE 01/27/ 3 DATE: 01/27/98 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Fax:(978)740-9705 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 245 North Street UNIT #: ,I OWNER/AGENT: Leonidas ✓t Elizabeth Phillioedas ADDRESS: 245 North Street CITY/TOWN: Salem MA ZIP CODE: 01970 24 HOUR PHONE: 744-9227 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 HEALTH DEPARTMENT 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. FOR THE BOARD OF HEALTH qvl"Clle� Q JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 APPLICATION FOR CERTIFICTE OF FITNESS Fax:(508)740-9705 IN ACCORDANCE WITH STATE SANITARY! CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT a p 'r�,p � J UNIT #��A1 J OWNER/LESSER _J G 1 MANAGER/AGENT ADDRESS s� �h d WL1 . I� ADDRESS CITY (� /�//� CITY -,RESIDENCE PHONE BUSINESS PHONE (24 HRS.) BUSINESS PHONE — TOTAL NUMBER OF ROOMS: S� ROOM USE: 1. 5. 6. 7. 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 TIRE OF/ INSPECTION APPLICANTS SIGNATURE 26e" � DATE INSPECTORS USE ONLY DATE OF INITIAL INSPECTION: 1? DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: J 7 (��' DATE FEE PAID:_/_� t_ TYPE OF UNIT: DWELLING (/ OTHER NOTES : CODE ENFORCEMENT INSPECTOR CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO - - NINE NORTH STREET HEALTH AGENT - Tel:(508)741-1800 Fax:(508)740-9705 RELEASE In accordance with Massachusetts General Laws Chapter 111 ; Code of Massachusetts Regulations 410.000 et. seq. ; State Sanitary Code Chapter II and Article XIII of the Citv of Salem Ordinance, undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health or its author- ized agents to inspect the residence identified below in accordance with the aforementioned statutes, regulations and ordinances. In the event it is necessary that said inspection be done in my/our absence, I/we expressly authorize the same and for my/our successors and assigns hereby release and discharge the City of Salem, Salem Board of Health and its authorized agents from any,loss or injury sustained of whatever nature and description occasioned .. by my/our absence during said inspecti-on: TENANT/LESSEE OWNER/LESSOR 5- A10 sg4l DRESS S4 /e PtA <v l A- ADDRESS --- — ADDRESS OF UNIT TO BE INSPECTED DATE