Loading...
SKERRY STREETSKERRY STREET :R. JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CERT.# 143-99 FEE $25.00 DATE: 03/25/99 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 4 Skerry Street OWNER/AGENT: Raymond Talbot ADDRESS: 4 Skerry Street CITY/TOWN: Salem, MA ZIP CODE: 01970 UNIT #: 2 24 HOUR PHONE: 744-0137 NINE NORTH STREET Tel: (978) 741-1800 Fax: (978) 740-9705 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 MORE INFORMATION CALL 978-741-1800. FOR THE BOARD OF HEALTH �j'O It-���, ((JOANNE SCOTT, MPH,RS,CH0 HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 V3 "9 9 JOANNE SCOTT, MPH, RS, CHO NINE NORTH STREET HEALTH AGENT TCI: (978) 741-1800 APPLICATION FOR CERTIFICATE OF FITNESS Fax: (978) 740-9705 IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITA IOM". PROPERTY LOCATED AT UNIT # IS THIS UNIT DESIGNATED AS IR GHT LEFT FRONT CK PLEASE CIRCLE ONE OWNER/LESSER MANAGER/AGENT ADDRESS ��J ADDRESS2 CITY RESIDENCE PHONE BUSINESS PHONE (24 HRS.) BUSINESS PHON TOTAL NUMBER OF ROOMS:: S ROOM USE: 1—IL-2. /, 3.—,5 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 HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TIMF OF INSPFCTION APPLICANTS INSPECTORS USE ONLY DATE OF INITIAL INSPECTIONS —,g )7- f f DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFIC3 �L DATE FEE PAID: 3.� TYPE OF UNIT: DWELLING_4�__H, OTER G (` {� �Z 3 f q NOTES: CODE ENFORCEMENT INSPECTOR 5/19/98 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CERT.# 399-99 FEE $25.00 DATE: 07/29/99 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 4 Skerry Street OWNER/AGENT: Raymond Talbot ADDRESS: 4 Skerry Street CITY/TOWN: Salem, MA ZIP CODE: 01970 UNIT #: 3 24 HOUR PHONE: 744-0137 NINE NORTH STREET Tel: (978) 741-1800 Fax: (978) 740-9705 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, 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 MORE INFORMATION CALL 978-741-1800. FOR THE BOARD OF HEALTH loaL* ANNE 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 APPLICATION FOR CERTIFICATE OF FITNESS Tel: (978) 741-1800 Fax: (978) 740-9705 IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITA2:6, N" PROPERTY LOCATED AT ( UNIT #__3 IS THIS UNIT DESIGNATED AS No P.O. Box CITY BACK PLEASE CIRCLE ONE —MANAGER/AGENT No P.O. Box CITY RESIDENCE PHONE i7 — a ,� BUSINESS PHONE (24 HRS.) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1. 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 HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. APPLICANTS SIGNATURE U \c DATE INSPECTORS USE ONLY DATE OF INITIAL INSPECTION 7 -,moi �J, f DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE:% -d-4 -ff DATE FEE PAID: % —6 5 TYPE OF UNIT: DWELLING CODE ENFORCEMENT INSPECTOR CHECK # 76 CHECK DATE lG Y 9/28/98 f JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970 - CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 5 Skerry Street OWNER/AGENT: Mark Helms ADDRESS: 5 Skerry Street CERT.# 83-02 FEE $25.00 DATE: 02/19/2002 120 Washington Street — 4'" Floor Tel # (978)-741-1800 Fax # (978)-745-0343 UNIT #: 2 CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 284-4707 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, 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 MORE INFORMATION CALL 978-741-1800. FOR THE BOARD OF HEALTH JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR STANLEY USOVICZ, JR. MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT APPLICATION FOR CERTIFICATE OF FITNESS o'3-Ga2- IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". l PROPERTY LOCATED AT UNIT # d� IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE Ifo P.O. Box No P.O. Box ADDRESS ADDRESS CITY S`z_� CITY ;/%� C.7 K..4 170 yiq-7Yt-- RESIDENCE PHONES y f BUSINESS PHONE (24 HRS.) 2'0_ay7v� BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1. 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 HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. /.% //7 APPLICAN i S SIGNATURE INSPECTORS USE ONLY DATE OF INITIAL INSPECTION Q—n� DATE OF REINSPECT/ 0 DATE OF ISSUANCE OF CERTIFICATE: ' V0 DATE FEE PAID: 2 -*t 'i r TYPE OF UNIT: DWELLINGXOTHER_ CHECK #3 CHECK DATE CODE ENFORCEMENT INSPECTOR 9/28/98 RF LF.ASF. 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 1=he 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. L. 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 agent; from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. TENANT/LESSEE OWNER/LESSOR S ADDRESS — — ADDRESS - -tea-_ ADDRESS OF UNIT TO BE INSPECTED DATE / CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 3 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 - FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO - - MAYOR HEALTH AGENT RF LF.ASF. 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 1=he 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. L. 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 agent; from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. TENANT/LESSEE OWNER/LESSOR S ADDRESS — — ADDRESS - -tea-_ ADDRESS OF UNIT TO BE INSPECTED DATE CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970 02/14/2002 JOANNE SCOTT, MPH, RS, CHO 120 Washington Street — 4'" Floor HEALTH AGENT Tel # (978)-741-1800 Pannas Familv Homestead. Trust c/o George Pappas, Trustee 17 Longstreet Road Fax#(9/ti)-140-U343 Peabody, MA 01960 PROPERTY LOCATED AT 7 Skerry Street UNIT # 1 Dear Sir/Madam: It has come to our attention, that you may be considering renting a dwelling unit _:e above address. In accordance with Chapter 11, Article XIII of the City of Salem Code of Ordinances, Section 2-334,titled nCertificate of Fitness," each dwelling unit must be inspected and certified prior to allowing occupancy. The inspection will be conducted in accordance with 105 CMR; State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.000; State Sanitary Code, Chapter II: Minimum Standards of Fitness for Human Habitation. Please notify us if you do not intend to rent the unit. Please contact this department within 24 hours of receipt of this notice at 978-741-1800, to schedule an appointment for an inspection. Our office hours are Monday thru Wednesday from 8:00 a.m. - 4:00 p.m. Thursday 8:00 a.m. - 7:00 p.m. and Friday 8:00 a.m. - 4:00 p.m. Failure to comply with this procedure, may result in a fine of Twenty (20) dollars per day for every day that the dwelling unit is occupied without a Certificate of Fitness. A $25.00 check payable to the City of Salem is required for each unit inspected at the time of inspection. A property owner is required to pay gas and electricity for residential -tenants if there is not a written letting agreement stating the tenant is responsible for those utilities and if the meter(s) records electricity and gas use which is not used exclusively by that tenant. The Department of Public Utilities has billed property owners for their tenants' entire utility bills retroactive to the date of initial occupancy in cases in which cross -metering has been proven to exist. OR THE BOARDqF � HEALTH Joanne Scott, MPH,RS,CHO Health Agent REPLY TO PABLO VALDEZ CODE ENFORCEMENT INSPECTOR JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CERT.# 11-01 FEE $25.00 DATE: 01/18/2001 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 8 Skerry Street OWNER/AGENT: Charles Roderick ADDRESS: 8 Skerry Street - CITY/TOWN: Salem, MA ZIP CODE: 01970 UNIT #: 1 24 HOUR PHONE: 745-6288 NINE NORTH STREET Tel: (978) 741-1800 Fax: (978) 740-9705 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, 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 MORE INFORMATION CALL 978-741-1800. FOR THE BOARD OF HEALTH JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT V CODE ENFORCEMENT INSPECTOR JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 APPLICATION FOR CERTIFICATE OF FITNESS NINE NORTH STREET Tel: (978) 741-1800 Fax: (978) 740-9705 IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT 2'�'�� J UNIT #j IS THIS UNIT DESIGNATED ASRIGHT LEFT /FRONT BACK PLEASE CIRCLE ONE OWN ER/tE6@ERC/WI.10 /70�e`14Z_- MANAGER/AGENTSBM_e ADDRESS .� 511_eP'�Y � AnnpQqr, CO wi R CITY /e"41 RESIDENCE PHONE ��J�'�I����'dBUSINESS PHONE (24 HRS.) BUSINESS PHONE 'ec 1/. TOTAL NUMBER OF ROOMS: ROOM U'1LER'2. 3. 4. 5. 6. 7 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. APPLICANTS SIGNATURE INSPECTORS USE ONLY DATE OF INITIAL INSPECTION 0- !S -0 ( DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: / g -b/ DATE FEE PAID:L- - o ) D `d / TYPE OF UNIT: DWELLING OTHER_ CHECK #� a g� CHECK DATED 11 NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 RELEASE NINE NORTH STREET Tel: (508) 741-1800 Fax: (508) 740-9705 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 author- ized agents to inspect the residence identified below in accordance with ttte 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. TENANT/LESSEE OWNER/EB c ADDRESS _ -- --- f,DDRESS-- ADDRESS OF UNIT TO 63E INSPECTED SAT Kimberley Driscoll Mayor City of Salem, Massachusetts Board of Health 120 Washington Street, 4th Floor, Salem, MA 01970 Tel. (978) 741-1800 Fax. (978) 745-0343 health@salem.com CERTIFICATE OF FITNESS CERTIFICATE #: GHL-17-134 DATE ISSUED: 5/5/2017 Property Located at: 8 SKERRY STREET UNIT #2 Owner/Agent: Cynthia Catt Address: 11 Squire Armour Road City/Town: Windham, NH Zip Code: 03087 9 PublicHealth Prevent. Promote. Protect. Larry Ramdin, MPH, REHS, CHO Health Agent 24 Hour Phone: (603) 327-7038 Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division 3, Section 705: Certificate of fitness of rented dwelling unit, apartment or tenement. 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. Note: This approval does not certify compliance with the state lead law for occupants under 6 years of age. Larry Ramdin, MPH, REHS, CHO HEALTH AGENT B fo ////SAN1ITARIAY--**"' KIMBERLEY DRISCOLL MAYOR LARRY RAMDIN, RS/REHS, CHO, CP -FS HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTI-I 120 WASHINGTON STREET. 47 FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 LRAMDINL(�SALEM.COM Application for Certificate of Fitness IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" PROPERTY LOCATED AT U a�Z i f �`� , ' J IAX r//k U I / / 770 UNIT# 2— ISHIS UNIT DISI ATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE OWNER/LESSER MANAGER/ AGENT NO P.O. BOX i, t'/iv/.//1yrzIF/.YIG`�.'YY_YY il19 RESIDENCE PHONEL [)� ;LL I BUSINESS PHONE (24HRS) BUSINESS TOTAL NUMBER OF ROOMS: .. I!�'L'1I%.��►irli lir'l�rEs'iN � ,�i d' THERE IS A FIFTY ($50) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEF/lS'PA?%ABLE AT T gTIMEAOF INSPECTION11 – _ APPLICANT'S SIGNA Inspectors use only Date on initial inspection: M�4LI / Date of reinspection: � q Date of issuance of certificate: ;S i Date fee paid: ��y2a Type of unit: Dwelline Other Check #Check date: S1©4�r7 Cy/ orceme� spector j �OND�, City of Salem, Massachusetts m Board of Health 120 Washington Street, 4th Floor, Salem, PabliCHea tth MA 01970 Prevent. Promote. Protect. Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, RENS, CHo Mayor Iramdin@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE#: GHL-16-64 DATE ISSUED: 3/2/2016 Property Located at: 9 SKERRY STREET UNIT#1 Owner/Agent: Michael McMahon Address: 9 Skerry Street#2 City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(339) 440-7045 Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division 3, Section 705: Certificate of fitness of rented dwelling unit, apartment or tenement. 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 Larry Ramdin, MPH, REHS, CHO HEALTH AGENT SANITARIAN KIMBERLEY DRISCOLL MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4"' FLOOR TEL. (978) 741-1800 Fax (978) 745-0343 lramdin@salem.com 11 PublicHealth Prevent. Promatt. Pral¢t. LARRY ILIMDIN, RS/RE1IS, CHO, CP -FS HEAL17-1 AGENT Application for Certificate of Fitness IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" �] !/ FEEL: $50.00 j A� PROPERTY LOCATED AT I J Ic f� rl�f � ()�1 �w- AkA Of 5l'(-' UNIT# IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK. PLEASE CIRCLE ONE OWNER/LESSER m"C�6 MCMCL� MANAGER/ AGENT NO P.O. BOX ADDRESS `� �D%<< r/ Gln �7— ADDRESS CITY, STATE, ZIP �)� �w. /(/��+ L CITY, STATE, ZIP RESIDENCE PHONE 051 yy 0 70 y5 BUSINESS PHONE (24HRS) BUSINESS PHONE nit kwC,CO I TOTAL NUMBER OF ROOMS: 5� ROOM USE: 1. k461v, 2. 1; J 3. 4. Air a, ��✓fl — 6. 7. 8. 9. 1 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 PAYABLE AT THE TIME OF INSPECTION Inspectors use only Date on initial inspection: 0 ({ Date of reinspection:_ Date of issuance of certificate: Date fee paid: Type of unit: Dwelling Other Check # (465 Check date:: Code o cement Inspector X16-6�