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PROCTOR STREET PROCTOR STREET i r r CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH / z 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 W W W.SALEM.COM Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO Mayor HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE# 173-07 DATE ISSUED: 4/5/2007 Property Located at: 4 Proctor Street UNIT#A-1 Owner/Agent: Scott Galber Address: 203 Washington Street#254 City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-269-4173 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 1� Al � J ANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSEWS BOARD OF HEALTH 120 WASHINGTON STREET. 4TH FLOOR SALEM, MA 0 1970 TEL, 978-741-1800 FAx 978-745-0343 HEALTH AGENT | Kimberley Driscoll Mayor APPLICATION FOR CERTIFICATE 0FFITNESS |NACCORDANCE WITH STATE SANITARY CODE, CHAPTER ||, |O6CMR 410.O80 "M|N|WYUW1STANDARDS UFFITNESS FOR HUMAN HAB(TAT|UN" � PROPERTY LOCATED AT °°- ��� VN|T #���/ _-�_-*_-----�_----- -_�------���_-----_-�-' ' / |STHIS UNIT DESIGNATED /\S RIGHT LEFT FRON BACK PLEASE CIRCLE ONE OWNER/LESSERSCQtt RES|DENCEPHONE— ] ~BUSINESS BU@|NES8PHON � TOTAL NUk�BER ()FR08��S� �_�___ RO{>MUSEi 1` 2,-/36 ~vt�-3-- - 5_6 THERE THERE ' PAYABLE BY CHECK0RMONEY ORDER T0THE C| THIS FEE |3PAYABLE xTTHE T|/NE0F |A9PECT|0N APPLICANTS SIGNATURE DAT[DALE __ �= �y LNI��-P_ECLORS USE ONLY 0 � ��~ �� � _x D#TE0FREINSPECTION DATE OF ISSUANCE OFCERTIRCATE: 41 DATEFE17PAID. 174TYPE OF UNIT DVI/FLLINQ�/ O1_HFR CHECK ;: rt7 7ECKDA|-E L4 -� � NOTES CERT.# 322-97 FEE $25.00 �11' IfF" DATE: 05/27/97 ty� CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 6 Proctor Street UNIT #: 1 OWNER/AGENT: John Surrette ADDRESS: 8 Proctor Street CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-7099 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 �Ilpag 7) J U JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR I IL -97 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970.3928 JOANNE SCOTT, MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tei:(508)741-1800 APPLICATION FOR CERTIFICTE OF FITNESS Far:(508)740-9705 IN ACCORDANCE WITH STATE SANITARY CODE, ,CHAPTER IT, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT UNIT / � OWNER/LESSER �� e. MANAGER/AGENT � �� ADDRESS Y/`�//ic TGZ J 7 ADDRESS;reig, CITY �/��A442 CITY Y9t� 'RESIDENCE PHONE BUSINESS PHONE (24 HRS.);7{u_� BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: i. 2. 3. 4 ._ 5. 5. 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: ONLY DATE OF INITIAL INSPECTION: 2Z DAI'E OF REINSPECTION`___ _! DATE OF ISSUANCE OF CERTIFICATE: 7 �Gj '� DATE FEE PAID: TYPE OF UNIT': DWELLING f' OTHER_ � — NOTES:______­_�'`� i j CODE FNFORCEMENT INSPECTOR ND � City of Salem, Massachusetts /6 Board of Health 120 Washington Street, 4th Floor, Salem, MA 01970 Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, REHS, CHO Mayor health@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE #: GHL-16-236 r DATE ISSUED: 717/2016 Property Located at: 6 PROCTOR STREET UNIT#2 Owner/Agent: Andries Booysen, Ashley Jones Address: 6 Proctor Street City/Town: Salem , MA Zip Code: 01970 24 Hour Phone:(704) 816-0669 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 G V / Larry Ramdin, MPH, REHS, CHO { eD7 SANITARIAN HEALTH AGENT RECEIVED NO F}}ROM`�'�S I� /�'�%I �(kT01S A''��.w�" ,. . - ..�ayft.Tr 'J-:'"✓v , �* 4 �''« +' "" /.'fir' « •• :. � ,,y' ..•/• w `t'✓' Y 4 Account Total"$ s- �, Y R CITY OF SALEM, MASSACHUSETTS I Bwm of HEALTH 120 WAST JINGrON STREET,4T"FLOOIL Tat... (978) 741-1800 KIMBERLEY DRISCOLL FAX (978) 745-0343 MAYOR LRANIDIN&SALENLCOM LARRY RAMI)IN,RS/REBS,CFIO,CP-FS - HEALn i AOEN,r Application for Certificate of Fitness IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" d FEE: $50.00 PROPERTY LOCATED AT (0 1 066 g— SChM M\'� O PI O UNIT# IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE n (��� OWNER/LESSERA��ag A(I'Ctiy Ikgi� 4 C MANAGER/AGENT N�A ADDRESS 1 YOdw a J ADDRESS N) A CITY, STATE,ZIP a,'--tM t \ � 1 o CITY, STATE,ZIP �1 RESIDENCE PHONE_70LN3Ib-0 1 BUSINESS PHONE(24HRS) BUSINESS PHONE LDi-1qT— I TOTAL NUMBER OF ROOMS: p_' �p ROOM USE: L�t�(A� 2.PKft . 1bi\mj". LA\i'mdpt Qm �pcuV�dvt 6.4a5edyPOK. 8. 9. 3 10. THERE IS A FIFTY($50)DOLL E,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FE IS PA BLE AT THE TIME OF INSPECTION r APPLICANT'S SIGNATURE DATE (01�� 'I Inspectors use only co,^, Date on initial inspection: IQTI Date of reinspection: _1 1 1 W Date of issuance of certificate: �i I 1 I 1 L Date fee paid: lP Type of unit: D/.w,ellinOther Check# Check date: (ri ,7 Lo Notes: .1 V'0 0 66C h eg4<- .12Q(, Cod n ^ ent Inspe6vr U i Inspecticin o (0 PrOCfD r �i` Vn� f Date IQ 27ji !) Time ` f Name Address Owner f�SYW2�j JW e5(I�Anel Q�S1 ( 'oo-V� 422) Tel. No. IOy Type of Inspection n&j Y L C� C]#- f"'t � ass Inspector (7 r) ( ' ) Remarks and Violations are listed below: ID,S CMR Coo, 000 14an r i'1 S qolAq �-h e s4c I'vs =loose 4 4.n A411CIr4 .1NIS orr P e-d 6b r !4, ? Gu-p in a)r b-e-k eePn )a^Phvoom Artie( �e-n 4r � c)05 ej Cbrmo�f 7/711 Co 3 oy{e CcoSe-* dors h :1L nSJ411,ocPdel' Nc�/e /�, G a)Qr Lz"G/ P e 0oLS +i h IrS4 a_ -er Sf�I�S -f�ese r arr's ar,e J;1 prl, 5 n l VA64 clooc Bun r-0(3(n. inn OLD 014 A;Zj ,eh&?C1 1 k,)m %,()0, MOMIJ,itf111 Y001Y1 LA) t LL fJ G i - Co - 1 el i fYti65 �odmorn Co to roL ✓Y1 1 - i o Chas rr be -? Co i� ven v vel CoA k �6 S V ,gin ojhen rOcu vs CLr e mcA-d e . a ''L �� +� 0� vbsefve� 7 in Report Received by: CITY OF SALEM9 MASSACHUSETTS .� BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR o SALEM, MA 01970 �'. TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. UISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT May 7, 2003 Paula Baliotis 12 Greenway Road Salem, MA 01970 PROPERTY LOCATED AT 21 Proctor Street 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 the Board of H alth Reply to Joanne Scott MPH, RS, CHO Pablo Valdez Health Agent Code Enforcement Inspector �n City of Salem, Massachusetts r Board of Health 120 Washington Street, 4th Floor, Salem, Pabiitc� MA 01970 Prevent. Promote. Protect. Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin,MPH, REHs,CHO Mayor health@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE#: GHL-17-140 DATE ISSUED: 5/10/2017 Property Located at: 22 PROCTOR STREET UNIT#2 Owner/Agent: Jason Mclsaac Address: 17A Old Topsfield Road City/Town: Boxford, MA Zip Code: 01921 24 Hour Phone:(781) 799-7107 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. i 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. e ey B ro Larry Ramdin, MPH, REHS, CHO SANITARI HEALTH AGENT //// C11'ry or sm.1",�<f N/1 SS i\C,F1 UISFITI'S 120 WAM I I\:GTON S11611,1, 1'" 1'1,0()R T r... (9 7 9'.7 11-18(a KIAIIIIA01FIN DRIS0 A-I. 1:.\x ;�978) 7-13-0343 YOR L u In R_\\I i A N.iclv Rr I is,(❑.1 in,C], 1:�, lit:tori A61-N 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" FEE: $50.00 �vv\, MA. PROPERTY LOCATED AT AG-iUNIT# is'riw IJNvr DISIGNATFI)AS RIGHT LIEFFFROMFOR BACK, im LPLEASECIRC.E )Nr OWNER/LESSER 7JA L 0.41 /Q L Z�-c A4w( MANAGFR/AGFNT -CAvk-tl - NO P.O.BOX ADDRESS n --ADDRESS CITY,STATE.ZIP CITY, STATE, ZIP RESIDENCE PHONES -BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1. P2 2. St C 3. f 4 L L 5. 9­1A1 6. 7. GI /-tj 8. 9. to. 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 BLEAT THE TIME OF INSPECTION APPLICANT'S SIGNATURE DATE Wz" 77 Inspectors use only Date on initial inspection:-. Date of reinspection: r/ Date of issuance of certificate: V_2=7 Date fee paid: Type of unit: Dwelling—VOther Check#=6005_2q7 Check date: Notes: rSee_ k�aclij) /Other cement Iyt ector Date Time Inspectsonof Name Address Pror4Or Sr 4T=Zg4 r4T=Zg4� Owner, laiQl, M TAOLC Tel. No. 121- 111- 2`011 Typeof Inspection ^ h s •-_.—_ Inspector r r yL ( ' Remarks and Violations are listed below: j i win ny✓ t�2nL to S an rd �✓ IY1�Do .s SO�iq '0 Pell r t MAMA/ w aG } S ✓ G „ W.�Drn/moo K r f� lien f iqJ�, I� z- Y�h� rtI1 G[pe kel £t— r r also cF , Its y,rpm-_� ° Fva,lr Glass rar1� r "' me- S f ! &z;: = ,+ly w.. 130°F, 4f =,t 1 Qff,,L 6Y29,1 LY iJr� ,pPrE9P}Ph�© Z4�, L� /a-- Y/fa.j(61(luj n�IX�''r 'TnP TYYTYfT P�II�YLV7fP _C , d4 J7AtJ,,Q f+',.Ybnh Mns, ! f PY2C DY' Wr t+1 Ci, GF _� t f l}Y�S' ?tf�t+, rhrn� as,re door L[ ciu C i/li�lin r r4L' J A exitr P D r, Cfroear4meelf ACLS ZL 'vV W W4 D' S t � s r f o r a r < LA tCif� �_PSJ(7ttr F}Y [ �t���fJtJ t - Report Received by: Inspection'of dah cl pr+ Ment Date LR�2o.2.� Time// / Name Address 22 Prnr_fnr S&ei #Z1'7d M3 Owner Tel. No. Type of Inspection (,Pr lne Inspector If"rr ) ( ' Remarks and Violations are listed below: 1 � t t t MO vL S'�art :4r cf} ram rai IIn�t LC != wfn u. ©h T e 120OP' X0.11 �Yn y� like- ( oon 4vA 0. fa,, f!Y[.CYI./�P12AiY oY'_ [4. S`GV'CP ! w�, r f /� " Swl4o i4 LIL4 near ��lc�� �r S cI a�n I MAq Covero r, vje- cA- e4ve" for Swl +rh. / _ L rr r f1++� a�'hybo v,li ow C` ��Iliha fl- nM ' SeA!74, ena,lr W1 r 1 W8Z So fees (gem e)m � r Q r I I —Hewa'�o,� j 5 al ��, Rjuce, L v Iernaerajvre �o t4 ;s' IJi em a 10OF� T 30°F, Owney� iS to corr-rd j -'Iola+ enir Ower � S +o �'ge_ �aL' P" n / eo-]A JM SCAA_ ��e. 0.r re– iYJW'*z+i� olive_ 0 Il Gorrrr�'l0klf AAA/e- Leln�� MIRde, Tli ,�'em ardL �l" lie l+ti W;/I [�� yt�i�o(�,��r�.IlheY'eSlF- iheCl�rre�_-f'iI�hS -f'h J r 2hfyr�2�je.�rhr. (.. hLa "Mpy" r � Report Received by: Inspectonof_TWn Qpa4-4 e*-d- ' Date Q2- Timef_lr�:�w.m Name } gyp' Address ! 2 ke-c- or^ S- ,-ezzj ;W2o n - 3 Owner JaSotiLS�u1 C, r Tel. No. � 1 7R - 7L/ Type of Inspection f,�r-f IL'COCL Fr4-ne-.f'S Inspector ( � 1 Remarks and Violations are listed below: AoQm4mwi 2— rW / nc f / �� or S //AU ruw,.u,,fc+r�Q r) fnC S'C:rrP�N f 0f^ Il 41 en VI'MA N 40 Ae S'L/ LNr'TT J myIS +o kA S o 4 F /AL 11II /TI( V' OLdrrftI Y idi L Cmrrec-� Ivy I' �(c�2�" f(c, ve6or4,, pT-,P r Ve- 10 CD nvr, r r. Report Received by: City of Salem, Massachusetts i ' a q Board of Health 120 Washington Street, 4th Floor, Salem, PUC�IC>SItl1 Preveot.Promote. Prowl MA 01970 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-17-141 DATE ISSUED: 5/1 012 01 7 Property Located at: 22 PROCTOR STREET UNIT#3 Owner/Agent: Jason Mclsaac Address: 17A Old Topsfield Road City/Town: Boxford, MA Zip Code: 01921 24 Hour Phone:(781)799-7107 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 8 years of age. /J. rey r Larry Ramdin, MPH, RENS, CHO SAN IT AN HEALTH AGENT CITY 01; S U I tiF Vl ititi,�(J ILsSIs"TTS I�n Bmknoi III \1,111a 1't1CV'�,niu rlm Sil I to I I Ltlnit Tf l,. (978) 741-1800 r978) 745-0343 NIvYOR Ll(VIWN' %i R;nmtr;,IRs/iwf r,�,(.-I a icr-I Tlt:u:ril:AccNI Application for Certificate of Fitness IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" 7 {� FEE: $50.00 L PROPERTY LOCATED AT -2 ffl�( -V2, sr, SAL ✓1 ,�✓t UNIT# IS THIS UNIT DISIGNATED AS RIGIU LNLFITI'FRONT OR BACK PLEASE CIRCLE ONE _ OWNFR/LESSERnn �I l U�S `AA ('"`` MANAGER/AGENT ADDRESS IJ��1 Ni k ) ii, ADDRESS P CITY, STATE,ZIP I X797�. CITY, STATE,Zi RESIDENCE PHONE 'J/ ! `t� �. llD 7 BUSINESS PHONE(24HRS) BUSINESS PHONE 4, TOTAL NUMBER OF ROOMS: ROOM USE: 1. 2. t? L 3. )Z�rbLt{w 4. L+L10 5. 6. 7. 8. 9. 10. THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE IS ABLE AT THE TIME OF INSPECTION APPLICANT'S SIGNATURE DATE Inspectors use only Date on initial inspection: Z�/23 Date of reinspection: 6 S Date of issuance of certificate: y� 1��17 Date fee paid: Type of unit: Dwellin Other Check#0000065"7.77 Check date: ��20� cl 7 Mores: I Sce A f Li C.rner-AM CEn' rcementy pector Inspection of n nnf Date Time IF Name �A Address 2�jX Ror Off r S4-✓l'yr Owner Jn cr„ M /(11, ( TSn/" C, Tel. No. ' I Q I' 71 - /- ( 1 Type of Inspection l o� a r�� r nl� Y�-�neSS Inspector ( � 1 Remarks and Violations are listed below: / ' "I"1'r!fy IIrA hJ4 ,n✓ I in/Anw rA L/r Il: 1, �rN lf�r A l(7�I(.f�JP �� — '✓1/" r � n//SPY$ //�(1/ W14 V7 ten • n n ✓ Srf lr,, { lCl!/2 �C "� /,P1/✓0 JAQk /$ APj �� be SJ122M Acar,�,r,-n4 TI J LYn��Y^ 'O+ %Ar n(J(71AZ 'I L)4 -O� <r. i� S DYl I�S (,)t,/YI IJ,P I l, i j2(j t/ ons nn/oc�4L coy✓fr4� _ 1w, f11 _�(C�� �r,� c J y(( elll)><tn4i -� RS VE00/'1', ✓Ylfr ( hNry 1.✓11�PY Mi�C Cn P C' Yh n/A// T 'P/A1I7 CC J�Jh ( /1 Report Received by: Inspection of an ann r-�w�e„4 Date � / 2•d/y��1� Time -I , lJ�rm y� Name / Address )--7 gYra(�l/OY•p> i�-/rP� �$�-/� �r•� +F,� Owner_ �a Snn M/(_�Z Sr ck,G / Tel. No. _ /ql' /q I- /��/ Type of Inspection l Pr-(-,{ Ila�'P- O f7r+he.SS Inspector Jeffrey Pa'acy ( ' ) Remarks and Violations are listed below: �V�I�JC �Pn � rIn/}nl (f /1Pa le ('} Illinn rnntv� !�n In nl l� r'�l7PN rAH� < 'C7 SE �Yn Y�Prlii �P/� i/ n/I'An �n�j le n.�r w ,n �nr , i f() y-In I r`) P. n A ( In( rn ? I✓ 'V1 ln.vuSn rW nrtnt c clack ✓)✓nnP✓ Cr&,e PmS , y OASrrr/e ( ;Mv74 t / t P PH4-rvo IOluDn nn�nl P- n. rPn nt n1.1_ll de C,nn,(r� .6 �e el0elled, 1� !( ; �J/IPn ti/rnr�f)XA/ r. Una k,+c Len Cr �//l`�< AA�-�//1]Sn � IS CAinny fnr� 1t alfn lnn(e " " C- /h i,JPn 1 , BE 1\PPur✓ Q/aSt nnnl Ye DG r n f 12en ran Jon r5 Drn 0,01,/v J / ^`� Un1l 4.r(A4P✓ �PM nP rQ �UVL IS Gt+ J �6�. I nWC✓ / n�Wr ✓ Sn 1T I ( rJe�WPPn00! 1 30°F,, / Nl ' '/ _ I IVrYrn rnns.� j 'w oef n"l HinyK, l�P✓Jra ✓ '/n t" l n , r Vnn /n u NPs, re(-�' -{vnn-� G.n+�rnn(a. �nnr hoc r, l^ 'l,nn YPn✓ fn ('/n, l<e/Jr, l✓ 5,(.5 +. to ? '�' DYIPN S a In nj C Ince S rn✓Aer V, — Tn__-4-(,✓„ (IP rA rnnnhc Inco jrrl it)W„ .ti 4 l,1l ityy fri Y1 eAP, 4 ill 61, 1-1141119 (P_ r1/1 *1A TTr..yn n, ✓r..✓l7nt. rn nnnll rrAr ar'�"P r�orf///`�w -�'h�n 7'Pn -+sr�- n� -her ! dGnnrfe fc. ,, APS4 4- d n✓' �uS GY li(.,l /,nn Lt 1n� C�,)�blN/, In�•1n+ a 1,.../P (InSt� �nn✓, !(Pa»ny2 ✓tPelrn„ ✓J!.. n {' -i,�� ✓e r�n�rn � a✓Prz , 1 1 �R F ✓ nn rxJl r .rNl n �n n �I A �nw s ✓P�r !rl �Drr� rr� r, A +nvn S(vn4ljo , rker)aA ✓fr 6/1w P. (!yrr N , J eP , ( Prov rAp. Cr 1✓,rrn[ n , f�/ ✓r/>6 r,,.iA lr� Cn I..r1r11,/ S Cn,,, k(r)f nt7PnPrA anrArin�e� 1 )P� vnnS nn r,oA rn ! ONI� /H- ra /A //W111 0(S A �., rn n%Alw)7'PI rynr rn 1 /1 ^er20L,r Mr, Yre91M(e ,..i �n/1nw. 1 r n,A r.,nnny'jP rn ',, v , i ✓rr. �,� �c. 'I�,.ic, N b,/4 %Ainy/��/ , ///�1n , 11,./88 r l ,,. Nr,., ,�•-r,a- .f, Report Received by: Insp"tion of Min n lle% -+ A- 04 Date (97/N/10!(- Time q'001'11, )_ Prl(4n✓ Name A� Address2rnP ,:,rr Owner . )n (^A N fna<_ I Tel. No. /'/ Type of Inspection Cn I A-P n+/ Cjliip SS Inspector , �f4ry rrn u ( ' 1 Remarks and Violations are listed below: / fUynmr Jove 4 of f' ✓411? l� vA IIn< LKC rw w1nini.1 Oki / TNr n69{�nf! _.. VAH �I rnm 4, LOO- \A.rA rw Tnvyl C✓✓f.em IPIAi✓ o✓ V aOklce. SCyeen, SW74C.N In �n flw v P) AK k,4(Le, L a hn / SS rn ie (n\✓t✓/ ✓olje_ rA (,A \le✓ ?n✓ I ISn�� ✓nnw, w r,rinw NrAS � li,�Iinu tj,nn� far , eHU r w�n��� So Sn<heS ('�l9Pn nn� (' IIMP prnprlrlv , r� ! r f n b t wa+a✓ I s � of �ed Iry ho+ wale✓ �cm/ae✓a lvr,! Sn ;4 I S he+A ee 1100FCA 130°F /Wt,'Ii !I 4o Cnr.rr4 rk l' y,AIA 4 nn s . DU,✓er 1S ✓o G'X/ '7'he Ila /rm Pno ✓ n+ —� Cgetxb 4) Sr hPA„'P. a Ve- IIn S1�Qf 4Inh OIl(P a 1 COe✓r(� /9h IS Lila n[rN Y),,ode , fT 1( Kx le/11 A r Ron,/.I n+ UPrA4 WI 'I rLet krin l I/V Oh Ae iniq re SS n-F 'Fhel'n4rrv( -�� nHS en rurP 4Pv nYP LiAr, (nrn✓JIr c(A1In a �,rNc /y WM ki MP 1" � J - Report Received by: CIlY OF SALEM, NWSACHUSEI"I;S lu B0_vu)OF HEAI.1'H 120 WASHINGTON STREET,4"'FLOOR PublicIiealth Prevent.Promote.Protect. -FEL. (978) 741-1800 FAX (978) 745-034.1 IQMBERLEY DRISCOLL healthQsalem.com L,:\RKY R,L4fI>IN,RS/KERS,CRO,(_114" MAYOR I IEAI;PII AGENT Jason L. Mclsaac 7/7/16 17 A Old Topsfield Road Boxford, MA 01921 RE: 22 Proctor Street Dear Mr. Mclsaac: It has come to our attention that you are renting units at the above address and our records indicate you have not obtained a Certificate of Fitness for these units. 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 through 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$50.00 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 the Board of Health: Reply to: 4Z:Z— Larry Ramdin Stephanie Holinko Health Agent Sanitarian CC: File +6, CITY OF SALEM9 MASSACHUSETTS �L HEALTH AGENT 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741.1800 FAX 978.745-0343 KIMBERLEY DRISCOLL JSCOTT@SALEM.COM MAYOR JOANNE SCOTT HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#527-07 DATE ISSUED: 10/23/2007 Property Located at: 35 Proctor Street UNIT# 1 Owner/Agent: Anthony P. Murphy Address: 31 Fairmount Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-375-3311 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 VL� el VNNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR C > CITY OF SALEM, MASSACHUSETTS ,1. BOARD OF HEALTH ��0 I • t ` 120 WASHINGTON STREET, 4TH FLOOR / SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, R5, 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 HUMAN HABITATION". PROPERTY LOCATED AT hc-�yr- sl- UNIT# IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER .0>GV/ MVy MANAGER/AGENT No P.O. Box No P.O. Box ADDRESS I 'Iy2G(- 0t,"nf SVADDRESS CITY�`P./n�l M# CITY RESIDENCE PHON 7S 13/11311 BUSINESS PHONE (24 HRS.) BUSINESS PHONE77��1311 TOTAL NUMBER OF ROOMS:__ ROOM USE: _3._6fj_ 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 DATE OF INITIAL OF INITIAL INSPECTION�Q���_DATEE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE/_o--' 3 --BATE FEE PAID: i6 # DATE 9 TYPE OF UNIT: DWELLIN CHECK CHECK OTHER /Q-�.3_ NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 CITY OF SALEM9 MASSACHUSETTS BOARD OF HEALTH 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 Release 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 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. 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 lose or injury sustained of whatever nature and description occasioned by my/out absence during said inspection. 41011m� cka& " Tenant/ ssee Owle sor Address Address QST AddreA on unit to be inspected Id 19-on h D1101 1 City of Salem, Massachusetts � t � T Board of Health 120 Washington Street, 4th Floor, Salem, PutbliCHealth Yrnvnoc_ PIPs MI. Prnffir�t_ MA 01970 Kimberley C riscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, RENS,CHO Mayor Iramdin@salem.com Health Agent CERTIFICATE: OF FITNESS CERTIFICATE#: GHL-15-333 DATE ISSUED: 10/1312015 Property Located <it: 36 PROCTOR STREET UNIT#1 Owner/Agent: Wlodek Matczak Address: 4 Kenney Road City/Town: bliddteton, MA Zip Code: 01949 24 Hour Phone:(978) 337-7280 Pursuant to the rei luirements of City of Salem ordinance Chapter 2 Article IV Division 3, Section 705: Certificate of fitness of rented dwelling un t, apartment or tenement.An inspection of your vacant Dwelling/Rooming Unit at the above address has been approved ant is in compliance with 105 CMR 410.000: Massachusetts State Sanitary Code, Chapter II "Minimum Standards of Fitness for Human Habitation". Therefore, this Ce lificate is issued by the Code Enforcement Division of the Salem Board of Health and the unit may now be rented and/or cccupied. Maximum Number of occupants, must comply with 105 CMR 410.000. Certificate valid fcr 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 BOAR&OF HEALTH �1 Larry Ramdin, MPH, RENS, CHO f HEALTH AGENT SANITARIAN s CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGl'ON STREFr,4"�FLOOR PubliCHealth Prevent.Vromme.Prolvm. TEL. (978) 741-1800 FAX(978) 745-0343 KIMBERLEY DRISCOLL Iramdin@salem.com MAYOR LA RR]'KA�dDIN,RS/RIaHs,CMO,CP-FS HFAI:PI-I AGLNT 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 '2i Cn �C J L� d��/ `fi GCaeNA/\ UNIT# IS THIS UNIT DISSIIGnNATED AS RIGHT LEFT FRONT OR BAC PLEASE CIRCLE ONE OWNER/LESSER \IJ�c� \�I\�y�`2 MANAGER/AGENT NO P.O. BOX ADDRESS—4 V,,t ,-4NNve.y `Q �� ADDRESS CITY, STATE,ZIP \ " � z VN CITY, STATE, ZIP RESIDENCE PHONE 2 BUSINESS PHONE(24HRS) BUSINESS PHONE q �f�j �5 3J� 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 T E TIME OF INSPECTION APPLICANT'S SIGNATURE L/�G�¢ DATE Or,1" l Inspectors use only - - -- _ _ - - - - Date on initial inspection: ���( '/S Date of reinspection: Date of issuance of certificate: Date fee paid: O Type of unit: Dwelling Other Check#1 I��_Check date: f o S Notes: C&kYnfbkqrnent Inspector ,. CITY OF SALEM, MASSACHUSETTS md! BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 KIMBERLEY DRISCOLL JSCOTT@5ALEM.COM MAYOR JOANNE SCOTT HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE # 123-08 DATE ISSUED: 3/11/2008 Property Located at: 35 Proctor Street UNIT#2 Owner/Agent: Anthony P. Murphy Address: 31 Fairmont Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 375-3311 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. FF RRDOF,HEALTH JOANNE SCOTT, MSH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPE OR Qj � ... CITY OF SALEM, MASSACHUSETTS I BOARD OF HEALTH 120 WASHINGTON STREET,4`FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR 1sc0rr e sAu•:M.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." PROPERTY LACATED AT 7� Pt-n(-A-ay .S'r UNIT# IS THEY UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE OWNER/LESSER /' A oj7 y M UC y MANAGER/AGENT NO P.O. BOX ADDRESS ir•m o v h r S-" ADDRESS CITY,STATE,ZIP� Wt CITY,STATE,ZIP ./L14 0/g'70 RESIDENCE PHONE q7 3237--3,3/1 BUSINESS PHONE(24HRS) ,SSI w,P BUSINESS PHONE 5el »,? TOTAL NUMBER OF ROOMS:= ROOM USE: an 2.0avinR,o,-, 3.Aj u..5 ran 4. Aejrwt 5.�y�/rpt 6. 7. 8. 9. 10. THERE IS A TWENTY-FP✓E($25)DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE IS P YABLE AT THE TIME OF INSPECTION APPLICANTS SIGNATURE DATE 3-I/-6 Inspectors use only Date on initial inspection: S' -/ ti Date of reinspection: Date of issuance of certificate:Tj t -a Date fee paid: Type of unit: DwellinglOther Check#I$) b Check date: 3 I Notes: Code Enforcement Inspector I CITY OF SALEM, MASSACHUSETTS + - BOARD OF HEALTH 120 WASHINGTON STREET,4`"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR 1SCarr sALrw COM JOANNE SCOTT, HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#370-08 DATE ISSUED: 8/15/2008 Property Located at: 71 Procotr Street UNIT# 1 Owner/Agent: Dale Herdman Address: 71 Proctor Street 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 THE BOARD OF HEALTH V JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENF E M INSPECTOR N V--VfiAU . CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH c� r 120 WASHINGTON STREET,4°i FLOOR TEL. (978) 741-1800 I{IMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR iSCOTr(rdSAia ni.COM JOANNE SCOTT, HEALTH AGENT l VVV Application for Certificate of Fitness IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION." n FEE: $50.00 PROPERTY LOCATED AT /� P 0 GGA ��IGHT UNIT#ISTHIS UNIT D'IISIGNATED AEFT FRONTO 'CK-TLEASE.C RCLE.ONE OWNER/LESSER DAL-c- ,-R' f7 f k.4n H 6 MANAGER/AGENT ADDRESS 71 �ied ci6,ie. S'�- ADDRESS CITY, STATE,ZIP_ .5,#Z& I 70 CITY, STATE,ZIP RESIDENCE PHONE 97?7 yS-37BUSINESS PHONE(24HRS) BUSINESS PHONE Ilk=,33 S' 6 V 9a-- TOTAL NUMBER OF ROOMS: / // ROOM USE: 1. 8i'-b/COb%'�2. 8F/�ddhn3. k)lft � -A)4. 1n/'vlrv4 5 ill/ 1&j 6. 7. 8. 9. J 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:R -1 5-d Date of reinspection: Date of issuance of certificate: Date fee paid: S o Y Type of unit: Dwelling V- Other Check# ADb q--Check date: Notes: or4 Code Enforcement Inspector 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR esiee:rNisnuM(ilsnir:M.coK DAVID GREENMUM,RS ACPING H v.AL 7 i.AGENT CERTIFICATE OF FITNESS CERTIFICATE #435-10 DATE ISSUED: 9/8/2010 Property Located at: 76 Proctor Street UNIT# 1 Owner/Agent: Joao Rebelo Address: 12 Clark Avenue City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-852-4546 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 PF HEALTH A� DAVID GREENBAUM, RS ACTING HEALTH AGENT CODE ENFOFWEMENT INSPECTOR 1 CITY OF SALEM, MASSACHUSETTS BEARD OF HEALTH 120 WASPIINGTON STREET,4".FLOOR TEL. (978) 741-1800 IQMBERLEY DRISCOLL FAX (978) 745-0343 MAYOR COM DAVID GREENBAUM,RS ACTING HE LTH 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 G P90eM.e UNIT# 1 IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR AAO�,PLEASE CIRCLE ONE OWNER/LESSER --1:nQ0 RC R €l C�j MANAGER/AGENT NO P.O. BOX —\ ADDRESS / (C:V,4/2,, 4Ills - ADDRESS CITY, STATE, ZIPc5/4 61W fZ4-TS CITY, STATE,ZIP (' RESIDENCEPHONEBUSINESS PHONE(24HRS)!?'}ff-da-7A:5S/ BUSINESS PHONE 6 ��- �511 TOTAL NUMBER OF ROOMS: ROOM USE: 1. KjVee6/6N 2.bjk&0c49 3.7j/1/.&i91 4. 8E't'ek)01 15.60' zwo PQ&W-f 7. TA?12pon 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 J APPLICANT'S SIGNATURE_z� a gA DATE©9.9 r2-0 Inspectors use only Date on initial inspection: I�UI Date of reinspection: Date of issuance of certificate: U Date fee paid: a D Type of unit: Dwelling II6ther IC,hecUk# ff33 Check date: L Notes: pr(\ 0� h ryGj�!) ' 17��fGfA1 ) Fa) C- 1p_ eL9`T Code Enforcem /Inspector CITY OF SALEM, MASSACHUSETTS + BOARD OF HEALTH 120 WASHINGTON STREET,4°i FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978)745-0343 MAYOR TMANC1N1@SA1.rnt conn JANET MANCINI ACTING HEALTI I AGENT - CERTIFICATE OF FITNESS CERTIFICATE#13-09 DATE ISSUED: 1/6/2009 . Property Located at: 76 Proctor Street UNIT#2 Owner/Agent: Joao Rebelo Address: 76 Proctor Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 744-9169 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 4TET MANCINIING HEALTH AGENT / CODE ENFORCEM T INSPECTOR 1 CITY OF SALEM, MASSACHUSETTS • • BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 KINMERLEY DRISCOLL FAX(978) 745-0343 MAYOR 1DIONNE e SALEM.COM JANET DIONNE, ACTING 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." FEE: $50.00 PROPERTY LOCATED AT - UNIT#IV IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK.PLEASE CIRCLE ONE OWNER/LESSER 1r(ZZ r SF L n MANAGER/AGENT NO P.O. BOX - ADDRESS �i r�iP. o/2 C T-, ADDRESS CITY, STATE, CITY, STATE, ZIP 62,Ll� RESIDENCE PHONE BUSINESS PHONE(24HRS) BUSINESS PHONE '�,-��- 5 SyZU� TOTAL NUMBER OF ROOMS: ROOM USE: 1 BL�r) (Lcr71 l 2 L{eo z�a� 3 41C ?eci/ 5 fir'/�/5' Qoo�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: . ,o Qj Date of reinspection: Date of issuance of certificate:_ - �e - 6 g Date fee paid: Type of unit: Dwelling f/ Other Check# riO Check date: Notes: ode Enforcement Inspector CITY OF SALEM, MASSACHUSETTS o BOARD OF HEALTH 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#247-07 DATE ISSUED: 5/24/2007 Property Located at: 76 Proctor Street UNIT#2Front Owner/Agent: Joao Rebelo Address: 76 Proctor Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 744-9169 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, I! ANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • • 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 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 II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT C72 5� UNIT#LJZ IS THIS UNIT DESIGNATED AS RIGHT LEFT(FRONT ACK PLEASE CIRCLE ONE OWNER/LESSER_ aC7 MANAGER/AGENT No P.O. Box �� No P.O. Box ADDRESS b T/Yf)C l �� S;F ADDRESS CITY S,4CEp7 /7�39, 0E� ) CITY RESIDENCE PHONE -d?/,(9 BUSINESS PHONE (24 HRS.) BUSINESS PHONE - .y__4/11 5ya TOTAL NUMBER OF ROOMS:_O ROOM USE: 1.�L]�y�v2 � /2/�11 4E1,R�'7 5. 0RatQ 6.d&gWq T. 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 7��� /!�/�`7 DATE, y INSPECTORS USE ONLY DATE OF INITIAL INSPECTION�,/_-,;�q- --zl ___DATE OF REINSPECTION______.__.____ DATE OF ISSUANCE OF'' �CERTIFICATEJ-f-f 7 DATE FEE PAID._�!�'� 7 TYPE OF UNIT: DWF?_ __OTHER___ CHECK S(�_ __.CHECK DATE -Y ✓ "' NOTES:-,/= /af�uSf�vc�S_S_. CODE ENFORCEMENT INSPECTOR 9/28/98 CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH 120 WASHINGTON STREET,47'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL Fax(978) 745-0343 MAYOR DGRBENBAUM@SALr3M COM DAVID GREENBAUM ACTING HEAI..II-I AGENT CERTIFICATE OF FITNESS CERTIFICATE#261-10 DATE ISSUED: 6/4/2010 Property Located at: 76 Proctor Street UNIT#3 Owner/Agent: Joao Rebelo Address: 76 Proctor Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-852-4546 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 EE V DA IDIGR NBAUM ACTING HEALTH AGENT CODE ENFORCEMENT INSPECTOR f 04P CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"{FLOOR TET.. (978)741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR DGREENBAUM&ALLM COM DAVID GREENBAmi, ACTING 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. FEE: $50.00 ROPERTYLOCATED AT 4( Racfor :st. UNIT# THIS uNtr DISIGNATED AS RIGHT LEFT FRONT OR SACK PLEASE CIRCLE ONE )WNER/LESSER MANAGER!AGENT O P.O.BOX .DDRESS a L ADDRESS TTY, STATE,ZIP S,Clf.t=r/ d?r9• DIC-14,10 CITY, STATE,ZIP ESIDENCE PHONE t:7_�U" `�1 6�BUSINESS PHONE(24HRS) & :�t 3'59–!A,! 4 6 USINESS PHONE OTAL NUMBER OF ROOMS: OOM USE: 1 2 3. 4. ! 5. ! 6. 7. 8. 9. — HERE IS A FIFTY($50)DOLLAR F AYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM DARD OF HEALTH THIS FEE IS IYAYABLE AT THE TIME OF INSPECTION PPLICANT'S SIGNATURE DATE A –fIGI 10� ate on initial inspection: (P N_/1® Date of reinspection: ite of issuance of certificate: Date fee paid: 0 To of unit: Dwelling � 'Other Check# 61 Check date: /d )tes: - 7um up -6+ wt A- 6"-fuer¢.., MCruL's in... CPv "bCx- r(revs in Add fWben -dor h kk— M de Eri \ ent Inspector CITY OF SALEM, MASSACHUSETTS BOaRD OF fIKALTH 120 WASHINGTON STREET,4„i FLOOR PI11aI'ICH Ith TEL. (978) 741-1800 K. x(978) 745-0343 KIMBERLEY DRISCOLL ham din salem.com MAYOR L:Ut1tY IL•VAdDIN,RS/111:11S,CHO,C11-FS HELA1:;nf AG73Nl' CERTIFICATE OF FITNESS CERTIFICATE#279-14 DATE ISSUED: 8/21/2014 Property Located at: 77 Proctor Street UNIT#2 Owner/Agent: Claire Cawley Address: 61 Columbus Avenue City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-479-9266 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 RftDIN� HEALTH AGENT SANITARIAN 01,01,1 � KIMBERLEY DRISCOLL MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4' FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 IramdinAsalem.com Application for Certificate of Fitness IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" Q kEE: $50.00 PROPERTY LOCATED AT 71 Y r6'-- Q IR I'S - _ UNIT# a ILS TIM Mr. IGNAT/lED AS RIGHT LEFT FRONT OR uAC� PI<.EOE CI cL)&ONE oWNER/LEss LO C�/ _MANAGER/AGENT NO H.O.BOX / /� ADDRESS l � /L1- � 60 -// /� 11`e. DRESS �Z ei 't CITY,STATE,ZIP �I P.�( {'VI /d C1TY,STATE,ZIP RESIDENCE PHONE'7?97� Y ) BUSINESS PHONE(24HRs> 97g BUSINESS PHONE TOTAL NUMBER OF ROOMS:_ ROOM USE: 1. LC- 2. kit. 3. 1D('hrn4 4. ef" 5. P) 4.G PCZ 7. A i2 $. 9. 10. T THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE I PAYABLE AT THE Z OF INSPECTION APPLICANT'S SIGNATURE DATE a Inspectors use only Date on initial inspection: 2�1 Date of reinspection: Date of issuance of certificate: Date fee paid: Type of unit Dwelling Other CCheck#Check date: _ Notes: e—rinuT 4-ifyw Ivl 1�7j<"' CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4'"FLOOR TEL. (978) 741-1800 IQMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR Dcxer;NBAUM@SALe%�LCOM DAVID GREP.NBAUM ACTING HEALTH AGI?N'I' CERTIFICATE OF FITNESS CERTIFICATE#343-10 DATE ISSUED: 7/21/2010 Property Located at: 83 Proctor Street UNIT# Owner/Agent: Beth Dunbar Address: 83 1/2 Proctor Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-5946 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 BOAT Cq OF HEALTH AU I �Q DAVID GREENBAUM ACTING HEALTH AGENT CODE ENFORCZMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 00 120 WASHINGTON STREE'T',4"'FLOOR TEL (978)741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DG EFNBAUM(a &LIN COM DAVID GREEmmum, ACTING 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." FEES:: $50.00 ZOPERTYLOCATED AT 3 Pro ✓ ?4r-4..e-+ UNIT# IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK.PLEASE CIRCLE ONE WNER/LESSER L14tj� I}U n 44r- MANAGER/AGENT >P.O. Box ! PrOL�OY }DRESS S+ ADDRESS TY, STATE,ZIP Al,, , M A d 117 7'9 CITY, STATE,ZIP iSIDENCE PHONE V 7'>`S 59$46 BUSINESS PHONE(24HRS) ISINESSPHONE g7F 97010'1 ITAL NUMBER OF ROOMS- )OM USE: OOMS:IdMUSE: 1 /Cihc/w, 2. 3 deH 4. tiaJ.aoM 5. �h 6 dewew 7 8. 9. 10. ERE IS A FIF'T`Y($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BARD OF HEALTH THIS FEE IS PAYABLE AT THE TIME OF INSPECTION PLICANT'S SIGNATUREDATE JInspectors use only e on initial inspection:_ 1 f Date of reinspection: e of issuance of certificate: -71d110 Date fee paid: a d /o �e of unit: Dwelling_lZOther Check# S (X Check date:, es: jm ilk tttalirl place, .0 nlIsSo 1r11glb(dlm e Enforlqjnnt Inspector CERT.# 265-97 3 - FEE $25.00 DATE: 04/29/97 mr� CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 85 1/2 Proctor Street UNIT #: 1 OWNER/AGENT: Frederick Juden ADDRESS: 85 Proctor Street CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-4137 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 ' • J x��� Jp 6 t • CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tei:(508)741-1800 APPLICATION FOR CERTIFICTE OF FITNESS Fax:(508)740-9705 IN ACCORDANCE WITH STATE SANITARY! CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT Z_j /�jQOe7aR $j UNIT I OWNER/LESSER f&bbele I)' 74)b GA MANAGER/AGENT ADDRESS SS 10Re)cTa!eS7: ADDRESS CITY 34,AEm, m D /97 C7 CITY =RESIDENCE PHONE ;5)e -7054-Y137 BUSINESS PHONE (24 HRS.) BUSINESS PHONE 5 Dg- -7W-V137 TOTAL NUMBER OF ROOMS:" ROOM USE: I. c4ew `2. PWIV61foon 3.1-iyilj pw n 4 . ISDCoorn 5. 8FIbAoo�i 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 DATE INSPECTORS USE ONLY DATE OF INITIAL INSPECTION: 7 DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: FEE PAID: 7 " —E7 TYPE OF UNIT: DWELLING I/ OTHER NOTES: �C CODE ENFORCEMENT INSPECTOR ` XV CITY OF SALEMr MASSACHUSETTS v1. 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 CERTIFICATE OF FITNESS CERTIFICATE#: 416-03 DATE ISSUED: 8/12/2003 Property Located at:: 86 Proctor Street UNIT#: 1 Owner/Agent: Barbara Soulard Address: 84 Proctor Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 744-1925 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. 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. 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 C DE ENFORCEMENT INSPECTOR ja CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH /!J i 120 WASHINGTON STREET, 4TH FLOOR 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 to 90e—,4 ��7 UNIT#4 IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNS LESSE rr �� MANAGER/AGENT o O. Bo� No P.O. Box ADDRESS r- c�7�� ADDRESS CITY py- -77CITY��/� RESIDENCE PHONE97 /W/Z2�USINESS PHONE (24 HRS.) BUSINESS PHONE TOTAL NUMBER OF ROOMS:_ ROOM USE: 1ll / .141, 8. THERE IS A TWENTY-FIVE($25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM HEALTH DEPARTMENT—THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. APPLICANTS SIGNATU DATE f o?Oo_3 INSPECTORS USE ONLY DATE OF INITIAL INSPECTION 8- Q V -3 DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE$ -[Z »!9 DATE FEE PAID: -V_ TYPE OF UNIT: DWELLING 44KOTHER CHECK# .3 y CHECK DATE!(?Z 3 NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 i CITY OF SALEM9 MASSACHUSETTS BOARD OF HEALTH g! 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 h TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#: 416-03 DATE ISSUED: 8/12/2003 Property Located at:: 86 Proctor Street UNIT#: 1 Owner/Agent: Barbara Soulard Address: 84 Proctor Street City/Town: Salem MA Zip Code: 01970 24 Hour Phone: 744-1925 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. 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. 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 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#34-07 DATE ISSUED: 1/25/07 Property Located at: 87 1/2 Proctor Street UNIT# 1 Owner/Agent: George Snow Address: 87 Proctor Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-1681 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 ,r CITY OF SALEM, MASSACHUSETTS ,"„�, BOARD OF HEALTHA 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 979-74 t-1900 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 It. 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION'. PROPERTY LOCATED AT s UNIT # !_ IS THIS UNIT DESIGNATED AS RIGHT LEFT FF_ONT RACK PLEASE CIRCLE ONE OWNERILESSER r _MANAGER/AGENT, No P.O. Box No P.O. Box i ADDRESS CITY 1 RESIDENCE PHONE 22roy-i4%-1 —BUSINESS PHONE (24 HRS.)`__.—_ BUSINESS PHONE TOTAL NUMBER OF ROOMS: 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, �Y APPLICANTS SIGNATURES, •_ 4»^-«^-__—_-_-_—DATE_11zs�0 INSPECTORS USE ONLY DAZE OF INiTiAL iNSPECTION,j- 7_ _. _DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE:/- O 7 DATE FEE PAID:, f d 54 TYPE OF UNIT DWELLI�QZ . OTHER, �y_ CHECK 0 S4 CHECK DATE � a� "2 7 N0 TES: ;,1v r.Jir .. h*L2i171� I/ rl�Ic. CODE ENFORCEMENT INSPECTOR City of Salem, Massachusetts 9 Board of Health } 120 Washington Street, 4th Floor, Salem, P! ith MA 01970 Prevent.Promote. Protect. Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, REHS, CHO Mayor health@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE#: GHL-17-31 DATE ISSUED: 2/2/2017 Property Located at: 91 PROCTOR STREET UNIT# Owner/Agent: Mark Hernando Address: 121 Marlborough Road City/Town: Salem, Ma Zip Code: 01970 24 Hour Phone:(978) 210-5575 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. -,,�P/j, 0 Larry Ramdin, MPH, REHS, CHO HEALTH AGENT SANITARIAN CITY OF SALEM, MASSACHUSETTS) BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL (978)741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR LRAMD1N@SALF.M.0)M LARRY RAMDIN,RS/RAHS,CHO,CP-FS n k ACn ,� AA)b0 0 CIO mcA��. tj 6'T- HEALTH AGENT 7 F 7� Nv iJ hi 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 9P'-OC?O Y �, UNIT# IS TB7S UNrF DIfSIGNATED AS RIGHT LEFT'FRONT OR BACK.PLEA,SSEMCLE ONE c�2CYC7) OWNER/LESSER Rb �i 1 tlorVQn �V MANAGER/AGENT IIS 6rl6 4e P NO P.O.BOX f ® ADDRESS ADDRESS I ZI tWa 1&r-0 CITY, STATE,ZIP CITY,STATE,ZT / /y C/J/�A '0110 JO RESIDENCE PHONE BUSINESS PHONE(24HRS)l9 7S) z 5 BUSINESS PHONE TOTAL NUMBER OF ROOMS: �5 ROOMUSE: 1. Li&'W 2. IJ;Lrniny 3. k—,4C141ftit. .YnaraS. dI'o� K1 6. 0 7. L7 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 4 ,11 7, - /L./ rDATE /3/ 2 01 7 Inspectors use only Date on initial inspection: Date of reinspectio Date of issuance of certificate: Date fee paid: Type of unit: Dwelling Other Check#Check date: Notes: Code Enf rcement Inspector 4 o-y C'oncr{n! - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - �r� v_e �'IFW w 4-fer� FMdo $►sol -ftp 14 - - - - - -H b0Ard fnsee=ror erm;SS�br� -o - - / �4�-fln ►� fou �—. - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - -n - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . _ _ _ _ _ _ _ _ _ _ _ _ _ ._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - l ' _ _ _ _ _ _ _ Inspection �o/f�� ��� Date Time D Name �io�La&A� 006 n Address Owner ,., ��r, /� �� (� Tel. No. Type of Inspection �\� Y X, l� ':fiM " 1 Inspector J�-0 ( ' Remarks and Violations are listed below: OA("�ICAOfW U-Oe a2 !WKIC1 . a I -Ru)y. time °r brma i Cf---- l Ll Report Received by: ' CITY OF SALEM,MASSACHUSETTS BOARD OF HEALTH - 120 WASHINGTON STREET 4"'FLOOR PublicHealth TEL. (978) 741-1800 Fax(978)745-0343 KIMBERLEY DRISCOLL Lratiidin@salem.com salem.com LARRY RAMDIN,RS/REFIS,CHO,CP-1^J MAYOR HEAL;ri I AGi?N'r CERTIFICATE OF FITNESS CERTIFICATE#432-13 DATE ISSUED: 12/23/2013 Property Located at: 104 Proctor Street UNIT# 1 Owner/Agent: Miroslaw Kantorosinski Address: 407 Essex Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 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 LA RAMDIN HEALTH AGENT SANITARIAN KANTOROSINSKI CHIROPRACTIC INC. ACCIDENTS,TRAUMA AND REMANUTATION Hablamos espahol www.masschito.com , Dr. Mike Kantorosinski 407 Essex Street Tel(978)741-3477 Salem,MA 01970 Fax(978)744-7757 _.. CITY OF SALEM, MASSACHUSETTS 1P wj 5 BOARD OF HEALTH 120 WASHINGTON STREET 4".FLOOR PablicHeatth Prevent.Promote.Protect. TEL. (978)741-1800 Fax(978)745-0343 KIMBERLEY DRISCOLL IramdinCasalem.com - �,-•,�.• LA]tlt]'RANII>IN,RS/RFIIS,(:110,CP-I;S MAYOR HEAT:I'I-I 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 f�� V YD( UNIT# IS THIS(JN1T DISIGNATED AS RIGHT LEFT FRONT OR BACK.PLEASE CIRCLE ONE OWNER/LESSER kj&o�, ,� Y��_T��C/A19Y..IMANAGER%AGENT NO P.O.BOX ADDRESS 4,01 S —ADDRESS-- CITY, DDRESSCITY, STATE,ZIP O tg!7 O CrFY, STATE,ZIP r,R RESIDENCE PHONE 7 A°�,� (F Q r7 BUSINESS PHONE(24HRS) BUSINESS PHONE g b 7 y I — 3 9-7 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 PAYABIX AT THE TIME OF INSPECTION APPLICANT'S SIGNATURE DATE l Z—2},, 13 Inspectors use only Date on initial inspection:_L_ �a 3 13 Date of reinspection: Date of issuance of certificate: Date fee paid: Type of unit: Dwelling Other Check# q1. Check date: 7 0 I l Notes: Code Enforcement � a CITY OF SALEM, MASSACHUSETTS tt BoaRD or HEAL'TH 120 WASHINGTON-1 STREET,4"'FLOOR K1Nff1ERL.L-:Y DRISCOLL TEL. (978) 741-1800 FAN (978) 745-0343 MAYOR lramdinQsalem.com LARRY RAMI)IN,R4/RFU IS,CIR),C114S HI!AI.I I I A(;I'.N'I' CERTIFICATE OF FITNESS CERTIFICATE#538-11 DATE ISSUED: 12/27/2011 Property Located at: 104 Proctor Street UNIT#2 Owner/Agent: Mike Kantorosinski Address: 407 Essex Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 744-7589 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 LALA R HEALTH AGENT E ENFORtEWNT INSPECTOR CITY OF SALEM, NIASSACHUSET'I'S BOARD OF H!Arez-, 1'-)0W.\SFilNGTOi\, S'I'RErT,4...Fwoiz JCS TEL. (9-18) 741-1800 KJMBERLFY DWSCOIJ, FAN (978 ) 745-0343 MAYOR Hv\vrit A(;VINT Application for Certificate of Fitness IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" EEEL. $50.00 PROPERTY LOCATED AT 9Y1DCtNV` 5� � UNIT#--,-), IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE OWNER/LESSER—Mj!?P�UKr�)(05 PJ �NAGERJ AGENT NO P.O. BOX ADDRESS1/7 ADDRESS CITY, STATE,ZIP L4g, ,0197o CITY, STATE,ZIP--_ RESIDENCE PHONE' HONE BUSINESS PHONE(24HRS)—_ BUSINESS PHONE0JWkf— e I0 TOTAL NUMBER OF ROOMS: ROOM USE: 1. 2. Yv� 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 PAYABLrAAT THE TIME-OF INSPECTION APPLICANT'S SIGNATUREAa­r�L�k� C- DATE Inspectors use only Date on initial inspection: //it Date of reinspection: Date of issuance of certificate: Date fee paid: Type of unit: Dwelling Other Check#�„�K�__,_Chcck date:. Notes: CWE-EhOcdhent Inspector • CITY OF SALEM, MASSACHUSETTS - BOARD OF HEALTH r 130 WASHING]ON STREE.C,4` FLOOR Tr .. (978) 741-1800 IQMBERLEY DRISCOLL FAR (978) 745-0343 MAYOR LRADa>IN&AI.P,iM.c mi LARRY RANWIN,RS/RHI IS,CI IO,C11-1-S I-IISAI:I'I I AGISN'1, Release 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 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. 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 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 Updated 5/23/11 CITE' OF SALEM, MASSACI -usETTS BOARD of; Ha.\1.til 120 WAST-nNGTON STRE1 I,4"' FLoOR. KIMBERLEY DRISCOLFAY L AK (978) 741-1803 F (978} 745-0.343 NL\Yo.R Iramd n ��glein.c�m 1..ARRY RlAN1D1N,RS/RI':I IS,C1 IO,(J)*S F-1VAJ XH A(;r,,NT CERTIFICATE OF FITNESS POLICY 1. A Certificate of Fitness inspection is required for all rental units older than 5 years, per City of Salem ordinance; 2. A Certificate of Fitness is good for I year or the life of the tenant, whichever is longer; 3. A Certificate of Fitness inspection may be obtained by calling or coming into the Health Department and requesting an appointment; 4. Appointments must be requested at least 24 hours in advance pending an open appointment; 5. No "same day" appointments will be granted; 6. All appointments are subject to the schedule of the inspector; 7. A rental unit will be considered occupied when either the previous tenant or the current tenant has belongings in the unit. In the case of an occupied unit, either the tenant whose belongings are in the unit must be present at the time of inspection, OR have signed a release statement allowing the Board of Health to inspect the unit. 8. Please allow at least one week turnaround time for the Certificate to be issued, especially at the end of the month; 9. A Certificate of Fitness will be granted when: a. An inspection has been conducted by a Health Department employee b. An application has been filled out and a check or money order has been received 10. If you have any questions, please contact the Health Department f CITY OF SALEM, MASSACHUSETTS - BOARD OF HEALTH 120 WASHINGTON STREET,4°.FLOOR TEL. (978) 741-1800 IQM13LItLLY llRISCOLJ FAX (978) 745-0343 MAYOR lramdiua,salem.com LARRY RAMI)IN,RS/111;I IS,CI 10,CP-F'S HI1;JV.:1'II AE;I,N'I' CERTIFICATE OF FITNESS CERTIFICATE # 165-11 DATE ISSUED: 5/25/2011 Property Located at: 104 Proctor Street UNIT#3 Owner/Agent: Mike Kantorosinski Address: 407 Essex Street 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 THE BOARD OF HEALTH LARRY RAMDIN HEALTH AGENT CODE EN RCEMENT INSPECTOR • CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4""FLOOR TI-L. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR INAMDIN&AUN.COM LARRY RAMDIN,ItS/REI IS,CI 10,CP-1-S H6:Al:I'I-I AGIi.N'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" FEE: $510.00 PROPERTY LOCATED AT ` Iynb w S t' UNIT# n IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE OWNER/LESSERi k IAOX,N,-� 14t�AS-#SOANAGER/AGENT ADDRESS 7 EPA4A� ADDRESS J CITY, STATE, ZIP S _Q - Imo, p CITY, STATE, ZIP 0/?10 RESIDENCE PHONE 7 '7YDSI"� /5Yy I BUSINESS PHONE(24HRS) BUSINESS PHONE f) rl - of "/'0 TOTAL NUMBER OF ROOMS: ROOM USE: 1. 2. hge--� 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 THE T SPECTION APPLICANT'S SIGNATURE DATE Inspectors use only Date on initial inspection: Date of reinspection: Date of issuance of certificate: Date fee paid: 54_ I I Type of unit: Dwelling Other Check# Check date: Notes: Code Enforcement Inspector