6 POPE STREET y ripe Se� l-
CONDIr,,Q
City of Salem, Massachusetts
6aw Board of Health
120 Washington Street, 4th Floor, Salem, Plnb]icHealth
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-16-177
DATE ISSUED: 5/20/2016
Property Located at: 6 POPE STREET UNIT#
Owner/Agent: Carlos Rodriguez
Address: 529 Columbus Avenue
City/Town: Boston, MA Zip Code: 02118 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.
FOR THE BOARD OF HEALTH
J re arosy
Larry Ramdin, MPH, REHS, CHO
HEALTH AGENT SANITARIAN
CITY OF SALEM, MASSACHUSETTS V .
BOARD OF HEALTH
120 WASHINGTON STREET,4m FLOOR ,
TEL. (978) 741-1800 FAX(978)745-0343
KIMBERLEY DRISCOLL kamdin@salem.com
' MAYOR LARRY RAMllIN,RS/REITs,C140,CP-fS
HL'ALm 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 I0 �p UNIT#_�A
IS THIS UNIT D SIGNATED AS RIGHT INT FRONT ORBACK.PLEASE CIRCLE ONE
OWNUILESSER. ra.loS QAvz5u,7- MANAGER/AGENT btaw-uU ta%�
NO P.O.BOX
ADDRESS SZq CmLM6v5 Ave— -4y ADDRESS 1k k 10
CITY, STATE,ZIP 04Qn , M/f ozgx CITY, STATE ZIP UAM VJA LM01
RESIDENCE PHONE BUSINESS PHONE(24HRS) Gl"o C 26
BUSINESS PHONEI +o Ck UIO
TOTAL NUMBER OF ROOMS:
ROOM USE: I. l:a:A� 2. 1: tom 3. It-A < 4. bepL c:) 5. bva1 3
6 I aa.xan 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 FIE IS PAYABLE AT THE TIME OF INSPECTION
APPLICANT'S SIGNATURE N/Vl�i DATE Jr Iq f C�
Inspectors use only
Date on initial inspectional q12-OU Date of reinspection:
Date of issuance of certificate: T Date fee paid: Q&Vao2z
Type of unit: Dwelling Other Check# 2 Z . _Check date: Q��.� 1(6
Notes:
C oy ement h7d6or