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SUMNER ROAD�M] 0 S-Umhee, Roo n Kimberley Driscoll Mayor Property Located at: Owner/Agent: Address: 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-17-198 DATE ISSUED: 7/6/2017 11 SUMNER ROAD UNIT #1 Bronislaw & Suzanne Krol 11 Sumner Road CityfTown: Salem, MA Zip Code: 01970 Ut a PublicHeaith Preamx. Promote. Protect, Larry Ramdin, MPH, RENS, CHO Health Agent 24 Hour Phone: 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 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 Fitnessis 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 s KIMBERLEY DRISCOLL MAYOR LARRY RAMDIN, RS/REHS, CHO, CP -FS HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD 013 HEALTH 120 WASHINGTON STREET, 4T`' FI.,OOR TEL. (978) 741-1800 FAx (978) 745-0343 LRAMDI N([SAI.EM.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" FEE: $50.00 PROPERTY LOCATED AT // I �/�)� /Q(),4 n UNIT# 1 IS THIS UNIT DISIGNATED AS RIGHT EFT ONT OR BACK PLEASE CIRCLE ONE NO P.O. BOX CITY, STATE, ZIPS /4 L EM MA , 0 197 O CITY, STATE, ZIP. RESIDENCE PHONE %A - G / Ff - 3 / 0 7 BUSINESS PHONE (24HR BUSINESS PHONE TOTAL NUMBER OF ROOMS: < ROOM USE: 1. 2. 3. 4. 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 TE_sc/7( Inspectors use only Date on initial inspection: Date of reinspection: Date of issuance of certificate: Date fee paid. Type of unit: Dwelling Other Check # _Check date: Code Enforcement Inspector KIMBERI.EY DRISCOLL MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, t+FLOOR TLa.. (978) 741-1800 FAA (978) 745-0343 lramdin e salcm.com CERTIFICATE OF FITNESS CERTIFICATE # 220-14 DATE ISSUED: 7/8/2014 Property Located at: 11 Sumner Road UNIT # 1 Owner/Agent: Benny Krol Address: 11 Sumner Road City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-745-6223 LARRY RAM AN, RS/RHI-IS, CI K), CP-I;S Hv,Ai:rI:rAGBN I' Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division3, 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 R7aMDIN 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 lramdinna,salem.com lu Wv-�I, PublicHealth Prevent. Promote. Protect, LARRY RAMDIN, ILS/RJ--'11-[S, CI 10, CP*S HEAT:PFI 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" nF/E�E: $50.00 PROPERTY LOCATED AT // . /I m 11/y- /u UNIT#- XTHIS USI SIGNATED AS RIG T LEFr FRONT OR BACK, PLEASE CIRCLE ONE Oe b / 1 NO P.O. BOX CITY, STATE, ZIP , STATE, ZIP ��©/ l () RESIDENCE PHONE !� ;? ) 3 BUSINESS PHONE (24HRS BUSINESS TOTAL NUMBER OF ROOMS: , ROOM USE: THERE IS A FIFTY ($50) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH' APPLICANT'S SIGNA Inspectors use only Date on initial inspection: % 1 $ I i t'i Date of reinspection: Date of issuance of certificate: Date fee paid: , ]� Type of unit: Dwelling Other Check #_Check date: &.4te. CodeNfi)(Cl6ment Inspector KIMBERLFY DRISCOLL MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HFALTH 120 WASHINGTON STREET, 4"" FLOOR TFL. (978) 741-1800 FAX (978) 745-0343 lramdin@salcm.com CERTIFICATE OF FITNESS POLICY U publicHeaith rrc.m�. rmmme. rra�c=�. LARRY RAMDIN, RS/RI.IIS, CI -IO, CP—FS HFAV , rI-I AG F.N'r 1. A Certificate of Fitness inspection is required for all rental units older than 5 years, per City of Salem ordinance; 2. A Certificate of Fitness is good for 1 year or the life of the tenant; whichever is longer; 3. A Certificate of Fitness inspection may be obtained by calling or coming into the Health Department and requesting an appointment; 4. Appointments must be requested at least 24 hours in advance pending an open appointment; 5. No "same day" appointments will be granted; 6. All appointments are subject to the schedule of the inspector; 7. A rental unit will be considered occupied when either the previous tenant or the current tenant has belongings in the unit. In the case of an occupied unit, either the tenant whose belongings are in the unit must be present at the time of inspection, OR have signed a release statement allowing the Board of Health to inspect the unit. 8. Please allow at least one week turnaround time for the Certificate to be issued, especially at the end of the month; 9. A Certificate of Fitness will be granted when: a. An inspection has been conducted by a Health Department employee b. An application has been filled out and a check or money order has been received 10. If you have any questions, please contact the Health Department