PRINCE STREET PLACE PRINCE STREET PLACE
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CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
STANLEY J. USOVICZ, JR. FAX 978-745-0343
MAYOR www.SALEM.COM
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#716-05
DATE ISSUED: 11/28/05
Property Located at: 1 Prince Street Place UNIT# 1
Owner/Agent: Lafayette Housing
Address: 102 Lafayette Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-4961
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
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
i
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
• 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970 �t—
TEL. 978-741-1800
FAX 978-745-0343
STANLEY i1 SOY;CZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
i
APPLICATION FOR CERTIFICATE OF FITNESS
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT Ak�i rt�C� LC4d`!(> _UNIT#—
IS THIS UNIT DESIGNATED ASIR GHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER Lafayette—Haus' ng —MANAGER/AGENT Salem Property Managers ,
No P.O. Box No P.O.Box
ADDRESS1n2 T.afayette St ADDREM 02 Lafavette Street
CITY' Salem CITY Salam _
RESIDENCE PHONE BUSINESS PHONE (24 HR&pj8- 745-4961
BUSINESS PHONE 978 745-4961
s
TOTAL NUMBER OF ROOMS:
ROOM USE: 1.L% (2w_2.14ACb 3.
5.► +_L..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
I TIME OF INSPECTION. t
APPLICANTS SIGNATURE DATE -4//
F
IN�WEC
i
7 SUE ONLY
i. GATE OF iNiTiAL INSPECTION L%- U Jr DATE OF REINSPECTION
s DATE OF ISSUANCE OF CERTIFICATE:Z4-.)-K'✓��DATE FEE PAID:
TYPE OF UNtT: DWELLIN OTHER` CHECK#_--6 __ DATE�d T
NOTES:
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I CODE ENFORCEMENT INSPECTOR
9(28/98 .
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f CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
e SALEM, MA 01970
TEL. 978-741-1800
STANLEY J. USOVICZ, JR. FAx 978-745-0343
MAYOR wW W.SALEM.COM
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#714-05
DATE ISSUED: 11/28/05
Property Located at: 2 Prince Street Place UNIT#2
Owner/Agent: Lafayette Housing
Address: 1021-afayette Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-4961
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
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH f �
t 120 WASHINGTON STREET, 4TH FLOOR
3
SALEM, MA 41970
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".
i
E PROPERTY LOCATED AT A . 1916,�G. UNIT# sr
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSF_.R. hafavUsin_uMANAGER/AGEN7Salem Property Managers ,
No P.O. Box No P.O. Box
4, ADDRESS 02 Lafayette ct, ADDRESS102 Lafayette Street
I
I CITY_' Salem CITY Sa 1 em
J
RESIDENCE PHONE BUSINESS PHONE (24 HRS.p78- 745-4961
s
BUSINESS PHONE 978 745-4961
{ TOTAL NUMBER OF ROOMS:
s
ROOM USE: 1.L;vQm 2.-L3. de jgxy-_4.�9iQx�,,,
r
I
1 THERE IS A TWENTY-FIVE($25:40)DOLLAR FEE,PAYABLE BY CHECK OR MONEY
ORDER TO THE CITY OF SALEM HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE
3 TIME OF INSPECTION.
APPLICANTS SIGNATURE / DATE JI 4 S
t I ECO S USE ONLY
r
€ DATE OF iNiTiAL INSPECTION 11'd Y DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: DATE FEE PAID: ) y`i
TYPE OF UNIT: DWELL N�OTHER_ CHECK#-46J—CHECK DATE,%�-�-uJ
NOTES:
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CODE ENFORCEMENT INSPECTOR 9128/98
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1
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
�0$
TEL. 978-741-1800
STANLEY J. USOVICZ, JR. FAX 978-745-0343
MAYOR W W W.SALEM.COM
JOANNE SCOTr, MPH, RS, CHO
HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#715-05
DATE ISSUED: 11/28/05
Property Located at: 2 Prince Street Place UNIT#4
Owner/Agent: Lafayette Housing
Address: 102 Lafayette Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-4961
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 ll"
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
JO NE�MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
l
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
• 1,20 WASHINGTON STREET, ATH FLOOR
3
SALEM, MA 01970
TEL. 978-741.1800
FAX 978-745.0343
STANLEY IF SOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
i
r
APPLICATION FOR CERTIFICATE OF FITNESS
S
1N ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION".
1I I
I PROPERTY LOCATED AT d Pr I nke,��1, �6ti UNIT#A
d
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSERLaf ette_ Hau ing- MANAGER/AGENTSalem Property Managers ,
No P.O. Box No P.O.Box
ADDRESS1ng. T,afA)7e{,le_ st ADDREM02 Lafayette Street
CITY r' Salem CITY qa 1 tem
} RESIDENCE PHONE BUSINESS PHONE {24 HRS.p?8- 7454961
BUSINESS PHONE 978 745-4961
TOTAL NUMBER OF ROOMS:
ROOM USE: 1.Lw11^ 2. 8.Pat4 Kra 4. &IVm_
i
3
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. f
APPLICANTS SIGNATURE / DATE
�32ECTURSU L
DATE OF iNi T iAL INSPECTION DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIRCATEa/-,(z DATE FEE PAID:��.7 3 v4r
r TYPE OF UNIT: DWELLING0THER_ CHECK#___��^CHECK DATE
NOTES:
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s
CODE ENFORCEMENT INSPECTOR 9/28/98
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Y
• CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH IV
120 WASHINGTON STREET,4°i FLOOR Ptllll)i1CHC81 h
Prevent.Promote.Protect.
TEL. (978)741-1800 FAX(978) 745-0343
KIMBERLEY DRISCOLL Iramdin@salem.com
LARRY IiAMDIN,RS/REHS,CHO,CP-IBJ
MAYOR
Hue1CIH AGI?N'I'
CERTIFICATE OF FITNESS
CERTIFICATE#24-13
DATE ISSUED: 1/28/2013
Property Located at: 2 Prince Street Place UNIT#6
Owner/Agent: Lafayette Housing Limited Partnership
Address: 102 Lafayette Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-4961
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
E I
LA MDIN , J
HEALTH AGENT SANITARIAN
I( �
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
"mar 120 WASHINGTON STREET,4"FLOOR
TEL. (978) 741-1800
KIMIBERLEY DRISCO1.1. FAX(978) 745-0343
MAYOR LRAMDIN@SAI.6M.COM
LARRY RAR31)IN,ILS/RF1-IS,Cf10,CP-FS
HE9LTH 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 2 PRINCE ST. PL., SALEM MA 01970 UNIT# 6
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
NORTH SHORE COMM.
OWNER/LESSE LAFAYETTE HOUSING LIMITED PARTNERSHIP MANAGER/AGENT DEV. COALITION
NO P.O.BOX
ADDRESS 106 LAFAYETTE ST. ADDRESS
CITY, STATE,ZIP SALEM, MA 01970 CITY, STATE,ZIP
RESIDENCE PHONE BUSINESS PHONE(24HRS) 978-745-4961
BUSINESS PHONE 978-825-4010
TOTAL NUMBER OF ROOMS: 2
ROOM USE: LLIV. ROM 2. KITCHEN 3 BEDRM. 4 BEDRM. 5. BEDRM.
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 14EALTH THIS FEE IS PAYABLE AT T14E TIME OF INSPECTION
APPLICANT'S SIGNATURE DATE
Inspectors use only
Date on initial inspection: Date of reinspection:
Date of issuance of certificate: ) '2 3' 13 Date fee paid:
Type of unit: Dwelling_ Other Check# Check date: 7 13
Notes: .
Code Enforcement Inspector
CITY OF SALEM, MASSACHUSETTS
` BOARD OF HEALTH
120 WASHINGTON STREET,4" FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL Fax(978) 745-0343
MAYOR DGRceNl3AUM@SAM.m.M.COM
DAVID GRE t'MmUM
ACTING HEALTH AGENT'
CERTIFICATE OF FITNESS
CERTIFICATE#75-10
DATE ISSUED: 2/19/2010
Property Located at: 2 Prince Street Place UNIT#8
Owner/Agent: Lafayette Housing
Address: 102 Lafayette Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-4961
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 ll"
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 O1 F HEALTH
DAVID GREENBAUM
ACTING HEALTH AGENT CODE ENFbRtEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4'"FLOOR
TEL(978)741-1800
KIMBERLEY DRISCOLL FAX(978)745-0343
MAYOR =nyals .COM
JOANNE SCOTT,
HEALTH AGENT
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMA HABITATION."
FF• O.OD
PROPERTY LACATED AT i n1 1'-A fle-c-b c�4i A UNIT#
IS TMS UNrf DISIGNATED AS Rlr-Wr LEFT FRONT OR BACK.PLEASE CIRCLE ONE
OWNER/LESSER Lafavette Housing L.P. MANAGER/AGENT Salem Property Managers
NO P.O.BOX
ADDRESS 102 Lafayette Street ADDRESS102 Lafayette Street
CTTY,STATF,ZIPSalam M�y__j}la7n CTTY,STATEZIP Salem, MA 01970 .
RESIDENCE PHONE BUSMSPHONE(24HRS) (978) 745-4961
BUSMSPHONE 1978) 745-8071
TOTAL NUMBER OF ROOMS:
ROOM USE: 1.� 2. t --3. Koww 4. -614-aft, 5. &4A&bu,
b 7. 9. 10.
THERE IS A SEVENTY FINU$75)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF
SALEM BOARD OF HEALTH TW FEE 19 PAYAB AT THE TIME OF INSPECTION
APPLICANTS SIGNATURE DATE
bmptors use only //"1/ /
/
Date on initial inspection t 1 C1 11 JU Date of reinspoction:a 1/"1//O
Date of issum=of certificate: a 1 G 1ly Date fee paid:_ 0/w/U
Type of unit: Dwelling�Other Check# C�_Check date:-
Notes'. Lr-
ate:Notes: r dtz � t1it2 44(1Vf��N.
Code E"ement Inspector
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,C FLOOR
TEL(978)741-1800
IOMBERI EI'DR1SCOLL FAX Mg)745-0343
MAYOR UQM3QAT COM
JOANNE SCOTT,
HEALTH AGENT I
Relowase-
In accordance with Massachusetts General Laws Chapter 111;Code of Massachusetts Regulations 410.000 et. Seq. ;
State Sanitary Code Chapter II and Article XIII of the City of Salem Ordinance,undersigned owner/lessor and
tenautllessee 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/out absence.Uwe 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 lose or injury sustained of whatever nature and description occasioned by my/out absence
during said inspection.
Tenant/Lessee Owner/Lessor
Address Address
Address on unit to be inspected
Date
CITY OF SALEM, MASSACHUSETTS
os BOARD OF HEALTH
z 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
STANLEY J. USOVICZ, JR. FAx 978-745-0343
MAYOR W W W.SALEM.COM
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#743-05
DATE ISSUED: 12/9/05
Property Located at: 3 Prince Street Place UNIT#Town House
Owner/Agent: Lafayette Housing
Address: 102 Lafayette Street '
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-4961
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
1��o L& y
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
" BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 0.1970 (�f
TEL. 978-741-1800 1 �
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". ASC.
PROPERTY LOCATED AT,'� prl p Le✓ (aLP���o�� L�- UNIT#
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
t
OWNERILESSER_Lafayettegn-nStinig MANAGER/AGENTSalem Property Managei
No P.O.Box No PJO.Box
ADDRESS102 r,afayLttte-t. ADDRESS102 Lafayette Street
CITY:-' Salem CITY Sa1em
RESIDENCE PHONE BUSINESS PHONE{24 HRS.$78- 745-4961
BUSINESS PHONE 978 745-4961
s
TOTAL NUMBER OF ROOMS:
ROOM USE: 1 tpU 2w_, ��r _3.
I
5A _S, T. 8.
THERE I5 A TWENTY-FIVE($25.00)DOLLAR FEE, PAYABLE BY CHECK OR MONEY
4 ORDER TO THE.CITY OF SALEM HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE
TIME OF INSPECTION. , ^
APPLICANTS SIGNATURE DATE /*
ECTO
F LATE OF INITIAL INSPECTION -' DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE:,,4Z--(�=O DATE FEE PAID:-/-c
TYPE OF UNIT: pWELL1N �OTHER� CHECK#CHECK DATE/.2 - a�
NOTES:
a
CODE ENFORCEMENT INSPECTOR 9128198
i
f. ya
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOORCERT.# 62-03
SALEM, MA 01970FEE $25.00
TEL. 978-741-1800 DATE: 02/24/2003
FAX 978-745-0343
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 3 Prince Street Place UNIT #: 1
OWNER/AGENT: Salem Point Rental
ADDRESS: 102 Lafayette Street
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-4961
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
Y
�3
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET
Tel:(978)7411800
HEALTH AGENT
APPLICATION FOR CERTIFICATE OF FITNESS 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 J Ef—I nL2 5�_ PI Ca -, &,J r UNIT #
IS THIS UNIT DESIGNATED AS RIGH LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSERSalpm Point Rental MANAGER/AGENTgalem Property- Managers , Zn(
ADDRESS 102 Tafayette Street ADDRESS102 Tafavette Street
CITY Salem, MA 01970 CITY S—lem,MA 01970
RESIDENCE PHONE BUSINESS PHONE (24 HRS.) 978-745-4961
BUSINESS PHONEg7 R-745-so71
TOTAL NUMBER OF ROOMS:
ROOM USE: 1P1'IAM 2.�jdq�!_3. 4. (5041tw
5. Pow & &e)A� 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 r
APPLICANTS SIGNATURE / DATE L 2
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION 2 -)- LP-o 3 DATE OF REINSPECTION '
DATE OF ISSUANCE OF CERTIFICATE:7:` 3DATE �FnPAID: 7 - 0
Id s 6&Ff--
TYPE OF UNIT: DWELLING OTHER__ 3 - a3
NOTES:
CODE ENFORCEMENT INSPECTOR
5/19/98
CITY OF SALEM,,MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4".FLOOR PublicmIotealth
TI%L. (978) 741-1800 FAX(978) 745-0343
ICNIBE11LEY DRISCOLL tramdin@salem.com
LARRY IL\MllIN,RtiAF.HS,CIIO,CP-FS
MAYOR HI3,\LTH A(; N'P
CERTIFICATE OF FITNESS
CERTIFICATE# 156-13
DATE ISSUED: 5/10/2013
Property Located at: 3 Prince Street Place UNIT#3
Owner/Agent: Lafayette Housing
Address: 102 Lafayette Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-4961
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 T E B RD OF HEALTH
LARRY RAMDIN
HEALTH AGENT SANITARIAN
CITY OF SALEM, MASSACHUSETTS
BOARD of HEALTH
120 WASI-[INGPON SI'RFF`P,4°' FLoolt
TEL. (978) 741-1800
KI1\[BERLEY DRISCOLL FAX (978) 745-0343
MAYOR LR\ lolNnsal.r\Lcrnl
LARRY RAVNFDIN, RS/RFiIS,(J 10,CP-FS
1-11 AL;PI IACENT
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 3 PRINCE STREET PLACE, SALEM MA 01970 UNIT#'
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
NORTH SHORE COMM.
OWNER/LESSE LAFAYETTE HOUSING LIMITED PARTNERSHIP MANAGER/AGENT DEV. COALITION
NO P.O. BOX
ADDRESS 102 LAFAYETTE ST. ADDRESS 102 LAFAYETTE ST.
CITY, STATE, ZIP SALEM. MA 01970 CITY, STATE, ZIP SALEM, MA 01970
RESIDENCE PHONE BUSINESS PHONE(24HRS) 978-745-4961
BUSINESS PHONE 978-825-4010
TOTAL NUMBER OF ROOMS: 5
ROOM USE: l.LIV. ROM 2.KITCHEN 3. BEDRM 4. BEDRM 5. BEDRM
6. BEDRM 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: s/ ID 13 Date of reinspection:
Date of issuance of certificate: Date fee paid: 5))
Type of unit: Dwelling Other Check# 0 /0 Check date:
Notes:
Code N �ehwnt Inspector
o CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
gj 120 WASHINGTON STREET, 4TH FLOOR
. o SALEM, MA 01970
TEL. 978-741-1 800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#439-05
DATE ISSUED: 7/11/05
Property Located at: 4 Prince Street Place UNIT# 10
Owner/Agent: Lafayette Housing
Address: 102 Lafayette Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-4961
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.
FO
,RTHE BOARD OF ALTH
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
v '� BOARD OF HEALTH
• 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA
970
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�H A112C-e 5 / /Q G� UNIT# ICS
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER Lafa et _ Eaux ng _MANAGER/AGENTSalem Property Manager
No P.O. Box T No P.O. Box
ADDRESS1n2 rafayette St ADDRESS102 Lafayette Street
CITY Salem CITY Salem
RESIDENCE PHONE BUSINESS PHONE (24 HRS.g78- 745-4961
BUSINESS PHONE 978 745-4961
TOTAL NUMBER OF ROOMS: --LL�''
ROOM USE: 1.�1()•/� 2. 46% . �^'
5.&�,/ill 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-7 I - D ' DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: 7 - I - �^ DATE FEE PAID: 7
i
TYPE OF UNIT: DWELLINGOTHER_ CHECK# CHECK DATE z
NOTES:
CODE ENFORCEMENT INSPECTOR 9/28/98
.co CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
s
3 120 WASHINGTON STREET, 4TH FLOOR
t I� o 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#438-05
DATE ISSUED: 7/11/05
Property Located at: 4 Prince Street Place UNIT# 12
Owner/Agent: Lafayette Housing
Address: 102 Lafayette Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-741-4961
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
JO MPICHO
1EA TH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
a
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970TEL. 978-741-1800FAX 978-745-0343
STANLEY USOVIC2, 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".'7
PROPERTY LOCATED AT *11� L S[1 F11"e- SC^- UNIT#
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER Lafa a _Honc' nT_MANAGER/AGENTSalem Property Manager
No P.O. Box No P.O. Box
ADDRESS1n2 TafA)jpi-+a ct ADDRESS102 Lafayette Street
CITY. Salem CITY Sal Pm
RESIDENCE PHONE BUSINESS PHONE (24 HRS.p78- 745-4961
BUSINESS PHONE 978 745-4961
TOTAL NUMBER OF ROOMS:
ROOM USE: 1.Z 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 SIGNATURE DATE
INSPECTORS USE ONLY
J
DATE OF iNiTiAL INSPECTION DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: DATE FEE PAID: ` '-
TYPE OF UNIT: DWELLINGOTHER_ CHECK# / 0 Y CHECK DATE Z/=�
NOTES: \
CODE ENFORCEMENT INSPECTOR 9/28/98
CITY OF SALEM, MASSACHUSETTS llll
BOARD OF HEALTH
120 WASHINGTON STREET,4`FLOOR PRb.1CFIeAltll
Prevent.Promote,Protect.
TEL. (978) 741-1800 FAX(978)745-0343
KIMBERLEY DRISCOLL lxamdin@salem.com
LARRY RAMlllN,RS/RII-1S,CPlO,CP-FS
MAYOR HF AI:ni AG FNT
CERTIFICATE OF FITNESS
CERTIFICATE#270-13
DATE ISSUED: 7/26/2013
Property Located at: 4 Prince Street Place UNIT#14
Owner/Agent: Lafayette Housing
Address: 102 Lafayette Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-4961
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 WALTH
LARRY RAMDIN
HEALTH AGENT SANITAR
CITY OF SALEM, MASSACHUSETTS a
BOARD OF HEALTH
�.
120 V(1ASFDNG'1"ON S'I7tEE+'L',4TO 1�L.00R
TEL. (978) 741-1800
JUTABERLEY DRISCOLL FAX(978) 745-0343
MAYOR LRAMDIN0a_SALF,%a c0m1
LARRY RANiDIN,RS/RFI IS,CF1O,CP-FS
HVAL.T1 I AG ENT
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 4 PRINCE STREET PLACE, SALEM MA 01970 UNIT# 14
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
NORTH SHORE COMM.
OWNER/LESSE LAFAYETTE HOUSING LIMITED PARTNERSHIP MANAGER/AGENT DEV. COALITION
NO P.O.BOX
ADDRESS 102 LAFAYETTE ST. ADDRESS 102 LAFAYETTE ST.
CITY, STATE, ZIP SALEM. MA 01970 CITY, STATE,ZIP SALEM, MA 01970
RESIDENCE PHONE BUSINESS PHONE (24HRS) 978-745-4961
BUSINESS PHONE 978-825-4010
TOTAL NUMBER OF ROOMS: 5
ROOM USE: 1.LIV. ROM 2.KITC14EN 3. BEDRM 4. BEDRM 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: Date of reinspection:
Date of issuance of certificate: Date fee paid:
Type of unit: Dwelling-Other-Check#_ _ D Check date: �I 3
Notes:
Code Nakr&AentInspector
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
K 9,
120 WASHINGTON STREET, 4TH FLOOR
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#210-05
DATE ISSUED: 3/23/05
Property Located at: 4 Prince Street Place UNIT# 16
Owner/Agent: LafayetteHousing
Address: 102 Lafayette Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-4961
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
JOgp7NE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
• CITY OF SALEM, Mi4SSACHUSETTS
.
BOARD OF-HEALTH
120 WASHNGTON STREET,4TH FLOOR
SALEM,-MA 01970
a
TEL:978-741-1.800 /�J
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 It, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN
/HABITATION".
PROPERTY LOCATED AT � (!)L{�i S C ••T I GC�C . S C/laM UNIT#_1�J
IS THIS UNIT DESIGNATED AS RIGHT LEFTFRONT BACK PLEASE CIRCLE ONE
bWNER/LESSER Fayette ILaus'Lng MANAGER/AGENT3a1, E.roper_ty Managers
No P.O. Box No P.O.Box .
ADDRESS162 r.a{ayptte St. ADDRESS102 I;afayette Street
CITY= Salem CITY G&7 em
RESIDENCE PHONE BUSINESS PHONE (24 HRS,978- 74,5-4961
BUSINESS PHONE 978 745-4961
TOTAL NUMBER OF ROOMS:
ROOM USE: 1,61/ m Z 3jtx�4.�c
5.!3e6.-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 DATE
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION ,� -Z S! DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE:�r,7 7- DATE FEE PAID:, 3 -,,;z 2�-
TYPE OF UNIT: DWELLING ,&'ATHER_ CHECK#f 1 CHECK DATE,3—
NOTES:
CODE ENFORCEMENT INSPECTOR 9/28/98
CITY OF SALEM, MASSACHUSETTS
• _ BOARD of HEALTH
120 WASHINGTON STREL'f,4:�'FLOOR
TEL. (97 9)741-1800
KIMBERLEY DRISCOLL FAX(978)745-0343
MAYOR hfANIN 'A 'W. ` h
JAN F;P NIANCINI lT
ACTING Hiv untAGi,.N'P
CERTIFICATE OF FITNESS
CERTIFICATE#24?-09
DATE ISSUED: 5/1/2009
Property Located aL 5 Prince Street Place UNIT#Town House
Owner/Agent: Lafayette Housing
Address: 102 Lafayette 7eet
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-4961
An inspection of your vacant DwelIing/Roomtng.Unit atthe above address has-been approved
and is in compliance with 105 CMR 410.000: Massachusetts State Sanitary Code, Chapter II"
Minimum Standards-of Fitnessfor Human. ion".
Therefore, this Certificate is issued by the C�forcement 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,eneyear.fro date- issuanceocuntiltheaurrentten2ntvacatesrwhhever
is later.
This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy.
FOR THE BOARD OF HEALTH \1
JANET MANCtNI .
ACTING HEALTH AGENT ENFORCEMEfW WSP€CTM
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4'"FLOOR
TEL.(978) 741-1800
KIMBERLEY DRISCOLL FAX(978)745-0343
MAYOR COM
JOANNE SCOTT,
HEALTH AGENP
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR FNMA HABITATION."
PROPERTY LACATED AT �fJrtt� Ji ,Y'�A.G2 V � UNIT#
IS THLS UNIT DISIGNATED ASgIR GHT L FC FRONT OR BACK PLEASE CIRCLE ONE
OWNER/LESSER-Lafayette Housing L.P. MANAGER/AGENT Salem Property Managers
NO P.O.BOX
ADDRESS 102 Lafayette Street ADDRESS102 Lafayette Street
C17Y,STATE,ZIP__Salemt �970. CFFY,STATE,ZIP Salem, MA 01970
RESIDENCE PHONE
BUSINESS PHONE(24HRS) (978) 745-4951
BUSINESSPHONE (978) 745-8071
TOTAL NUMBER//OF ROOMS: //
ROOM USE: 1.�t--v 2. kr i'"G�iK•J3. ?4t4*(-- 4 &eje*"— S mac_
8. 9 10
THERE IS A SEVENTY-FIVE($75)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CTFY OF
SALEM BOARD OF HEALTH THIS FEE IS PAYABLE AT THE TIME OF INSPECTION
! APPLICANTS SIGNATURE_ DATE 1-4-010?
J Inspectors use only
Date on initial inspection:_ S!I,CPf Date of reinspection:
I Date of issuance of certificate: Date fee paid:
Type of unit: DwellingOther Check# Check date:
Notes: � S is PC'f 4-um ac� 45 P tee onh (![Y X30
Code Enforcement Inspector
CITY OF SALEM, MASSACHUSETTS
Pal
• BOARD of HEALTH
120 WaSffiNGTON STREEr,e FLOOR
TEL (978)741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR i rotes .ut .COM
JOANNE SCOTT,
HEALTH AGENT
Release
in accordance with Massachusetts General Laws Chapter 111; Code of Massachusetts Regulations 410.000 et. Seq. ;
State Sanitary Code Chapter H and Article MH 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/out absence. Uwe 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 lose or injury sustained of whatever nature and description occasioned by my/out absence
during said inspection
t,Aertagameet Agent for
Lafayette Housing L.P.
102 Lafayette Street
Salem,MA 01970
Tenant/Lessee Owner/Lessor
o-
-516"in .
Address Address
Address on unit,to be inspected
Hf3o� v�
Date
r
0 City of Salem, Massachusetts
Board of Health
120 Washington Street, 4th Floor, Salem, SPU [tb
MA 01970
Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramd+n, MPH, RENS,CHO
Mayor Iramdin@salem.com Health Agent
CERTIFICATE OF FITNESS
CERTIFICATE#: GHL-15-339
DATE ISSUED: 10/19/2015
Property Located at: 7 PRINCE STREET PLACE UNIT#
Owner/Agent: North Shore CDC
Address: 102 Lafayette Street
Clty/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(978)825-4018
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 N "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
19
Larry Ramdin, MPH, RENS, CHO
HEALTH AGENT S ITARIAN
CITY OF S:�kI,EM, MASSACHUSETTS
�
BOARD UP HE=\I,TH
.120 WASHINGTON STREE"I' 401 FLUOR
TEL. (978) 741-1800
]UNIBERLEY DRISCOLL FAX(978) 745-0343
MAYOR I.R�LA1DtNQsALEM.COM
LARR1 R.AMI)IN,RS/RLIIS,CI-10,
HEADLII A.GENI'
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 7 PRINCE STREET PLACE SALEM MA 01970 UNIT#
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
NORTH SHORE COMM.
OWNER/LESSE LAFAYETTE HOUSING LIMITED PARTNERSHIP MANAGER/AGENT DEV. COALITION
NO P.O.BOX
ADDRESS 102 LAFAYETTE ST. ADDRESS 102 LAFAYETTE ST.
CITY, STATE,ZIP SALEM,MA 01970 CITY, STATE,ZIP SALEM,MA 01970
RESIDENCE PHONE BUSINESS PHONE(24HRS) 978-745-4961
BUSINESS PHONE 978-825-4010
TOTAL NUMBER OF ROOMS: 5
ROOM USE: 1.LIV. ROM 2XITCHEN 3. BEDRM 4. BEDRM 5. BEDRM
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 PA)ABLR T THE TIME OF INSPECTION
APPLICANT'S SIGNATURE DATE
Inspectors use only
Date on initial inspection: 0/LS/2PtlE Date of reinspection:
Date of issuance of certificate: 10/JAS/`7o1r Date fee paid:1 V1512-0-1,5--
Type
15/2n11rType of unit: Dwelling—z Other Check#2A x 7 _Check date: .-D/L�}�ZDljr
` / II r
Notes: Wear n� hwf�l rymm and- k fc hen s in II ee.s y' wt a- l W
F
C n rcement Inyctor
CITY OF SALEM, MASSACHUSETTS
` J BOARD OF HEALTI I
120 WASHINGTON STREET,4°'FLOOR
TEL. (978) 741-1800
KBOERLEY DRISCOLL FAZ(978)745-0343
MAYOR JSCOTr-SSAI.L'M.COM
JOANNE SCOTT,
HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#314-08
DATE ISSUED: 7/9/2008
Property Located at: 7 Prince Street Place UNIT#7
Owner/Agent: Lafayette Housing
Address: 102 Lafayette Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-745-4967
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 ANNE SCOTT, MPH, RS, CHfl 44 M �c
HEALTH AGENT C ENFO E NT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
'� BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
s' 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 FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT t r _ UNIT#n
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER Lafayette Hous ingLPMANAGER/AGENT Salem Property Managers
No P.O. Box No P.O. Box
ADDRESS102 Lafayette Street ADDRESS102 Lafayette Stret
CITY__- Salem, Ma 01970 CITY Salem, MA 01970
RESIDENCE PHONE_ BUSINESS PHONE (24 HRS.) 978-745-4961
BUSINESS PHONE 978-745-$071
TOTAL NUMBER OF ROOMS:
I/����'
ROOM USE: 1-40 41-2."^� � -4. ✓
5._AV49*",-67. 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
SPEC RS USE ONLY
DATE OF INITIAL INSPECTION / A/OS—DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: DATE FEE PAID:
TYPE OF UNIT: DWELLING —OTHER CHECK # CHECK DATE
NOTES*WAU hlr( l C.I Ck aimde
Pcoy—y 0c_ _ hroami-sio
-- - --
C NFORCEMENT INSPECTOR 9/28/98
i
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
s 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
STANLEY J. USOVICZ, JR. FAx 978-745-0343
MAYOR W WW.SALEM.COM
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#717-05
DATE ISSUED: 11/28/05
Property Located at: 9 Prince Street Place UNIT#
Owner/Agent: Lafayette Housing
Address: 102 Lafayette Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-4961
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
JOANNE SCOTT, MPH, RS, CHO /✓J
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
• - t 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MA�OR HEALTH AGENT
s'
APPLICATION FOR CERTIFICATE OF FITNESS
3
IN ACCORDANCE WITH STATE SANITARY CODE,CHAPTER ii, 105 CMR 410,000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION".
(�
4 PROPERTY LOCATED AT I `I�I 1 V�J.3-L LS C� UNIT#_
IS THIS UNIT DESIGNATED ASIR GHT LEFT FRONT BACK PLEASE CIRCLE ONE
j OWNER/LESSER„Lafayette HQuaing_MANAGER/AGENTSa3em P W-p rty Managers,
No P.O. Box No P.O.Box
ADDRESS102 T,afayatte St ADDRESS!02 Lafayette Street
1
CITY':- Salem CITY Ral pm
3
RESIDENCE PHONEBUSINESS PHONE (24 HRS.p7$— 745-4961
BUSINESS PHONE 978 745-4961
I
TOTAL NUMBER OF ROOMS: .5
ROOM USE: 1 LiV' 4M 2. 3. _4._
4
q 5.Q;;E LMI9 0. 7. $. _
A
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. f
APPLICANTS SIGNATURE l DATES
EAR'S USE
l
L
DATE OF INITIAL INSPECTION {/' )jV”'3 DATE OF REINSPECTION
i
I DATE OF ISSUANCE OF CERTIFICATE;[/-,J`,Y— -Y�DATE FEE PAID:
TYPE OF UNIT: DWELLING—OTHER` CHECK# CHECK DATE
NOTES:
I
s �A,
{ N,
CODE ENFORCEMENT INSPECTOR 9/28/98
i
E
CITE' OF SALEM, NIASSACHUSLTTS
BOARD OF FIEALTH
120 WASHINGTON STREET,4"FLOOR PubHCHea ith
Prevent.Promote.Protect.
TFL. (978) 741-1800 FAx(978) 745-0343
KI'NIBERLEY DRISCOLL lramdin ,salem.com
LARRY R 1,bIDIN,RS/REHS,CI IO,CP-C'S
NIAYOR HN.,17,.TI-I A(G ENT
CERTIFICATE OF FITNESS
CERTIFICATE# 163-14
DATE ISSUED: 5/30/2014
Property Located at: 11 Prince Street Place UNIT#
Owner/Agent: Lafayette Housing
Address: 102 Lafayette Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-4961
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 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
L Y RAMDIN
HEALTH AGENT SANITARIAN
r ' fl
°. CITY OF SALEM, MASSACHUSETTS �� ly
BOARD OF HEALTH I
120 WASHINGTON STREET,4"'.FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX (978) 745-0343
MAYOR 1,RAMDINnSALEM.COM
LARRY RANIDIN,RS/RITIS,CHO,C11-1;S
HEAL'111 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 11 PRINCE ST. PL., SALEM MA 01970 UNIT#
1S THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
NORTH SHORE COMM.
OWNER/LESSE LAFAYETTE HOUSING LIMITED PARTNERSHIP MANAGER/AGENT DEV. COALITION
NO P.O.BOX
ADDRESS 106 LAFAYETTE ST. ADDRESS
CITY, STATE, ZIP SALEM, MA 01970 CITY, STATE,ZIP
RESIDENCE PHONE BUSINESS PHONE(24HRS) 978-745-4961
BUSINESS PHONE 978-825-4010
TOTAL NUMBER OF ROOMS: 6
ROOM USE: LLIV. ROM 2. KITCHEN 3 BEDRM. 4 BEDRM. 5.BEDRM.
6 BEDRM. 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: Date of reinspection:
Date of issuance of certificate: Date fee paid:
Type of unit: Dwelling Other Check# Check date:
Notes:
Code Enforcement Inspector
4
CITY OF SALEM, MASSACHUSETTS
a BOARD OF HEALTH
a 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
STANLEY J. USOVICZ, JR. FAx 978-745-0343
MAYOR W W W.SALEM.COM
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#682-05
DATE ISSUED: 11/3/05
Property Located at: 13 Prince Street Place UNIT# 1
Owner/Agent: Lafayette Housing
Address: 102 Lafayette Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-4961
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 ll"
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 r
JOA NE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
• 120 WASHINGTON STREET, 4TH FLOOR YI �J{�/•�"_ t,/�
3
� SALEM, MA 0197
TEL. 978-741-1800
FAX 978-745-0343
STANLEY USOVICZ, JR. ,JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
4
t
i
APPLICATION FOR CERTIFICATE OF FITNESS
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN�HABITATION".
i
PROPERTY LOCATED AT P-21 Prl19L .0 ISI UNIT#
I IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNERILESSER Lafay MANAGER/AGENTSalem Property Managers,
No P.O. Box No P.O.Box
ADDRESS102 rafa),etle_ st ADDREM02 Lafayette Street
CIT` -1 Salem CITY Salem
z
RESIDENCE PHONE BUSINESS PHONE {24 HRS.P78- 745-4961
e
BUSINESS PHONE 978 745-4961
TOTAL NUMBER OF ROOMS:
ROOM USE: 1L_I0 90A 2..k 3
j 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.
/ IIJ
j APPLICANTS SIGNATURE DATE
N O SU E L
DATE OF INITIAL INSPECTION //- -v J� DATE OF REINSPECTION
f DATE OF ISSUANCE OF CERTIFICATE& - DATE FEE PAID:
TYPE OF UNIT: DWELLING OTHER_ CHECK#_._CHECK DATE ~a
i
NOTES:
s
CODE ENFORCEMENT INSPECTOR 9/28/98
i
i
1
�ONDIT
kP eO' CERT.# 176-99
FEE $25.00
�. DATE: 04/13/99
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: 13 Prince Street Place UNIT #: 15
OWNER/AGENT: Salem Point Rental Prop.
ADDRESS: 102 Lafayette Street
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-4961
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 MORE INFORMATION CALL 978-741-1800.
FOR THE BOARD OF HEALTH
'JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
I
3
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET
HEALTH AGENT T01:(978)741-1800
APPLICATION FOR CERTIFICATE OF FITNESS 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 13 lor)nCe SWOCe, &LEA, UNIT#
IS THIS UNIT DESIGNATED ASIR GHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER $a 1 am Pni nt Ranta 1 MANAGER/AGENT Ra 1 em Property Managers , Inc
ADDRESS ln2 TafavPtte StrPPt ADDRESS.-Ing Tafavrp_i-+-a Rtraat
CITYc_oa.=T o n, Mn 01970 0 CITY Salam,, MA ()1-97o _
RESIDENCE PHONE BUSINESS PHONE (24 HRS.) 978-745-4961
BUSINESS PHONE 97a-745-Rn71
TOTAL NUMBER OF ROOMS:
ROOM USE: 1 3ALLm, 4._y44L/ n?
5.Vu ,6. y7. 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 a6
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION-V -;(, _f DATE OF REINSPECTION _
DATE OF ISSUANCE OF CERTIFICATE-/3 j;f DATE FEE PAID:
TYPE OF UNIT: DWELLING OTHER__ (J L7 b a 2 3 7
NOTES,
CODE ENFORCEMENT INSPECTOR
5/19/98
' CIN OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
°Ne TEL. 978-741-1800
STANLEY J. USOVICZ, JR. FAX 978-745-0343
MAYOR W W W.SALEM.COM
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#745-05
DATE ISSUED: 12/9/05
Property Located at: 15 Prince Street Place UNIT#Town House
Owner/Agent: Lafayette Housing
Address: 102 Lafayette Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-4961
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.- r
FOVHE BOARD OF/HALT�H'
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
d
I
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
M • 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970 �) f
TEL. 978-741-1800
FAX 978-745-0343
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
i
i
s`
s
APPLICATION FOR CERTIFICATE OF FITNESS
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER il, 105 CMR 410,000
} "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". _
PROPERTYLOCATEDATfS J`Ir/Y1CZc5� 1o�+r1? —UNIT#��
k
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
1
OWNER/LESSFR-L-a-fAyett-eEmisinq MANAGERIAGENT lem Property Manage?
No P.O. Box No PO.Box
ADDRESS102 LalfaYprp c+ ADDRESS102 Lafayette Street
CITY= Salem CITY galem
RESIDENCE PHONE BUSINESS PHONE (24 HRS.978 745-4961
BUSINESS PHONE 978 745-4961
TOTAL NUMBER OF ROOMS:
ROOM USE: 11--1✓re4-4 2.
F
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 a
]IVV4,P t S USE ONLY
DATE OF iNiTiAL INSPECTION /a —�—p S� DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE:I.2 DATE FEE
PAID:— 7 `O'er
TYPE OF UNIT: DWELLINt HER CHECK#CHECK DATE L �
i NOTES.
i
CODE ENFORCEMENT INSPECTOR
9/28/98
r
4
t
CITY OF SALEM, MASSACHUSETTS
$ BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
M^M SALEM, MA 01970
9qq TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE# 196-04
DATE ISSUED: 05/11/2004
Property Located at: 15 Prince Street Place UNIT# 15
Owner/Agent: Salem Point Rental
Address: 102 Lafayette Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-4961
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.
R-THE BOARD�H
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
4 A,
i
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
i
ANNE SCOTT.t IPH,RSI CHO NINE NORTH STREET
HEALTH AGENT Tel:(976)741-1800
APPLICATION FOR CERTIFICATE OF FITNESS Fax:(978)740.9705
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
IV Nilf 4UM STANDARDS OF FITNESS FOR HUMAN HABITATION". ( �
PROPERTY LOCATED AT ? YC 1 Y1( P C4�dCQ&. ,. ,Sd 'TSI 4 UNIT#
I
IS TH UNIT DESIGNATED AS RIGH- LEFT FRONT BACK PLEASE CIRCLE ONE
OWN RILESER rta.]-E1tLpni n+ RPn+a 1 MANAGERJAGENT-,�,,a 1 Pm PrnnPr+v Managers , Inc
ADDRESS Jing rADDRESS 7n2. Tafn%7P}-I'P R+YPP4
j
CITY CITY Salem, M_A__ 01970
F I
RESI ENCEIPHONE BUSINESS PHONE (24 HRS.) 978-745-4961
BUSINESS PHONE 47R-74s-an71
TOTAL NUMBER OF49OOMS:
� ( � �
ROO USE:I f, yU�2.4id,, 3.Qwcam 4.�12T-i
i
5.�6. 7. B.-
i
THE FE IS ATWENTY-FIVE($25,00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY
ORD R TO THE CITY OF SALEM HEALTH DEPART ENT THIS FEE IS PAYABLE AT THE
TIME OF INSPECTION
i
APP CANTS SIGNATURE DATE O
IN, CTORS USE ONLY
DAT OF INITIAL INSPECTION "5 f '�� DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: 'I l-��DATE FEE PAID _`
TYP ( OF UNIT: DWELLING OTHER_ #- j-t/`�
�j{
NOT S:
I
i
I I
CODE ENFORCEMENT INSPECTOR
, 1
5/119/98