PURCHASE STREET PURCHASE STREET
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CITY OF SALEM, MASSACHUSETTS
BOARD OF HH.-ATH
120 WASHINGTON STREET,4t"FLOOR PablicHealth
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TEL. (978) 741-1800 FA,,(978) 745-0343
KIM 3ERLEY DRISCOLL li-amdin@salem.com
- LARRY RAMDIN,RS/REhIS,CHO,CP-vs i
MAYOR Ht3A1_:rut AGI NP
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CERTIFICATE OF FITNESS
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CERTIFICATE #474-12
DATE ISSUED: 12/13/2012
Property Located at: 1 Purchase Street UNIT# 1
Owner/Agent: Lori Silva
Address: 1 Purchase Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 741-4242
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 Ile
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 LTH
LARRY RAMDIN
HEALTH AGENT SANITARIAN
f CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON SFREET,4"'FLOOR PublicHealth
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"I'LL. (978) 741-1800 FAx(978) 745-0343
KIMBERLEY DRISCOLL Iralndin .salem.com
MAYOR e LARRY 1L\�4DIN,RS/RI3HS,CFlO,CP-FS
H FAL;FI I AG FNT
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION"
p FEE: $50.00
PROPERTY LOCATED AT 1 Uy C (in$;s �3r Sc�kn / /4 01 ,�7G UNIT# 1
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER LO r i Sii Lei— MANAGER/AGENT S�I ✓i.2.
NO P.O. BOX
ADDRESS /'u r�Sym_. c4. ?'. ADDRESS � c (-P
CITY, STATE,ZIP SQ,LP_,t CITY, STATE,ZIP /W/4 6
RESIDENCE PHONE Q �--7 ' `l 2y 2. BUSINESS PHONE(24HRS)
BUSINESS PHONE q 2k.3 3 f- 9 0 3J`
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. jKI1hCtt2. L & 3. ,(312 4. /2 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 Ce , ��r DATE I 2 -a
Inspectors use only
Date on initial inspection: Q11319 Date of reinspection:
Date of issuance of certificate: 4 Date fee paid: /
Type of unit: Dwelling Other Check# Check date:
Notes:
C e r ment Inspector