SCOTIA STREET6
V
SCOTIA STREET
T
Y
K NMERLEY DRISCOLL
MAYOR
JOANNE SCOTT,
HEALTH AGENT
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET. 4t° FLOOR
TEL. (978) 741-1800
FAx (978) 745-0343
1KOI r&A Ent. COM
CERTIFICATE OF FITNESS
CERTIFICATE # 304-08
DATE ISSUED: 7/3/2008
Property Located at: 12 Scotia Street UNIT # 1
Owner/Agent: Deborah Conroy
Address: 27 Appleby Road
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 744-3294
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
,! //IL F 0UL�
KIMBERLEY DRISCOLL
MAYOR
JOANNE SCOTT,
HEALTH AGENT
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4"' FLOOR
TEL. (978) 741-1800
FAX (978) 745-0343
Iscarr D SALEM. COM
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMA HABITATION."
FEE: $75.00 � � /J
PROPERTY LACATED AT �n( UNIT#—
IS THI UNIT DISIGNATED AS RIGHT LEFT FRONT ORBACK, PLEA SE CIRCLE ONE
' ' �_ i . I_ �_ � ��x '
RESIDENCE PHONEQ� �G/ ve? 9 c% BUSINESS PHONE (241-1
BUSINESS
TOTAL NUMBER OF ROOMS:—
ROOM
OOMS:
ROOM USE:
THERE IS A SEVENTY-FIVE($75) 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
APPLICANTS
Inspectors use only
Date on initial inspection: 1-/ 1310 V Date of reinspection:
Date of issuance of certificate: of 1 q Date fee paid:
Type of unit: Dwelling Other Check #Check date:
Notes: of UJIAAO gs in ICti(,Vun QVtd Ovtp in back Wroorn -A0 'h0i tLJr-,�
Coe nforcement Inspector
Fol
KIMBERLEY DRISCOLL
MAYOR
JOANNE SCOTT,
HEALTH AGENT
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4P FLOOR
TEL. (978) 741-1800
FAX (978) 745-0343
1SCUIT(ll�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.
aln4= Lk
enant/Lessee Owner/Lessor
Address Address
a Sc o 2�'o, S
Address on unit to be inspected
Date
i
o+�y, CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
s
:9 120 WASHINGTON STREET, 4TH FLOOR
a a SALEM, MA 01970
TEL. 978-741-1800
A FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE # 465-05
DATE ISSUED: 7/28/05
Property Located at: 12 Scotia Street UNIT # 2
Owner/Agent: Deborah Conroy
Address: 27 Appleby Road
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 745-7019
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
JO NNE SCOTT, MPH, RS, CHO
HEALTH AGENT
/Q V
CODE ENFORCEMENT INSPE TOR
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM. MA 01970
TEL. 978-74 1 -1800
FAX 978-745-034343 - q66_05�
STANLEY USOVICZ, JR,
MAYOR JOANNE SCOTT, MPH, RS, CHO
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
_UNIT q,g
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSEMANAGER/AGENT
No P.O. Box
.i1 _ n .1 UNO P.O. Box
CITY
CITY
RESIDENCE PHONE' % -2Y_y6 9,Q BUSINESS PHONE (24 HR
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:E
ROOM USE: 1 2
THERE IS A TWENTY-FIVE (525.00) 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 GS
NSPECjOR_S.USE ONLY
Q TE OF INITIAL- INSPE
--CTION --------- - DATE OF RFINSPFCIION
u,TE or IssuANcr or cL1; I IricA I F -J 7 0 ) DATF PE --E PAID 7 —2- 7 � 0r
_1_"E 0 UNIT DWELI-ING.L�LHER CHF -CK g �'b31f CHECK DATE 7 vb
1v )IFS
CUTA- 1 -II[ ()IiCI MI N I INS111C 1011
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