SEWALL STREETSEWALL STREET
iv
e
CITY OF SALEM, MASSACHUSETTS
3
�]! BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
p SALEM, MA 01 970
.> TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. .JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE # 550-05
DATE ISSUED: 9/1/05
Property Located at: 5 Sewall Street UNIT # 2
Owner/Agent: John Nadizion
Address: 45 Dale Street
City/Town: Swampscott, MA Zip Code: 01907 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 11"
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
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT CO9ENAFORCE MENT INSPECTOR
f p CITY OF SALEM, MASSACHUSETTS
„y BOARD OF HEALTH
• • 120 WASHINGTON STREET, 4TH FLOOR M
SALEM, A 01970 S
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 FITNESSFOR HUMAN HABITATION". �j
PROPERTY LOCATED AT _J11/; (-74.�t�'"7 UNIT #
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER 7 0d"] 1J/ _A l' l - i 0'llMANAGER/AGENT
No P.O. Box No P.O. Box
ADDRESS 4S o6 �� �� AnnaGcc
RESIDENCE PHONE( 2,r/, ..ri-I, b"f6USINESS PHONE (24 HRS.)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ROOM USE: 1.__ 2.
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_ 4
APPLICANTS SIGNA
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION %LE q-7 _ DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: Y f DATE FEE PAID_
TYPE OF UNIT: DWELLI BOTHER _ CHECK N S J G'� CHECK DATE ✓ �' ��
NOTES,
CODE ENFORCEMENT INSPECTOR 9/28/98