SCHOOL STREET COURTSCHOOL STREETEET Com_
jaNydr.S11'Dt()ii A`p",
Arnim Ht"'1,W.:1i011 A1"I"w,
CERTIFICATE OF FITNESS
CERTIFICATE # 510-08
DATE ISSUED: 10/14/2008
Property Located at: 1 School Street Court UNIT # 1
Owner/Agent: Cheryl D. Liacos Halstead
Address: 1 School Street Court Apt. 2
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 BO D OF HEALTH
AN T DIO NE
CTING HEALTH AGENT CODE ENFORCERSN INSPECTOR
KIMBERLEY DRISCOLL
MAYOR
JANET DIONNE,
ACTING HEALTH AGENT
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4"' FLOOR
TEL. (978) 741-1800
FAX (978) 745-0343
IDIONNEnp SN.EM. CONI
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 -L 11x1 Ei2e ei7 t_CJ ue:,6 UNIT# %
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE
OWNER/L�ESSEReR 1, 3> L MANAGER/ AGENT avne-
NO P.O. BOX
ADDRESS I ---5k- hdQ/ 669f(ft Chad t0J4a ADDRESS S/gNIy
CITY, STATE, ZIP � / T 7 0 CITY, STATE, ZIPyGt�) ei
RESIDENCE PHONE C1 k- -Ig - Oo2(i) BUSINESS PHONE (24HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: LS
ROOM USE: 1 Ie eaom 2 Bedaw,3 Liy i nri 4 aC t id(P � 5 J�`N, oeC er)
7 3 n n
• �1
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
Inspectors use onl
Date on initial inspection: I c) -1 y -Q)r Date of reinspection:
Date of issuance of certificate: Ica -11 -y $ Date fee paid:_ I d ^ I `I dp
Type of unit: Dwelling ✓ Other Check # / 2 7 % Check date:
Notes: waxzquJ.
Code Enfo •cement Inspector
11
KIMBERLEY DRISCOLL
MAYOR
JANET DIONNE,
ACTING HEALTH AGENT
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4n' FLOOR
TEL. (978) 741-1800
FAx (978) 745-0343
1DIONNE SALEM. COM
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 Own`er/L s�sor
i � QU6 ovb-I i5dvo1.. 5t, Goon q-P6�
Address Address
1 C—JW6l 156Kr't+ Com o • f
Address on unit to be inspected
!o lg l o g
Date