PINGREE STREET PINGREE STREET
n
• CITY OF SALEM, MASSACHUSETTS lu
BOARD OF HEALTH
120 WASHINGTON STREET 4."FLOOR PublicHealth
STREET, Prevent.Promote.P,elerl.
TEL. (978) 741-1800 FAX(978)745-0343
KIMBERLEY DRISCOLL ltamclin@salem.com
MAYOR LARRY R,IMDIN,RS/REFIS,C110,CP-FS
HIAJ-XH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#43-14
DATE ISSUED: 2/24/2014
Property Located at: 14 Pingree Street UNIT# 1
Owner/Agent: Dave Potter
Address: 168 Puritan Road
City/Town: Swampscott, MA Zip Code: 01907 24 Hour Phone: 781-389-8641
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
LARRY RAMDINe J
HEALTH AGENT SANITARIAN
CITY OF SALEM,lYIASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4"'FLOOR
TEL (978)7414800 FAX(970 745-0343
KIMBERLEY DRISCOLL kgmd�m@salm.com
MAYOR LARRY RAMDIN,RS/KEPIS,CHO,CP-FS
HEALTH AGENT
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
' NW M STANDARDS OF FITNESS FOR HUMAN HABITATION"
FEE: $50.00
PROPERTY LOCATED AT / ' r"��('P� UNTf#
IS THIS UNIT DISIGNATED AS RIGHT LErr FROM OR BACK PLEASE CIRCLE ONE
OWNER/LESSER R e 5- MANAGER/AGENT I>O-V� -- o
NO P.O.BOX nn
ADDRESS ��� FL-�A�� P,cX ADDRESS S C' �'�
CITY;.STATE,ZIPs ww— S co / Crry STATE ZIP
RES] k- �Y /DENCE PHONE 7k -3 BUSINESS PHONE(14HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ROOM USE: 1 (2- 2 r-) '2 3. (32 4. 2 5.
6. l i (2.. 7. Qg-,cJ 8. rE 9. 10.
THERE IS A I=($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS F YABLE T THE TIME OF INSPECTION
APPLICANT'S SIGNATURE DATE `2 2�( /
Inspectors use only
Date on initial inspection: Date of reinspection
Date of issuance of certificate: 2 --2-1 -11) Date fee paid:
Type of unit: Dwelling ✓ Other Check# J'5 1 Check date: Z ZN I
Notes:
Code Euf t
• CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4'FLOORPI1b1Promote. th
TEL. (978) 741-1800 Fax(978) 745-0343
KIMBERLEY DRISCOLL Iramdin@salem.com salem.com
LARRY RAn-mIN,RS/RF r IS,cHo,cn-FS
MAYOR
HeAL'CFI AGEN"C
CERTIFICATE OF FITNESS
CERTIFICATE#44-14
DATE ISSUED: 2/24/2014
Property Located at: 14 Pingree Street UNIT#2
Owner/Agent: Dave Potter
Address: 168 Puritan Road
City/Town: Swampscott, MA Zip Code: 01907 24 Hour Phone: 781-389-8641
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
LAMDIN /
HEALTH AGENT ANITARIAN
i
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET;C FLOOR PrP Q�
TEL.(978)7414800 FAX(978)745-0343
KIMBERLEYDRISCOLL Iramdm salem.com
LARRY RANIDIN,RS/REHS,CHO,045
MAYOR 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'
l !/ FEE:.$50.00
PROPERTY LOCATED AT ! 7 P( k,N e S� UNIT#
IS THIS UNIT DISIG11NATED AS RIGHT LEFT FRONT OR BACIL PLEASE CIRCLE ONE
D
OWNER/LESSER 1pt$ . Feyh l` P-vin S'd(MANAGERIAGENT
NO ADDSS P _ 1
ADDRESS S A 0,—
CITY;.STATE,ZIP5L— ,S (,-, p �✓� C71-�07—CITY,STATE,ZIP
RESIDENCE PHONE M-3 F/- -(o W BUSINESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. 2 2. 2— 3. 4.
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 LE AT THE TIME OF INSPECTION
APPLICANT'S SIGNATURE DATE
Inspectors use onluse only
Date on initial inspection: Z`) �� Date of reinspection:
Date of issuance of certificate: Z Ly -in Date fee paid:
Type of unit: Dwelling U Other Check#�S� Check date:
Notes:
Code Enforcement Inspector
v�;co CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
9 120 WASHINGTON STREET, 4TH FLOOR
o SALEM, MA 01 970
�p TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#302-04
DATE ISSUED: 07/12/2004
Property Located at: 16 Pingree Street UNIT# 1
Owner/Agent: Christian Moreta
Address: 16 Pingree Street, #2
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-741-3152
An inspection of your vacant Dwelling/Rooming Unit at the above address has been approved
and is in compliance ante with 105 CMR 410.000: Massachusetts State Sanitary Code, Chapter 11"
Minimum Standards of Fitness fcr'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.
OR THE BOARD F HEALTH
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
ry�Q 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 AT T �/- UNIT#
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSERZ& 6� &OeF'Z�MANAGER/AGENT
No P.O. Box No P.O. Box
ADDRESS ADDRESS
CITY S/4 OL G1 CITY
RESIDENCE PHONE 7711/ 3is9 BUSINESS PHONE (24 HRS.)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:/ I /
ROOM USE: 14[/l,u /1/2. F16�� 3.btd 465J �ODt2
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.
APPLICANTSSIGNATUREg44�Z_ G7� DATE �a-
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION 7 �1 7 G '�c DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: 2 d f DATE FEE PAID: —( ? y
TYPE OF UNIT: DWELLING BOTHER_ CHECK#. a s CHECK DATE 7 l L 6 1�
NOTES:
CODE ENFORCEMENT INSPECTOR 9/28/98
o CITY OF SALEM9 MASSACHUSETTS
BOARD OF HEALTH
rp 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
s — TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
August, 27 2003
Fausto Moreta
16 Pingree Street
Salem, MA 01970
PROPERTY LOCATED 16 Pingree Street Unit 2
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 1: General Administrative Procedures and 105 CMR 410.000; State
Sanitary Code, Chapter 11: 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 ($20.00)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.
For of of H� Reply to
Joanne Scott MPH, RS, CHO Pablo Valdez
Health Agent Code Enforcement Inspector
l'
�. CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4."FLOOR PublicHealth
Prevent,Promote.Protect.
TEL. (978) 741-1800 Fax(978)745-0343
KIMBERLEY DRISCOLL Iramdin@salem.com
L;\RR]'RANiI)IN,RS/RL?I-IS,OLIO,CI LS
MAYOR I IL.;U;CLL AGI,,N'r
CERTIFICATE OF FITNESS
CERTIFICATE#170-14
DATE ISSUED: 5/15/2014
Property Located at: 20 Pingree Street UNIT# 1
Owner/Agent: Marc Nicastro
Address: 16R Sadler Street
City/Town Gloucester, MA Zip Code: 01930 24 Hour Phone: 508-335-8599
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 ARD HEALTH
LARRY RAMDIN
HEALTH AGENT SANITARIAN
vy r
y � 1
CITY orgy SALE MASSACHUSrETTS I� �
BOAR.I)OI III'ALM
1.20 WASHINGTON SIRFE!'f,4°'FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX (978) 745-0343
MAYOR LRAMDNaG Af.CM.CONI
LARRY RANIDIN,RS/REFIS,CHO,CP-FS
IIf ALrii AG F.Nr
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 20 Pingree St. Salem, MA 01970 UNIT# 1
IS THIS UNIT DLSIGNATED AS RIGHT LE RON OR BACK PLEASE CIRCLE ONE
OWNER/LESSER Marc Nlcastro MANAGER/AGENT Same
NO P.O.BOX
ADDRESS 16R Sadler St. ADDRESS Same
CITY, STATE,ZIP Gloucester, MA 01930 CITY, STATE,ZIP Same
RESIDENCE PHONE 978-281-4233 BUSINESS PHONE(24HRS) 508-335-8599
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: 6
ROOM USE: 1.Family Room 2 Spare Room 3. Kitchen 4.Bathroom 5. Bedroom 1
6•Bedroom 2 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
Marc Nicastro 5/12/2014
APPLICANT'S SIGNATURE DATE
)erectors use only
Date on initial inspection: it�� Date of reinspection:
Date of issuance of certificate: Date fee paid:
Type of unit: Dwelling Other Check# ) `/�Checkdate:
Notes:
Cod nfc ement Inspector
I�
CITY OF SALEM, MASSACHUSETTS
' BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343 -
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
1/12/05
Pedro Nunez
20 Pingree Street#1
Salem, MA 01970
PROPERTY LOCATED AT 20 Pingree 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 105 CMR 410.000; State
Sanitary Code, Chapter 11: 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. to 7:00 p.m. and Friday 8:00 a.m.— 12:00 p.m.
Failure to comply with this procedure, may result in a fine of Twenty($20.00) 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 tenant's entire utility bills retroactive to the date of initial occupancy in cases in
which cross-metering has been proven to exist.
For e Board of Health Reply to
Joanne Scott MPH, RS, CHO Pablo Valdez
Health Agent Code Enforcement Inspector
o CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
s s 120 WASHINGTON STREET, 4TH FLOOR
s!
a SALEM, MA 01970 CERT.# 161-03
T.� FEE $25.00
TEL. 978-741-1800 DATE: 04/25/2003
FAX 978-745-0343
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 20 Pingree Street UNIT #: 2
OWNER/AGENT: Pedro Nunez
ADDRESS: 20 Pingree Street #1
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-9420
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 NOR BUILDING RELATED CODES. FOR MORE
INFORMATION CALL 978-741-1800 . /
AOR THE BOARD Q'F "HEALTH
"�-'1fiC..�.i �•✓l�-,ter.
r.
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
r f
f
CITY OF SALEM, MASSACHUSETTS
' • ' •
DBOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR p
i J
SALEM, MA 01970
TEL. 978-741-1800
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 FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT 3 D �� n/Ci /2 ."' S UNIT# Z
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER ga'// U /J�Ulve U MANAGER/AGENT
No P.O. Box No P.O. Box
ADDRESS _'Ld k/ a S? ' ADDRESS
CITY SyA-/Oi4M- YNCA, CITY_ _
RESIDENCE PHONE BUSINESS PHONE (24 HRS.).__
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: S
ROOM USE: 1. 2.-3.-4.
5.__6._7._8.
THERE IS A TWENTY-FIVE($25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY
ORDER TO THE CITY OF SALEM HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE
TIME OF INSPECTION.
APPLICANTS SIGNATURDATE
lh� INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION q- ) 5_- d 3 DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE-.?f-a 3 DATE FEE PAID: Y- d i�- ° 3
TYPE OF UNIT: DWELLING OTHER_ CHECK#g 6 o 97/ CHECK DATE Y' u 3
NOTES
CODE ENFORCEMENT INSPECTOR 9/28/98
vg�.ON01T
CERT.$ 13-99
FEE $25.00
DATE: 01/08/99
���Mllyg
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET
HEALTH AGENT Tel: (978)741-1800
Fav(978)740-9705
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 22 Pingree Street UNIT #: 1
OWNER/AGENT: Richard McDonald
ADDRESS: 22 Pingree Street
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-3200
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
JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
r
i
r�
�ONUIT,(, Q
r� � 3-
5
ro
3 g;
���7MINE W
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�� ,�r��irec� S2-- UNIT# /
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER /n a, / & MANAGER/AGENT
No P.O. Box No P.O. Box
ADDRESS PGJer,nee 87� ADDRESS
CITY_R�r Zf,(4 "-? CITY
RESIDENCE PHONE Q?rrCIJd 3377Yr.?doa .c SZS
BUSINESS PHONE (24 HRS.)�78���'
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. _2. �—_3.
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 SIGNATUR _DATEE/ZW?4—
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION lib fl� DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE:L/J 0 DATE FEE PAID:_
TYPE OF UNIT: DWELLINGKOTHER__ CHECK# ;�-6) 6_CHECK DATE r �
NOTES:
CODE ENFORCEMENT INSPECTOR 9/28/98
+ CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
5S y 120 WASHINGTON STREET, 4TH FLOOR
i� SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE# 172-05
DATE ISSUED: 3/9/05
Property Located at: 22 Pingree Street UNIT#2
Owner/Agent: Victor Dume
Address: 22 Pingree Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 479-3861
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
�
i
JOANNE SCOTT, MPH, IRSS,`CCH•
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS t
�J BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR G
SALEM, MA 01970
TEL. 976-741-1800
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 AT /1L59�~�( UNIT#=
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER L6 C,toIRAN. ANAGER/AGENT `
No P.O. Box No P.O. Box
ADDRESS ADDRESS,/r,I? LG
CITY P_ 21 1� zi CITY 6/f o
RESIDENCE PHONE W-Z?4 1 SINESS PHONE (24 HRS.) 1'7ZJ-
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. 2. 3. 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. p
APPLICANTS ' IGNATU _ _DATE_,�__c "D
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION _DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE:.�_'_�'G O DATE FEE PAID:
TYPE OF UNIT: DWELLING OTHER CHECK# 3 5 CHECK DATES—
NOTES:
CODE ENFORCEMENT INSPECTOR 9/28/98
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
f SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
3/1/05
Victor Dume
22 Pingree Street
Salem, MA 01970
PROPERTY LOCATED AT 22 Pingree 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 105 CMR 410.000; State
Sanitary Code, Chapter 11: 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. to 7:00 p.m. and Friday 8:00 a.m. — 12:00 p.m.
Failure to comply with this procedure, may result in a fine of Twenty($20.00) 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 tenant's entire utility bills retroactive to the date of initial occupancy in cases in
which cross-metering has been proven to exist.
F r the Board of Health Reply to
panne Scott MPH, RS, CHO Pablo Valdez
Health Agent Code Enforcement Inspector
co r CITY OF SALEM, MASSACHUSETTS
vQ' BOARD OF HEALTH
• 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
.y�,�„
TEL. 978-74 1-1 800
FAX 978-745-0343
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
08/05/2002
Edwin Martinez & Victor Dume
22 Pingree Street
Salem, MA 01970
PROPERTY LOCATED AT 22 Pingree 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.
0R THE/ ARD/�/ HEH REPLY TO
l Joanne Scott, MPH,RS,CHO PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
F CITY OF SALEM, MASSACHUSE T`I'S 1ryV�'
BOARD OF HEALTH _
120 WASHINGTON STREET 4'"FLOOR P11b�CHC81th
STREET, Prevent.Promote.Protect.
TEL. (978)741-1800 Fax(978)745-0343
KIMBERLEY DRISCOLL ltamdin@salem.com
L;UiRT R,\MDIN,RS/KEPIS,CI f0,
MAYOR Hr•,.\1.;rlr AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#22-14
DATE ISSUED: 2/4/2014
Property Located at: 32 Pingree Street UNIT# 1
Owner/Agent: Bouchaib Boubakraouy
Address: 19 Central Street
City/Town: Evertett, MA Zip Code: 02149-2229 24 Hour Phone: 617-606-1275
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.
FFR THE BOARD OF HEALTH
LARRY RAMDIN
HEALTH AGENT f SANITARIAN
I
i
CITY OF SALEM, MASSACHUSETTS �I
BOARD OF HEALTH
120 WASHINGTON STREET,4! FLOOR P aRc
Hean
TEL: (978)741-1.800 FAX(978)745-0343
KDdBERLEY DRISCOLL ]ramdm a salem.com
MAYOR LARRY RAMDIN,RS/RENS,CFIO,CP-FS
HEALTH AGENT
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
,%4INIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION'
FEE: $50.00
PROPERTY LOCATED AT� 1 M 1k St .I a e M, . rl A 019 1 n UNIT#--�_
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
"WLESSER QV tj o�b 0 6 a 1 R I- ANAGER/AGENT
NO P.O.BOX --QQ�
ADDRESS O (` I I;, i A L.I fl t - ADDRESS
CITY,STATE,ZIP Ft U k P,t+- C1TY,STATE,ZIP
RESIDENCE PHONEr�a/ 13 ��I O B � BUSINESS PHONE(14HRS) 6y
BUSINESS PHONE 4f 3- I `L��
TOTAL NUMBER OF ROOMS:_
ROOM USE: 1. 2. 3. 4. 5.
Cb 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 DATE frl Z- ,1 E{
z.
InsDectotsuse onlvo&
Date on initial inspection: 1-`1'I y Date of reinspection:
Date of issuance of certificate: 2 l')`i Date fee paid: 2-14- Al
Type of unit: Dwelling ✓ 0ther Check#_25 a Check date: 1- 4-)L#
Notes:
Enforcement Insp�tor
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4"'FLOORPlib�1CHP.81th
rre.em.rromme.r.mam. -
TEL. (978)741-1800 FAx(978) 745-0343
KIMBERLEY DRISCOLL Irani&i@salein.com
L,\RRY RAN[D1N,RS/RIA NS,ChIO,CI'-FS
MAYOR HEAI:rrl Ac;I N'I'
March 17, 2015
Wendy Brea
Lynn, MA 01902
To whom it may Concern:
This letter is to inform you that check#336 dated January 5, 2015 in the amount of$50.00 for
Certificate of Fitness inspections has been returned to the Board of Health because of nonsufficient
funds.
There is a $25.00 charge for this returned check along with the original amount of$50.00. Please
send us a $75.00 money order or bank check to the Board of Health within 30 days of this notice.
Thank you.
For the Board of Health
Larry Ramdin,
Health Agent
LR/hlp
CERTIFIED MAIL: 7012 1640 0002 3313 3998
OEastern Bank $y E -
'
} r1ISIU FR'S "pi^_./
CITY OF SALEM �tl�l`3tf�77 r`�4'? c.)
GENERAL ACCOUNT ZBA
ATTN TREASURERS OFFICE Date: 02/20/2015
120 WASHINGTON ST 2ND FL
SALEM MA 01970-3527 Account: 9123881
We are charging your account for items 9
returned unpaid as listed below.
L
Returned Item Notice
Account Amount Description
8123881 50.00 Chargeback Item
L45Q2270415 5000tur ed o e I
§yMmary of Account Charges Number Aunt
Debit moTotal
[A7c9QIj0t Debit Total 1 50.00
1
N • " �S'+£ �"n 4 ^TLRM*tFcaa�i✓gPF
4i v�h l a.. 'E T y .R �Yv. i W�' Y`: - R' $ f Y ,•
t�' �0113U1798a
D2/20/2015,
E8032B87< u1 ae 77
s
rl.
This is a LEGAL COPY of your -
cfieck You can use d the �t; y+ {
satne way you would use the fy, 1 .
ortpinat check G ri• 'a, ' .. �a _ ,„, `"„ :r
RETURN/REASON�A. Ob nJ'; !�►' fi - ry
NOT SUFFICIENT FUNDS u7 t?" 4,IM, $ ,�j(� r
a - �gv
Ir e
V
i'3000 43$h 004'609 2? 4 i SwQ 3 36 .
41:0 L L000 1381: 00 4609 2 704 i SII@O 3 36 .'000000 5000.'
195 Market Street• Lynn. MA 01901-1508• 1-800-EASTERN (327-8376)•www.easternbank.com
EBF.mS
i
• ;'+ CITY OF SALEM, MNSSACHUSETTS V
BOARD OF
120 WASHING'roN STIu-uTI, 4"'FLOOR ,
TE..(978) 741-1800 FAX(978) 745-0343
KIMBERLEY L)RISC0L1. Iramdin salcm.com
LARRY RAMIAN,RS/1631IS,(A 10,(T-FS
MAYOR HR,A XI[A( @;NT
i
CERTIFICATE OF FITNESS
CERTIFICATE#21-15
DATE ISSUED: 1/5/2015
Prop, rty Located at: 32 Pingree Street UNIT#2
Owner/Agent: Marcia Pena
Addr:ss: 80 Washington Street
City/rown: Peabody, MA Zip Code: 01960 24 Hour Phone: 978-491-9714
Pursjant 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
vacs nt Dwelling/Rooming Unit at the above address has been approved and is in compliance with
105 SMR 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
Mea-th and the unit may now be rented and/or occupied_
Maximum Number of occupants, must comply with 105 CMR 410.000.
Cera ificate valid for one year from date of issuance or until the current tenant vacates, whichever
is later,
Thi=. Certificate of Fitness is valid only if there is a valid Certificate of Occupancy.
FOIL THE BOARD OF HEALTH
F:R MDIN
HEALTH AGENT SANITARIAN
CITY OF SALEM, MASSACHUSETTS
• BOARD OF HEALTH ')
120 WASHINGTON STREET,401 FLOOR l
TEL. (978)741-1800
KIMBERLEY DRISCOLL FAX(978)745-0343
MAYOR - LR SeU.E\4.COM
LARRY RAMDIN,RS/RIJIS,cm),CP-PS
H EALTi I AM-wr
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 _p n cmo UNIT#
IS THIS UNIT DISIGN XTED AS RIGHT LEFT FRONT OR BACK.PLEASE CIRCLE ONE
OWNER/LESSER Octf('� Des-yo- MANAGER/AGENT
NO P.O. BOX 14
ADDRESS D V��� \K�R�CI�1'C4� �-� ADDRESS
CITY, STATE,ZIP \TM p_ L\ hl 1 CITY, STATE,ZIP
RESIDENCE PHONE 1 `p- "1�I -G-I_ BUSINESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUMBER''OF
11 ROOMS \:S
ROOMUSE:
6 \1 1N (6b117. 8. 9. 10.
THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THISFABLE AT THE TIME OF INSPECTION
APPLICANT'S SIGNATURE'- b _� DATE
Inspectors use only
only
Date on initial inspection: II 5116 Date of reinspection:
Date of issuance of certificate: Date fee paid:
Type of unit: Dwelling Other Check# Check date:
Notes:
Code nfb ement Inspector
;co CITY OF SALEM, MASSACHUSETTS
3v BOARD OF HEALTH
- 1 20 WASHINGTON STREET, 4TH FLOOR
o SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#41-04
DATE ISSUED: 02/10/2004
Property Located at: 40 Pingree Street UNIT#: 1
Owner/Agent: Edwin Martinez
Address: P.O. Box 8464
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-360-8631
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 if 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 CRM 410.000.
Certificate valid for one year from date of issuance or until the current tenant vacates,whichever
is later.
This Certificate of Fitness if 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
CITY OF SALEM, MASSACHUSETTS
r '
' '� BOARD OF HEALTH
• i 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800 /
FAX 978-745-0343 /1 '`
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO U
MAYOR HEALTH AGENT
APPLICATION FOR CERTIFICATE OF FITNESS
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER It, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION'.
PROPERTY LOCATED AT�/^� (LC=C 5 UNIT 01
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNERILESSER_J� t Jr/ }+9}�(L�lf- MANAGEFVAGENT
No P.O. Box No P.O. Box
ADDRESS e o fOX kK. 4 q --ADDRESS--
CITY
_ADDRESS _CITY 341&-"1 jw4 0� 9 2 O CITY
RESIDENCE PHONE pr BUSINESS PHONE (24 HRS.)
BUSINESSPHONE��d'��Q ' ��
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. 2. - 3._ ._4.
5. 6.— T8.
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 SIGNATUREe2g DATE
SNS EC ORS USE O LY 1
DATE OF INITIAL INSPECTION _ / f1 __0DATE OF REINSPECTION _
DATE OF ISSUANCE OF CERTIFICATE' r`O rQ DATE FEE PAID: 2 't D " "
TYPE OF UNIT: DWELLING OTHER_ CHECK#CHECK DATE
NOTES: —
CODE ENFORCEMENT INSPECTOR 9128198
r CERT.# 36-00
3, IF R FEE $25.00
X
DATE: 01/14/2000
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: 40 Pinaree Street UNIT #: 2
OWNER/AGENT: Eridana M. Rodriguez
ADDRESS: 40 Pinaree Street #1
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-0592
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
li
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 HABITtATIIOW.
PROPERTY LOCATED AT f e� lY'cUNIT#
IS THIS UNIT DESIGNATED AS RIGHT LEFT FROM BACK PLEASE CIRCLE ONE
OWNER/LESSER ri 0 r)` Z MANAGER/AGENT
No P.O. Box No P.O. Box
ADDRESS �f�D �1+ r<P S'f ADDRESS
CITY
RESIDENCE PHONE q?l 2145 5_(} j2 BUSINESS PHONE (24 HRS.)
BUSINESS PHONE,
TOTAL NUMBER OF ROOMS:_�_(_t�
ROOM USE: 1.
THERE IS A TWENTY-FIVE($25.00)DOLLAR FEE, PAYABLE BY CHECK OR MONEY
ORDER TO THE CITY OF SALEM HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE
TIME OF INSPECTION.
APPLICANTS SIGNATURE DATE
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION /-/j 'O v DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE:I I f -00 DATE FEE PAID:
TYPE OF UNIT: DWELLINGkOTHER_ CHECK#.3 A l CHECK DATE Lid-40
NOTES: —
9/28/9$
CODE ENFORCEMENT INSPECTOR
°oND City of Salem, Massachusetts
Board of Health
120 Washington Street, 4th Floor, Salem, PublicHeatth
MA01970 Prevent. Promote. Protect.
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-16-11
DATE ISSUED: 1/15/2016
Property Located at: 44 PINGREE STREET UNIT#1
Owner/Agent: Smitha Thomas
Address: 915 Carden Street
City/Town: Union, NJ Zip Code: 07083 24 Hour Phone:(908)400-3688
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
0
c
Larry Ramdin, MPH, REHS, CHO
HEALTH AGENT SANITARIAN
CITY OF SALEM, MASSACHUSETTS
BOARD OA HEALTH
120 WASHINGTON STREET,4"FLOOR
TEL.(978)741-1800
KIMBERLEY DRISCOLL FAX(978)745-0343
MAYOR LSA�irJ �b
LARRY RAmm,RS/RAJ-is,mo,cp.m;
HEA1.7H AGJ-;NT
Application for Cert leate 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 C UNIT# el__
IS TATS UNIT DISIGNATID ASIR G!TT LE" RF Nf OR PL/EASB CntCLE ONE
OWNER/LESSER i{I SMU I o)_ MANAGER/AGENTI I,`c�12�"��
NO P.O.BOX I
ADDRESS 1 o P�9 I S Cr,i3 0 A ADDRESS �_4A` k, ' 1 r ✓C:�Sf.
�� II�
CITY, STATE,ZIP ,D lU CITY,STATE,ZIP 20 , G✓_
RESIDENCE PHONE2KC�2 L, � BUSINESS PHONE(24HRS) Sr3 r I r ud
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ROOM USE: 1.),,J;✓w xNt 2.'�"6410vl 3.1� i XM 4. ;t�rv0i2 5.
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�Z," DATE
Inspedors use only
Date on initial inspection: aL a)-12-OJ-6 Date of reinspection:
Date of issuance of certificate:01./ZZ/101� Date fee paid:01/12/2011;
Type of unit: Dwelling '✓ Other Check Check date: QUa/2011;
Notes:
A.
C o ement Iy ector
N"IMPORTANT•MESSAGE�;`'-
FOR _.
DATE�/� X07 .0.3 TIML�'• .M.
M
it
OF egg /y
PHONE AREA CODE NUMBER EXTENSION
O FAX
❑ MOBILE
AREA CODE NUMBER TIME TO CALL
6
7ELEPHDNED.„
GAME TC?GEE,YCU ;" WILL'CALL AGAIN
WANTS TO SEE YDU ;. RU,
,`AE'fURNEDYOURCALL ;`- WILLeFAXTOYOU`.°
MESSAGE
SIGNED
�IrrK FORM 4009
MADE IN U.S.A.
o CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
� c SALEM, MA 01970
gB TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
November 6, 2003
Marilyn Ferber
44 Pingree Street
Salem, MA 01970
PROPERTY LOCATED 44 Pingree Street Unit# 1 L
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 1: General Administrative Procedures and 105 CMR 410.000; State
Sanitary Code, Chapter 11: 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 ($20.00)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.
Fo thlf Health Reply to
Z.40�4�
Joanne Scott MPH, RS, CHO Pablo Valdez
Health Agent Code Enforcement Inspector
t .: 3
City of Salem, Massachusetts
Board of Health
120 Washington Street, 4th Floor, Salem, PuliliCHealth
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-17-360
DATE ISSUED: 10/23/2017
Property Located at: 44 PINGREE STREET UNIT#5
Owner/Agent: Steve Cecilio
Address: 46 Goldthwait Street
City/Town: Lynn, MA Zip Code: 01902 24 Hour Phone:
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.
Larry Ramdin, MPH, REHS, CHO
HEALTH AGENT SANITARIAN
806c' b o@ av " '
. 1, 11111
CITY OF SALEM, MASSACHUSF,T I'S
BOARD OF HEALTH
120 WASHINGTON STREET,4"i FLOOR PublicHealth
Pre,ent.Promote Protect.
TEL. (978) 741-1800 FAx(978) 745-0343
KIMBERLEY DRISCOLL lramdinawsalem.com
LAItRI'R;AMllIN,RS/RIF.I-IS,CI 10,CP-}�S
MAYOR
HEALII J A.'ENr
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 Prn,�r-re J4- UNIT# S
IIST.HIS UNIT
�DISIGNA ED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER —"vI6 C�C���U MANAGER/AGENT
ADDRESS G�L/ f n ADDRESS
CITY, STATE,ZIP
dA I Yl Y3 �� 77a CITY, STATE, ZIP
RESIDENCE PHONE `7h �5 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($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE IS PAYABLE AT THI TIME OF INSPECTION //1
APPLICANT'S SIGNATURE ����GGlli DATE V/2-_�n
Inspectors use only
Date on initial inspection: Date of reinspection:
Date of issuance of certificate: Date fee paid:
Type of unit: Dwelling Other Check# Check date:
Notes:
Code Enforcement Inspector
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4T"FLOOR PIIC�81t$
Prevent.Promote.Protect.
TEL. (978) 741-1800 F.-Z(978) 745-0343
KIMBERLEY DRISCOLL tramdin(@,,salem.com
MAYOR LdRRY RANID[N,RS/RE.IIS,CHO,CP-FS
HEAL.1'H AGENT
Release
In accordance with Massachusetts General Laws Chapter 111; Code of Massachusetts Regulations 410.000 et. Seq. ;
State Sanitary Code Chapter 11 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/our 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 loss or injury sustained of whatever nature and description occasioned by my/our absence
during said inspection.
rf)4P�/G
Tenant/Lessee Owner/Lessor
Address Address
LN b2Q Ce-2C 9- 014 SAi y1*,
Address on init to be inspected
Date
Updated 523/11
_tl
` " — CITY OF SALEM, MASSACHUSETTS LI
BOARD OF H&-,LTH
120 WASHINGTON STREET 4°-f FLOOR Pl1bi1CHP.11��1
ET, F .—m.r.�mmc.r•nueci.
TEL. (978) 741-1800 Fax(978) 745-0343
KIMBERLEY DRISCOLL Ixamdin@salem.com
IAaRY RnmD1N,as/aEl is,c110,cr-Fs
MAYOR 1-11:,m x1 I z1O ISNI'
CERTIFICATE OF FITNESS
CERTIFICATE#259-12
DATE ISSUED: 6/20/2012
Property Located at: 44 Pingree Street UNIT#5
Owner/Agent: Steve Cecilio
Address: 46 Goldthwait Street
City/Town: Lynn, MA Zip Code: 01902 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
LARRY RAMDIN
HEALTH AGENT IT AN
CITY OF SALEM, MASSACHUSETTS
BOARD OF-HEALTH
120 WASHINGTON STREET,4"'FLOOR VV��
TEL. (978) 741-1800
KIMI3ERLEY DRISCOLL FAX(978) 745-0343
MAYOR ISAMDIN(a SAJ,EN1 cora
L,ximy RANIDIN,RS/REI-IS,(;I-I ),
HI,A ml AG J;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
PROPERTY LOCATED AT vtz Al!l�rr�C 5;-, UNIT#
IS THIS UNIT
l!�DISI)GNA ED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER S> G CeGi'/I�b MANAGER/AGENT
NO P.O. BOX
ADDRESS �j� ADDRESS
CITY, STATE,ZIP !9/SDS. CITY, STATE,ZIP
RESIDENCE PHONEL?76 95�-Cpn BUSINESS PHONE(24HRS)
BUSINESS PHONE S0??
TOTAL NUMBER OF ROOMS: 3
ROOM USE: 1. SGL 2. 416h 3. ttim#1a�usNl. 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/ DATE
Inspectors use only
Date on initial inspection: j/1 Date of reinspection:
i
Date of issuance of certificate: Date fee paid:
Type of unit::Dwelling Other Check# Q Check date:
Notes: / I.
G \
c
�r
Code E W� emed Inspector
r
v���onlwr .Q
CERT.# 401-00
FEE $25 .00
DATE: 06/26/2000
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: 44 Pingree Street UNIT #: 6
OWNER/AGENT: Lloyd Green
ADDRESS: P.O. Box 82
CITY/TOWN: Nahant, MA ZIP CODE: 01908 24 HOUR PHONE: 596-2945
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.
FL,O'1R� THE BOARD OF HEALTH
JOANNE SCOTT, MPH,RS,CHO '—
HEALTH AGENT 0 E ENFORCEMENT INSPECTOR
i
y
W'i�yg0p
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 Tei:(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 JJ L( ___ __UNIT#_6
IS THIS UNIT DESIGNATED AS/RIGH T LEFT FKONT BACK PLEASE CIRCLE ONE
OWNER/LESSER� C r)-S eI-' MANAGER/AGENT _
No P.O. Bax No P.O.Bax
ADDRESS )0.0. p ADDRESS
CITY �1✓414. L� 7ice CITY
RESIDENCE PHONE 7 (4 _ d Y.S BUSINESS PHONE (24 HRS.),_ _
BUSINESS PHONE 5 � - K 1 I &
l
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. V 2.
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. {
G L� �
APPLICANTS SIGNATURE r /"ter DATE
IJNSPECTORS USE ONLY
DATE OF INITIAL INSPECTION 6,a� o DATE OF REINSPECTION �—
DATE OF ISSUANCE OF CERTIFICATE:_ &Zaap DATE FEE PAID: G a
TYPE OF UNIT: DWELLING OTHER,_„ CHECK# 7I/ CHECK DATE
NOTES:
COjdt�-EWReEMEN�ECTOR 9/28198
f
C
CERT.# 101-02
99
a a FEE $25.00
`' .... DATE: 02/27/2002
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-
JOANNE SCOTT, MPH, RS, CHO 120 Washington Street — 4'h Floor
HEALTH AGENT Tel # (978)-741-1800
Fax # (978)-745-0343
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 44 Pinaree Street UNIT #: 6 Right
OWNER/AGENT: Lloyd Green
ADDRESS: 133 Foster Road
CITY/TOWN: Swampscott, MA ZIP CODE: 01907 24 HOUR PHONE: 596-2945
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 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
1
I
I
r
CITY OF SALEM, MASSACHUSETTS I �Q
'� BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
s SALEM, MA 01970
TEL. 978-741-1800
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 FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT 'Ll lqIN!� ,ef £ S UNIT#
IS THIS UNIT DESIGNATED AS QgjHjEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER L�cYd &2E S tel/ MANAGER/AGENT
No P.O. Box No P.O. Box
ADDRESS_/ 33 I"o s't C 12 RA ADDRESS
CITY .SU/,9M s G d CITY
RESIDENCE PHONE�l06 - oZ% gS'BUSINESS PHONE (24 HRS.)
BUSINESS PHONE ?
TOTAL NUMBER OF ROOMS: J
zi
ROOM USE: 1. �1V .U ' 2. �t� 3. /� if 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 SIG NATURE-f- DATE Az
PECTORS USE ONLY
DATE OF INITIAL INSPECTION O- - a''7 a Z DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE:2 -,�-7 ti'-DATE FEE PAID: 7? '-)- 7 -V"-
TYPE OF UNIT: DWELLING kOTHER— CHECK#_CHECK DATE 2 7-r7 L
NOTES:
CODE ENFORCEMENT INSPECTOR 9/28/98