SWAMPSCOTT ROADSWAMPSCOTT ROAD
G CITY OF SALEM9 MASSACHUSETTS
�! HEALTH AGENT
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745.0343
KIMBERLEY DRISCOLL JSCOTT@SALEM.COM
MAYOR
JOANNE SCOTT
HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE # 498-07
DATE ISSUED: 10/10/2007
Property Located at: 75 Swampscott Road UNIT # 1
Owner/Agent: Carmine Mongiello
Address: 55 Eastman Avenue
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 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
�
XHErs.a-TQC_ _
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
V
CODE ENFORCEMENT INSPECT R
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
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT — u�' 6 . E ( UNIT # )
IS THIS UNIT DESIGNATED AS RIGHT LEF� FRONT BACK PLEASE CIRCLE ONE
OWNER/LES
No P.O. Box
0.2"s :
ER/AGENT
CITY_—G6 , l CITY
RESIDENCE PHONE ri l.�b�i0 313USINESS PHONE (24 HRS.)
BUSINESS
TOTAL NUMBER OF ROOMS:_
ROOM USE: 1. 4_ 2. L__3._ _4.\3
5._ 7. 8
y�8d�
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. '� �y
APPLICANTS SIGNATURE / _DATE h®—.147, -200_�
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION /0-0-0 2 DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATED /b -°"DATE FEE PAID. /a— / O ° i
TYPE OF UNIT: DWELL IN4"OTHERCHECK Y—CHECK DATE /0-10-07
CODE ENFORCEMENT INSPECTOR
9/28/98