PETER ROAD i�
PETER ROAD
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u CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH'
� s 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970 CERT.# 164-02
FEE $25.00
TEL. 978-741-1800 DATE: 03/22/2002
FAx 978-745-0343
STANLEY USOVICZ, JR. ,JOANNE SCOTT, MPH, RS, CHO.
MAYOR HEALTH AGENT
CERTIFICATE. OF FITNESS
PROPERTY LOCATED AT: 2 Peter Road UNIT #: House
OWNER/AGENT: Elizabeth Bouchard
ADDRESS: 145 Tedesco Street
CITY/TOWN: Marblehead, MA ZIP CODE: 01945 24. HOUR PHONE: 639-1798-
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- STANDARDSOF 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 BERENTED AND/OR OCCUPIED.
MAXIMUM NUMBER OF OCCUPANTS, BASED ON 105 CMR 410.0.00:. 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 , r
JOANNESCOTT- MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS SG {dZ
• / BOARD OF HEALTH /
• 120 WASHINGTON STREET, 4TH FLOOR
c
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 FITNES H^UM�A-N HABITATION".
PROPERTY LOCATED AT ��l/ (i 4 Bio IT#�
IS THIS UNIT DESIGNATED AS RIGHT LEFT ACK PLEASE CIRCLE ONE
OWNER/LESSER G MAUNA ER/AGENT
No P.O. Box G/No P.O. Box
ADDRESS <��� ADDRESS /
CITY CITY!=� ®/ 7
RESIDENCE PHON G3 / _/)BUSINESS PHONE (24 HRS.)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. 2. 3. 4.
5. 6. C/ 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. (24
APPLICANTS SIGNATURE DATE
INSP CTORS USE ONLY
DATE OF INITIAL INSPECTION 3 ,J _,�9 2/ DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: '' -2- U ZDATE FEE PAID; Z -e-
r
TYPE OF UNIT: DWELLING r OTHER_ CHECK# I l 5 CHECK DATEZ tJ
NOTES:
CODE ENFORCEMENT INSPECTOR 9/28/98
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�,A.CON01T
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-
02/21/2002 120 Washington Street, 40 Floor
JOANNE SCOTT, MPH, RS,CHO Tel: (978) 741-1800
HEALTH AGENT Fax (978) 745-0343
Robert L. Bouchard
145 Tedesco Street
Marblehead, MA 01945
PROPERTY LOCATED AT 2 Peter Road UNIT # House
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 105 CMR; State Sanitary Code, Chapter I: General Administrative
Procedures and 105 CMR 410.000; 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 24 hours 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.
Failure to comply with this procedure, may result in a fine of Twenty (20) dollars
per day for every day that the dwelling unit is occupied without a Certificate of
Fitness.
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 to exist.
OR THE BOARD,/qlF HEALTH REPLY TO
oanne Scott, MPH,RS,CHO PABLO VALDEZ
Health Agent CODE ENFORCEMENT INSPECTOR
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