RUSSELL DRIVE RUSSELL DRIVE
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CITY OF SALEM9 MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
,A SALEM, MA 01970
-Y TEL. 978-741-1800
FAX 978-745-0343
KIMBERLEY DRISCOLL JSCOTT@SALEM.COM
MAYOR
JOANNE SCOTT
HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE #91-08
DATE ISSUED: 2/26/2008
Property Located at: 2c Russell Drive UNIT#2C
Owner/Agent: Melanie Scialdone
Address: 12 Driscoll Lane
City/Town: Beverly, MA Zip Code: 01915 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 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
5ANT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
• 120 WASHINGTON STREET, 4TH FLOOR -
SALEM, MA 01970 ti
) TEL. 979-741-1900
FA% 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". Ifr�
PROPERTY LOCATED AT P 7Lt1/13 �� IT#.
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT13ACK PLEASE CIRCLE ONE
OWNER/LESSER_Un�Q` b -MANAGER/AGENT_ _ —.
No P.O. Box_ f f No P.O.Bax
ADDRESS I Gn� ADDRESS
CITYa �n�, CITY
E`t t _
RESIDENCE PHON (979)MI-K6), PHONE {24 HRS.)
BUSINESS PHONE I r21�09 0307 _
TOTAL NUMBER OF ROOMS:
ROOM USE: 1.__
5.
THERE IS A TWENTY-FIVE(,025.00) 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 DATEI��
IN ORSONLY
DATE OF INITIAL INSPECTION - d b '� _DATE OF REINSPECTION___`___
DATE OF ISSUANCE OF CERTIFICATES DATE FEE PAID:_ �v
TYPE OF UNIT. DWELLING OTHERCHECK # - CHECK DATE _ �}
NOTES:-V
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PDEENORCEMENT INSP TOR 9128198
CERT.# 524-97
3 9. FEE $25.00
DATE: 08/04/97
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: 12D Russell-Drive - -UNIT- #: D
OWNER/AGENT: Marie Tvrrel
ADDRESS: 67 Carter Road
CITY/TOWN: Lynnfield. MA ZIP CODE: 01940 24 HOUR PHONE: 334-2817
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
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT Tel:(508)741-1800
APPLICATION FOR CERTIFICTE OF FITNESS Fax:(508)740-9705
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 4110.000 "MINIMUM
STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT Z6W &,55E A4 jy��6J� UNIT #_ 7' _
OWNER/LESSERMANAGER/AGENT
ADDRESS S(�q /C%P�l SL- ADDRESS
CITY CITY
RESIDENCE PHONEo
f .. . — g�J BUSINESS PHONE {24 HRS.}
BUSINESS PHONE Lf7 0`202 t/,
TOTAL NUMBER OF ROOMS:_
ROOM USE: 1 .j-��� 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 HP.AL TMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION
t-PPLICANTS SICNATURE DATE
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION:_S�� (D / DATE OF REINSPECTIONY _
DATE OF ISSUANCE OF CERTIFICATE: p t , 5� DATE FEE PAID:
TYPE OF UNIT: DWELLING OTHER_
NOTES:
CODE ENFORCEMENT INSPECTOR
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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
REI:EASE
In accordance with Massachusetts General Laws Chapter III ; Code of Massachusetts
Regulations 410.000 et. seq. ; State Sanitary Code Chapter II and Article XIII of
the Cit; of Salem Ordinance, undersigned owner/lessor and tenant/lessee of a unit
of residential property, hereby authorize the Salem Board of Health or its author-
ized 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/our absence , !/we
expressly authorize 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 loss or injury sustained of whatever nature and description occasioned
by my/our absence during said inspection.
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ADDRESS ADDRESS /
ADDRESS OF UNIT T B E INSPECTED
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