PRESTON ROADPRESTON ROAD
��. CITY OF SALEM, MASSACHUSETTS
;. BOARD OF HEALTH
j 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 # 419-06
DATE ISSUED: 8/23/2006
Property Located at: 1 Preston Road UNIT # 1
Owner/Agent: Mark Levesque
Address: 396 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 T� D OF HEALTH
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
f,.
CODE ENFORCEMENT INSPECTOR
CttY OF SALEM, MASSACFiUSET S
0BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 979-74 1-1800
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
1 .
RHUMAN HABITATION",
PROPERTY LOCATED AT �--VA C��A_UNIT #J.-
017"10
IS THIS UNIT DESIGNATED AS RIGHI LEFT EBQK RACK PLEASE CIRCLE ONE
ENT
No P.O„
t;
yid
�: i f-<4 � 1000
RESIDENCE PHONM(� 'J�=5faBUSINESS PHONE (24 HRS.)___.__
BUSINESS PHONE If 392-=(ot4QQ .
TOTAL NUMBER OF ROOMS:ly.�
ROOM USE: 1..--.K�^__2_=-
5. 6.. 7
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
INSPECTORS USE NLY
DATE OF INITIAL INSPECTION ,3 __. _DATE OF REINSPECTION -..
DATE OF ISSUANCE OF CERTIFICATE. W .�3.o, 6 DATE FEE PAID _.
TYPE OF UNIT: DWEI-Vgj i,�OTHER_ -. CHECK Ji % Ii
NOTES:. -
CHECK DATE 9 .;? 3 -V G
CODEENFORCEMENI iNS>PE(,1OR 9/28/98
a �
s
Kimberley Driscoll
Mayor
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAx 978-745-0343
W W W.SALEM.COM
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE # 420-06
DATE ISSUED: 8/23/2006
Property Located at: 1 Preston Road UNIT # 2
Owner/Agent: Mark Levesque
Address: 396 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 If'
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
�c
?ANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
-�Q Lla�z
C D ENFORCEMENTINSPEC OR
C" OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
• 120 WAsHiNGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 878-741-1800
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 11, 105 CMR 410.000
"MINWUM STANDARDS OF FITNESS FOR HUMAN HABITATION". C)) ? ()
PROPERTY LOCATED AT '�NIT #
___a +"_ a
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT DA -CK PLEASE CIRCLE ONE r-1
ALm
OWNERILESSERLe 16 MANAGER/AGENT
No P.O. soxSox
'40 P.-)-
ADDRESS_a%L,L- A_
._ADDRESS
RESIDENCE PHONEM-53f-511-111SINESS PHONE (24 HRS.)
q
BUSINESS PHONE I
TOTAL NUMBER OF ROOMS:
ROOM USE: -------- __4
t;
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
(0 APPLICANTS SIGNATURE DATE
INSPECTORS USE _ONI�y
DATE OF REINSPECT ON
-A JE -QF INJITINLiNSPECTION ,70 (..-- 1
DATE OF ISSUANCE OF CERTIFfGATE. o. s DATE FEE PAID .
TYPE OFUNIT: DWEI_LINt__,`0THER. - CHFCKv J O E7 CHECK DATE (Z 5 --D
NOTES.
CODE ENPORCEMLNI INSPECTOR ()/28/98