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NORTHEND AVENUE NORTHEND AVENUE m s DON City of Salem, Massachusetts Board of Health 120 Washington Street, 4th Floor, Salem, PubliCHtlth MA 01970 Prevent. Promote, Protect. Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin,MPH, RENS,CH4 Mayor Iramdin@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE#: GHL-16-166 DATE ISSUED: 5/1812016 Property Located at: 16 NORTHEND AVENUE UNIT#2 Owner/Agent: Danny Baez Address: 16 Northend Avenue#1 City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(978)360-9078 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 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, 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 i7JefflreyBa`rosy�r Larry Ramdin, MPH, REHS, CHO HEALTH AGENT SANITARIAN I • CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR Prevent.p111)110He81th TEL. (978) 741-1800 FAX(978) 745-0343 KIMBERLEY DRISCOLL Iramdin@salem.com L. MAYOR -V2RY ILIMDIN,RS/REI-IS,(11-10,CP-FS HEAL;1'11 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 V e xd n- P UNIT#_ IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE OWNER/LESSER MANAGER/AGENT NO P.O. BOX r7h Q / e ADDRESS f Tk e P &,(,e CITY, STATE,Z1P 5`/{;� , �g�fl CITY, STATE, ZIP ��/y/Ij L CP,H�/ RESIDENCE PHONE ! 7 7 � � l� ��/fy 7JBUSINESS PHONE(24HRS) "/ ✓ ) C� 9f� 7� BUSINESS PHONE TOTAL NUMBER OF ROOMS: 6 ROOM USE: 1. 2. /3./ 4 5 7. `1. 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 L' DATE J Inspectors use only Date on initial inspection: Ozal-2Di Date of reinspection: Date of issuance of certificate: C)060,o u Date fee paid: ©v" c f Type of unit: Dwelling Other —Check# 2 Check date: OS ZD Notes; c hG 0 / Fry- 0.G E orcement ZsZpector TJ f' e • CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOORp11}l�1CH@81 Prtvm[.Promote.PlOw, TEL. (978) 741-1800 FAx(978) 745-0343 KIMBERLEY DRISCOLL lramdin@salem.com MAYOR LARRY IL\MllIN,RS/REFIS,CI-1O,CP-FS I-I12AL;I'I7 AGFNT 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 Updated 523/11 dcuzvnu�� City of Salem, Massachusetts Board of Health `9. 120 Washington Street, 4th Floor, Salem, PubliCHealth Prevent. Promote. Proton[. MA 01970 Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, REHS,CHO Mayor Iramdin@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE #: GHL-15-194 DATE ISSUED: 7/30/2015 Property Located at: 3 NORTHEND AVENUE UNIT#1 Owner/Agent: Dianne Reddy Address: 12 Nelson Avenue City/Town: Beverly, MA Zip Code: 01915 24 Hour Phone:(978)808-0817 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. FOR THE BOARD OF HEALTH Larry Ramdin, MPH, REHS, CHO HEALTH AGENT SANIT IAN CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4n'FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR i n AMDINQSA1AM.COM LARRY RAmmm RS/REHS,CHO,CP-1'S HEAmi 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 IS THIS UNIT DISIGNATED AS RIGS LJWFFROT>7 OR BACK PLEASE CIRCLE ONE OWNER/LESSERMANAGER/AGENT NO P.O.BOX ADDRESS ADDRESS ZQ Uf I� 0 0-P CITY, STATE,ZIP �U ` _G��Q ��`. P ITy,STATE,ZII f 1 RESIDENCE PHONE-9 —W Q dp BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS:_ \ ROOM USE: 1. 2. (:23 ) 4. 5 6. 7. 9. 10. THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CrrY OF SALEM BOARD OF HEALTH THIS FEE IS PAYABLE AT THE TIME OF INSPECTION APPLICANT'S SIGNATURE L DATE:� S . Inspectors use only Date on initial inspection: 07/2r7/2n2S- Date of reinspection: Date of issuance of certificate: A7/L'��2f�Z� Date fee paid: 07/2-'71 — Type of unit: Dwelling Other Check# Check date: 07/2 7/2o;4S' R I, k1/ f� I 1 T NOtes:d-r" lvrad 1n ilrLm avv- lO Kmeat_' ft)rfA me-eds U^mk wpaired, i C ..t ector " ? CITY OF SALEM MASSACHUSETTS lu BOARD OF HE\LTH 120 WASHINGTON STREET,4".FLOOR P 11111 TEL. (978) 741-1800 FAx(978) 745-0343 KIMBERLEY DRISCOLL kamdinnsalem.com LARRY RAMUIN,RS/RIia-IS,CHO,(T-FS MAYOR Hr;:AI:I'i I AGI;;N'i' CERTIFICATE OF FITNESS CERTIFICATE#263-12 DATE ISSUED:6/28/2012 Property Located at: 3 Northend Avenue UNIT# 1 Owner/Agent: William Reddy Address: 12 Nelson Avenue City/Town: Beverly, MA Zip Code: 01915 24 Hour Phone: 922-8188 An inspection of your vacant Dwelling/Rooming Unit at the above address has been approved and is in compliance with 105 CMR 410.000: Massachusetts State Sanitary Code, Chapter II" Minimum Standards of Fitness for Human Habitation". Therefore, this Certificate is issued by the Code Enforcement Division of the Salem Board of Health and the unit may now be rented and/or occupied. Maximum Number of occupants, must comply with 105 CMR 410.000. Certificate valid for one year from date of issuance or until the current tenant vacates, whichever is later. This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy. FOR THE OARD HEALTH LARRY RAMDIN AU Y, ) HEALTH AGENT SANITARIAN a CITY OF SALEM, MASSACHUSETTS o BOARD OF HEALTH �$q " 120 WASHINGTON STREET,4"'FLOOR _-- I:IIVIBERILRY DRISCOLL FAX(978) 745-0343 JRA"DIN 4�I.('(1M14 LARRY RANWIN,WS/RN IS,0110,(T-VS LIItAI;)'H A(wN'I' Application for Certtficate of Fitness IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" FEE: $50.00 fp PROPERTY LOCATED AT - o � 2 d� �y e., UNIT# IS'I'LIIS UNIT DISIGNATED AS RIGHT ICS I'MQNF OR BACK,PLEASE CIRCLE ONE LESSER w1 ' e .-Sr , MANAGER/AGENT_. S�td '1 e NO P.O.BOX ADDRESS to WetSONJ r j 4E_ ADDRESS CITY,STATE,ZIP 1 �ecl4tr7) CITY, STATE,ZIP — RESIDENCE PHONE x"18- Qaa -5?kW BUSINESS PHONE(24HRS) _ BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOMUSE: IR-&fOpin 3.�i� 5, _ 66 7. 8. --9-10. THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO TETE CITY OF SALEM BOARD OF HEALTH THIS FEE IS PAYABLE AT THE TIME OF INSPECTION APPLICANT'S SIGNATURE. t - ,_DATE a1cF C Il�ectors use only Date on initial inspection:_„ka= ,• / 2 Date of reinspection: Date of issuance of certificate: Date fee paid: _ ij 2 Type of unit: Dwelling 0 girth Check# �ZZ Check date: ^ �? Notes:____ CodeEnforce ent Inspector CITY OF SALEM, MASSACHUSETTS 3 m 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 SCOTT, MPH, RS, CHO HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#284-07 DATE ISSUED: 6/21/2007 Property Located at: 3 Northend Avenue UNIT#2 Owner/Agent: Dianne Reddy Address: 12 Nelson Avenue City/Town: Beverly, MA Zip Code: 01915 24 Hour Phone: 922-8188 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 12 J ANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA O1970 V V� TEL. 978-741-1600 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, 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 .HUMAN HABITATION". PROPERTY LOCATED AT Nd��-h e [��A UNIT#� IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER 1 f� MANAGER/AGENT No P.O. Box ` ^ ( P.O. Box ADDRESS I a I�It 1�G{l Ca,IND ADDRESS Inn CITY ,I L--�QP C� A� CITY_! Y J Cj J RESIDENCE PHONE �7 J�'cIZZ' YI&F BUSINESS PHONE (24 HRS.) BUSINESS PHONE 428 TOTAL NUMBER OF ROOMS:_ �, ROOM USE: 1. U��erI2. JC13. L bi4. 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 �01_� _DATE � h� INSPECTORS USE ONLY DATE OF INITIAL INSPECTION, -X I __.DATE OF REINSPECTION- DATE OF ISSUANCE OF CERTIFICATE i—w�DATE FEE PAID: L� 7 TYPE OF UNIT: DWELLIN (OTHER_ CHECK # 146 Z6 CHECK DATE j� - NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 CITY OF SALEM, MASSACHUSETTS BOARD OFHEALTH S 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 STANLEY J. USOVICZ, JR. FAX 978-745-0343 MAYOR W WWSALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#689-05 DATE ISSUED: 11/11/2005 Property Located at: 20 Northend Avenue UNIT#2 Owner/Agent: Patricia Ross Address: 20 Northend Avenue City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 781-910-4444 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. FO THE BOARD OF HEALTH 6/ JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS '00 BOARD OF HEALTH • 120 WASHINGTON STREET, 4TH FLOOR V a e SALEM, MA 01970 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 II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED ATS16 / Il)F7i ercd�/�>7U e UNIT# IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER FRILIu n- ROSS MANAGER/AGENT ins Mei ZZ4ft //so No P.O. Box No P.O. Box ADDRESS ZV NofA*aL+A AVf_ _ ADDRESS CITY Salem CITY m- RESIDENCE PHONE BUSINESS PHONE (24 HRS.) BUSINESS PHONE 9?1- 9/0 "-y`yyq TOTAL NUMBER OF ROOMS: (o ROOM USE: 2. LI�I.fiAW-Z. IsCL 4. acb 6. Ps 1 7. 8._ THERE IS A TWENTY-FIVE($25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALE-Y/FIEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. APPLICANTS SIGNAT REP� SL_DATE INSPECTORS USE ONLY 1 DATE OF INITIAL INSPECTION DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: —� 'v�DATE FEE PAID:��� TYPE OF UNIT: DWELL INXOTHER_—GHErIT# CHECK DATE O5,(75'013 d L NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT RELEASE In accordance with Massachusetts General Laws Chapter I11 ; Code of Massachusetts Regulations 410.000 et. seq. ; State Sanitary Code Chapter II and Article XIII of (:he 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 author— ized agents to inspect the residence identified below in accordance with the aforementioned statutes, regulations and ordinances. In the event it is necessary shat said inspection be done in my/our absence, !/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 a.gen:s from any loss or injury sustained of whatever nature and description occasioned by my/out absence during said inspection. AIR TEINANT/LESSEE Oh ER/i. S 3V1sv_v /� to �_ Ane _��4 �► ADDRi ss ADDRESS c ADT)RESS OF UNIT TO BE INSPECTED UATF. Y CITY OF SALEM, MASSACHUSETTS -y BOARD OF I F-U-TH 120 WASHINGTON STREET,4."FLOOR TEL. (978) 741-1800 IQMBLRLLY DRISCOLL FAX (978) 745-0343 MAYOR IraiT1cbn@salcm.com LARRY RAMDIN,RS/RAFIS,CHO,CP-FS HFAL I'll AGI,N'1' CERTIFICATE OF FITNESS CERTIFICATE#228-11 DATE ISSUED: 7/18/2011 Property Located at: 26 Northend Avenue UNIT# 1 Owner/Agent: Antonio Fernandez Address: 230 Jefferson Avenue 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 LARR RAMDIN HEALTH AGENT CODE EN CEMENT INSPECTOR ya. • CITY OF SALEM, MASSACHUSETTS BOARD or HEA]TH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 IUM13ERLEY DRISCOLL FAx (978) 745-0343 MAYOR I,R,,%miN@SAI,EM CONI LARRY RAMIAN,RS/RPJ IS,CI 10,(Y-IS HP.AI XI i AG I?NP 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 �aR iL� Z Al/�S�F 'K #< f 0/5?77V UNIT# IS THIS UNIT DISIGNATED AS_RI,G,H/T LEFT FRONT OR BACK,PLEASE CIRCLE ONE OWNER/LESSER },li fOGt—L'0 ��4A4 ANAGER/AGENT NO P.O. BOX ADDRESS 230 7� )C_e Of// ADDRESS CITY, STATE,ZIP 51. Zgnq ` ®/9?D CITY, STATE,ZIP RESIDENCE PHONE LIDS J2�� BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1. 2. 3. 4. 5. 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 1� ���_F�'�i���id DATE / Inspectors use only Date on initial inspection: �/I I Date of reinspection: Wit Date of issuance of certificate: 7119111 Date fee paid: 7 I i t Type of unit: Dwelling t--'Other Check# Check date: 7I1SA Notes:-/" U/1LOU U2P� I��r�liU e PE CL& '. ,04k k r JU , L\, is ba 6 ��i be1T . Code nforc ment Inspector ` Ci,ry of SALEM, MASSACHUSE'rys g BOARD OF HEALTH 120 WASHINGTON SI"RELT 4p. FLOOR -I'EL. (978) 741-1800 KIDQ ERLEY DRISCOLL Fel\(978)745-0.343 MAYOR > l n ads e n.co(n LARRY RAMDIN,RS/10P,1-IS,(A 10,CP-FS HFA : I I AG INT CERTIFICATE OF FITNESS CERTIFICATE#536-11 DATE ISSUED: 12/19/2011 Property Located at: 26 Northend Avenue UNIT#2 Owner/Agent: Eva Lopez Address: 26 Northend Avenue City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: i 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 11" 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 I RY RAMDIN HEALTH AGENT CODE EWORCEMENT IRSPECTOR I I i ►$� 1`��� �� �� � �I ��� �� 3���-`� CITY OF SALEM. MASSACHUSETFS 120W,\S BoARD or, HL,�:\jxi i llli\TG,ro,\,, ,STRI-17,-t',4` FLOM QD Tu. (978) 741-1800 KTN1BF,RLF,Y DRISCOLL FnY (978) 745-0343 MAYOR Ji\%11)]N, a�\jJN.(:0M LARRY RiV'00K 10;/101 1ti,(:[10, 1:1\Il I I A G ;X1 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 —jTq UNIT#— As T F.1 IS THIS UNIT DIS GNATED AS RIG T_FRONT OR BACK PLEASE CIRCLE ONE v OWNER/LESSERAAZZO/I//� � �ANAGER/AGENT NO P.O. BOX ADDRESS DRESS CITY, STATE, ZIP V/ � CITY, STATE, ZIP RESIDENCE PHONE__' �BUSINESS PHONE(241IRS) BUSINESS PHONE A — Z4 2; TOTAL NUMBER OF ROOMS: ROOM USE: 1. 2. 3, 4. 5. 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 SIGNATIJRa DATEIZ / Inspectors use only Date on initial inspection: ) 2 - Date of reinspection: Date of issuance of certificate: ! - Date fee paid: 1 X-1 Type ofunit: Dwelling t`- Other Check#)4-4X?*ACheck date: )2-)q- 1) ,iNb�� Notes: W4,jl�� T ode Enforcem 6t inspector r CITY OF SALEM, MASSACHUSE 1 TS BOARD OF HF rm 120 WASHINGTON STREET,4°1 FLOOR TF1. (978) 741-1800 KIMBERLEY DRISCOLL FAX (978) 745-0343 MAYOR enal�m�(ilS�Lrnl.�'O�I L miin'RAMDIN,RS/IWI IS,CI10,C134S FIHAI.I I I JV;kN'I 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 Updated 523/11- s CITY OF SALEM, MASSACHUSETT'S BOARD(w Hr v;I'11 120 WASHINGTON STREET,4"'FLOOR TEL (978) 741-1800 Kl7vlB RLEY DRISCOLL EVx (978) 745-0343 MAYOR Iramchn(a SlIeln.com 1.,MMY RAMI)I .',RS/R0 IS,UA 10,i T-FS 141?Al;(I t AGENT CERTIFICATE OF FITNESS POLICY 1. A Certificate of Fitness inspection is required for all rental units older than 5 years, per City of Salem ordinance; 2. A Certificate of Fitness is good for 1 year or the fife of the tenant, whichever is longer; 3. A Certificate of Fitness inspection may be obtained by calling or coming into the Health Department and requesting an appointment; 4. Appointments must be requested at least 24 hours in advance pending an open appointment; 5. No "same day" appointments will be granted; b. All appointments are subject to the schedule of the inspector; 7. A rental unit will be considered occupied when either the previous tenant or the current tenant has belongings in the unit. In the case of an occupied unit, either the tenant whose belongings are in the unit must be present at the time of inspection, OR have signed a release statement allowing the Board of health to inspect the unit. 8. Please allow at least one turnaround time for the Certificate to be issued, especially at the end of the month; 9. A Certificate of Fitness will be granted when: a. An inspection has been conducted by a Health Department employee b. An application has been filled out and a check or money order has been received 10. If you have any questions, please contact the Health Department