PICKERING STREET PICKERING STREET
9
° CERT.# 61-01
FEE $25.00
DATE: 02/12/2001
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: 7 Pickering Street UNIT #: 7
OWNER/AGENT: Oscar Padien
ADDRESS: 27 Chestnut Street
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-1670
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
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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 �I I' ,CK .INCA i1 UNIT#�-
IS THIS UNIT DESIGNATED AS RIGHT EFT FRONT BACK PLEASE CIRCLE ONE CZ1 CI') -rN(JT)
OWNER/LESSER IN)CAV, N MANAGER/AGENT NA
No P.O. Box No P.O. Box
ADDRESS ^ '27 CIiLiTN UT ST ADDRESS
CITY -//Y� Al A CITY
RESIDENCE PHONE �7 G-� ��Id� BUSINESS PHONE (24 HRS.) _ N�
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: I�
ROOM USE: 1. L Z 2. (PR 3.�V'
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
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION :2- 4.2- -o 1 DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE:,?-- DATE FEE PAID: 2-
TYPE
TYPE OF UNIT: DWELLINGOTHER_ CHECK# i q 3Y CHECK DATE '12-
NOTES-
CODE
-
NOTES:CODE ENFORCEMENT INSPECTOR 9/28/98
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3 5t
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 III ; Code of Massachusetts
Regulations 410.000 et. seq. ; State Sanitary Code Chapter II and Article XIII of
the Cit; 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, !/we
expressly authorize the same and for my/our successors and assigns hereby release
I 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 inspection.
n
TENANT/LESSEE OWNER/LESSOR
ADD RES— ADDRESS
UT Sr
ADDRESS OF UNIT TO BE INSPECTED
DA'PE