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TANGLEWOOD LANEJ • CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4'" FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX (978) 745-0343 MAYOR D(;R1TNBAUMQSA1,ISM.00M D,4VID GRF'.F.NBAum, RS ACTING HEAI.f'H A(ifiN'I' CERTIFICATE OF FITNESS CERTIFICATE # 428-10 DATE ISSUED: 9/1/2010 Property Located at: 2 Tanglewood Lane UNIT # 1206 Owner/Agent: East Coast Properties Address: 400 Highland Avenue City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-741-2003 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 DAVID GREENIBAVM, RS ACTING HEALTH AGENT INSPECTOR KINIBERLEY DRISCOLL MAYOR DAVID GREEN AUM, RS ACTING HE -I.TH AGENT CITY OF SALEM, MASSACHUSETTS - BOARD OF HEALTH 120 WASHINGTON S'PREEP, 4... FLOOR TEL. (978) 741-1800 Fax (978) 745-0343 DGR7,FNBAUM2S Nu!N-i. 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 LOCATED AT 2 TANGLEWOOD LANE UNIT# 1206 IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK, PLEASE CIRCLE ONE OWNER/LESSER BRIAN & JOCELYN ST.PIERRE MANAGER/AGENT NO P.O. BOX ADDRESS 400 HIGHLAND AVENUE ADDRESS SALEM CITY, STATE, ZIP. , STATE, ZIP EAST COAST PROPERTI MA 01970 RESIDENCEPHONE 978-741-2003 BUSINESS PHONE (24HRS) 978-741-2003 BUSINESS PHONE 978--741-2003 TOTAL NUMBER OF ROOMS: r ROOM USE: 1. Alk4RMI 2 `I 1,1/ 11 3 j111)% 4 ft /T% 5 JAL Y��j�j THERE IS A FIFTY ($50) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FE" PAYABLE AT TIJE TIME OF INSPECTION _ Inspectors use only Date on initial inspection: / ate of rems�ion. -� Date of issuance of certificate: l l b Date fee paid: 9 Type of unit: Dwelling -Other-Check # 5 Check date:_ Code enforcement Inspector ICM 3ERLEY DRISCOLL MAYOR DAVID G'REENBAUM, RS ACTING HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET', 4°i FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 DGR1A:NRAUb1PSA1.I.?V1. COM Release In accordance with Massachusetts General Laws Chapter 111; Code of Massachusetts Regulations 410.000 et. Seq. ; State Sanitary Code Chapter 11 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. Tenant/Lessee 49zx�� ner/Less J Address Address Address on unit to be inspected %1 -lo Date JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CITY OF SALEM BOARD OF HEALTH -Salem, Massachusetts 01570-3928 - i•.voya PROPERTY LOCATED AT: 3 Tanalewood Lane OWNER/AGENT: Clive & Susan Purchase ADDRESS: 12 Wyman Road CITY/TOWN: Marblehead, MA ZIP CODE: 01945 CERT.# 6-96 FEE $25.00 DATE: 01/12/96 NINE NORTH STREET Tei: (508) 741-1800 Fax: (508) 740-9705 UNIT #: 702 24 HOUR PHONE: 744-7090 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. OR THE BOARD OFHEALTH JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT DE ENFORCEMENT INSPECTOR CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 616 JOANNE SCOTT, MPH, RS, CHO NINE NORTH STREET HEALTH AGENT Tel: (508) 741-1800 APPLICATION FOR CERTIFICTE OF FITNESS Fax: (508) 740-9705 IN ACCORDANCE WITH STATE SANITARY'CODE,.CHAPTER II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED OWNER/LESSER S�cc-p-F70 n e . V UNIT ► 70a ADDRESS / �/1/ !n CZ ���J Rot CITY Ct. fJ t^ "' 6/'J7 ())9y-5 RESIDENCE PHONE 0 �f .BUSINESS P-Hoxe 5 b7 7— %d S ` MANAGER/AGENT ADDRESS CITY BUSINESS PHONE (24 TOTAL NUMBER OF ROOMS: / qq // ROOM USE: 1.�� V/ Gl2C . 3.L -- THERE IS A TWENTY—FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM HEALTH DEPARTME THIS FEEVIIS PAYABLE AT THE TIME OF INSPECTION APPLICANTS SIGNATURE Y�l�/1 G�C-DATE INSPECTORS USE ONLY DATE OF INITIAL INSPECTION: DATE OF REINSPECTION ,q DATE OF ISSUANCE OF CERTIFICATE:_ II-- -- /a ` 9,6 DATE FEE PAID: TYPE OF UNIT: DWELLING�THER NOTES: � 9 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH �Y 120 WASHINGTON STREET, 41° FLOOR TEL. (978) 741-1800 IC IMMERLEY DRISCOLL, FAY (978) 745-0343 MAYOR xaaar_NI;nuM(�snr.esnLc Jnr DAVID GIW':N BA u m, RS Ac HNG FIFAI.[I I A(;i',NP CERTIFICATE OF FITNESS CERTIFICATE # 464-10 DATE ISSUED: 9/22/2010 Property Located at: 4 Tanglewood Lane UNIT # 1205 Owner/Agent: Kim Reniska c/o East Coast Properties Address: 400 Highland Avenue City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-741-2003 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 Aaly DAVID GREENBAUM, RS 41� ACTING HEALTH AGENT CODE E4kO)RCEMENT INSPECTOR KIMBERLEY DRISCOLL MAYOR DAVID GREENBAUM, RS ACTING HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4"' FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 DGaI;BNLinobf@SAI.P:M. (OI\t w,io Application for Certificate of Fitness IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION." / ,1� / A�FE^-E:: /�$50.00 PROPERTY LOCATED AT � NG CCS e�wc e��k UNIT#-Z�J05 S THISON T DDIIS/IGNATTyED AS RIGHT LEFT FRONT OR BACK, PLEASE CIRCLE76P nM OWNER/LESSER—/y%�!rMANAGER/AGENT STS! NO P.O. BOX ADDRESS 7 % 6�4�J A/�JP ADDRESS 11X) CITY, STATE,f�/� CITY, STATE, ZIP r //✓��L� s�/ //�I� RESIDENCE PHONE / - /oma(/l/ BUSINESS PHONE (24HRS) BUSINESS TOTAL NUMBER OF ROOMS: yy�� ROOM USE: �I/10/� CI 2. / % 3. 94111) 4. j"//7 5. THERE IS A FIFTY ($50) DOLL EE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FE AT IM/EjOF� INSPECTION APPLICANT'S SIGNATURE r�(//t--- DATE Inspectors use only laa)�Date on initial inspection: oG� Date of reinspection: Date of issuance of certificate: I a / U Date fee paid: da Type of unit: Dwelling U --Other Check # p �lll Check date: / d d / o I. i , n 7� 1 I' 4 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 12 Tanglewood Lane OWNER/AGENT: Nancy .'. Golden ADDRESS: 4 E1 -Will Farm CERT.# 218-96 FEE $25.00 DATE: 04/16/96 UNIT #: 1201 CITY/TOWN: Bedford, MA ZIP CODE: 01730 24 HOUR PHONE: 741-2003 NINE NORTH STREET Tel: (508)741-1800 Fax: (508) 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 ABITATION"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 THE BOARD OF HEALTH JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT P CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS, CHO NINE NORTH STREET HEALTH AGENT Tel: (508) 741-1800 APPLICATION FOR GERTIFICTE OF FITNESS Fax: (508) 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- a--7L�f brx N UNIT #--taiwol-- OWNS ESSER l MANAGER/AGENT 1 XXrX D ADDRESS p{ A ADDRESS 0-M tyx UUti4 2L CITY 1� � PtJ20 _ L�ll�_ CITY _ RESIDENCE PHONE lL(� - a15� USCI BUSINESS PHONE (24 HRS.) BUSINESS PHONE �Q O : 3 �F/ - O 47 O _ TOTAL NUMBER OF ROOMS: J � ROOM USE: 1. aagAl)r 2. Ix4feo, 3. 4. a 60V.48. THERE IS A TWENTY-FIVE (25.00) DOLLAR PEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM* HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TIME OF IN(S�PECTI/OGN APPLICANTS SIGNATURE DATE INSPECTORS USE ONLY DATE OF INITIAL INSPECTION:DATE OF REINSPECTION _ DATE OF ISSUANCE OF CERTIFICATE:�% o el to DATE FEE PAID: TYPE OF UNIT: DWELLING OTHER NOTES: c _ C ENF R E NSPE R 316'592 187 US Postal Servica Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mad See reverse Sem to Street 6 Number Post Office, State, & LP Code Postage $ Certified Fee Special DeRwry Fee Restricted Delivery Fee Return Receipt Showing to Whom 6 Date Delivered Reese Receq Slpwig re Wlnm, Dare, & Addressee's M&M TOTAL Postage S Fees s Pxtrnark or Date , Stick postage stamps to article to cover First -Claw postage, certified mall fee, and charges for any selected optional services (See front). 1. If you want this receipt postmarked, stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service m window or hand it to your rural carder (no extra charge). m 2. If you do not want this receipt postmarked, stick the gummed stub to the right of the m return address of the article, date, detach, and retain the receipt, and mail the artide. 3. 8 you want a return receipt, write the certified mail number and your name and address N � on a return receipt card, Form 3811, and attach it to the from of the article by means of the gummed ends tt space permits. Otherwise, affix to back of article. Endorse front of ar ide F£TURN RECEIPT REDUESTED ajacem to the number. 4. H you want delivery restricted to the addressee, or to an authorized agent of the • C addressee, endorse RESTRICTED DELIVERY on the front of the article.aD ck 5. Enter fees for the services requested in the appropriate spaces on the front of this, 0 receipt. tt return receipt is requested, check the applicable blocks in item 1 of Form 3811. 6. Save this,receipt and present 8 9 you make an inquiry. ? a CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT May 14, 1996 Nancy F. Golden 12 Tanglewood Lane Salem, MA 01970 Dear Ms. Golden: NINE NORTH STREET Tel: (508) 741-1800 Fax: (508) 740-9705 Enclosed please find your $27.00 check #1246 dated April 16, 1996 for your Certificate of Fitness Inspection at 12 Tanglewod Lane. Thank you for sending another check for the correct amount of $25.00. If you have any questions please call my office. Very truly yours, oanne Scott Health Agent JS/mfp CERTIFIED MAIL P 316 592 187 NANCY F. GOLDEN 12 TANGLEWOOD LANE SALEM, MA 01970 1246 19 538351113 B e. BayBank lemo w 1:0113023574 266 19572115112 G �Comuon: - •Complete items 1 and/or 2 for additional services. I also wish to receive the -Complete items 3, and 4b. S0NIC8S (for an • Print your name and address on the reverse of this form so that we can return this and extra fee extra fee): card to you. -Attach this forth to the from of the mailpiace, or on the back if space does not 1. ❑ Addressee's Address permit. • Wdte'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery •The Return Receipt will show to whom the article was delivered and the date delivered. Consult postmaster for fee. A Article Artrtmecort 1m IA. Article Number Nancy Golden 12 Tanglewood Lane Salem, PIA 01970 fi and fee is paid) X '�llfli{if��f'{!'fl?1�(EI i4t1I'�i il��i!l�S�ISI!IIIIill i�i!{�f' PS Form 3811, December 1994 DOmestic ❑ Insured ❑ COD UNITED STATES POSTAL SERVICE . - I • First -Class Mail ' Postage & Fees Paid USPS Permit No. G-1 0 , • Print your name, address, and ZIP Code in this box • Salem HciIth Departrnent 9 North St. Salem. Mass. 01970 M M hY 2 11996' CITY OF SALEM, MASSACHUSETTS 3 ; BOARD OF HEALTH s 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE # 307-07 DATE ISSUED: 7/11/2007 Property Located at: 22 Tanglewood Lane UNIT # 1004 Owner/Agent: Mary Beth Lynn Address: 2 Franklin Pierce Drive City/Town: Peabody, MA Zip Code: 01960 24 Hour Phone: 617-413-5217 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 ?ANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS • • BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1000 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO Kimberley Driscoll HEALTH AGENT Mayor APPLICATION FOR CERTIFICATE OF FITNESS r 36-7-03 IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000 MINIMUM STANDARDS OF FITNESS F R HUMAN HABI ATION", PROPERTY LOCATED AT ,4 UNIT IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER 1%%- No P.O. Box MANAGER/AGENT ADDRESS No P.0 Box a �2 ADDRESS__ CITY �A /P/ CITY RESIDENCE PHONEV' BUSINESS PHONE (24 HRS.) BUSINESS PHONE�/14 TOTAL NUMBER OF ROOMS:. ROOM USE 1. "44%(?> 2 AI/[L { r--- 1--_3.�11Lt'-4 THERE IS A TWENTY-FIVE ($25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDERTO THE CITY OF SALEM HEALTH I TIME OF INSPECTION. DEPA TMENT THIS FEE IS PAYABLE AT THE APPLICANTS SIGNATURE - - --DATE _7.7 1- a INSPECTORS USE ONLY DATE OF INITIAL INSPECTION -7 DATE OF REINSPFCTION DATE OF ISSUANCE OF CERTIFICATFJ //,o77 DDAAT� FCF�EGCE PAID: TYPE OF UNIT DWEI-LOTHER CHECK !I _[ O J IJ�� / ✓✓Illi'' �tJ HECK DATF NOTES CODE ENFORCE-MLN1 IiV WL(ITC)R !J1211.�S1d Em KIMBERLEY DRISCOLL MAYOR CFTY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4r" FLOOR TEL. (978) 741-1800 Fax (978) 745-0343 lramdin@salem.com CERTIFICATE OF FITNESS CERTIFICATE # 262-12 DATE ISSUED: 6/27/2012 Property Located at: 26 Tanglewood Lane UNIT # 1002 Owner/Agent: East Coast Properties Address: 400 Highland Avenue City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-741-2003 IV PublicHea ith r•r�.,�m. r�,•mm�. r.m«t. LAR,tY Rr NHAN, RS/RF'HS, CI 10, C114,S HCAI:[T-IA( rVNf 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 e Y RAMDIN HEALTH AGENT KIMBERLEY DRISCOLL MAYOR LARRY RAMDIN, RS/RFI TS, CIIO, (:P -FS HF,m xi i AG F.N , CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 41° FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 LRAMDIN@C tiALENLCONI Application for Certificate of Fitness 0- g, I,)/ 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�k *6 ia (?4e UNIT#� ATHISNIT Dnn IGNATED'A�SSR�IG�HT LEFT FRONT OR B� PLEASE CIRCLE O E OWNER/LESSERflj (%�ti(/ MANAGER/AGENT/ t NO P.O. BOXADDRESSi6A6(4& e ADDRESS CITY, STATE, ZIP n /� CITY, STATE, ZIP RESIDENCE PHONE //Q.Q(/ /�/��/Z� V, 5 BUSINESS PHONE (24HRS) BUSINESS PHONE 1, 'e TOTAL NUMBER OF ROOMS:. i1��i3i/1Li11/�G /%i�!/T/�!//// THERE IS A FIFTY ($50) DOLLAR FEE, PAYABLE CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEYABLE AT/I'IIEITIME OF INSPECTION APPLICANT'S /r- Inspectors use only Date on initial inspection: `/UZ-7112 Date of reinspection: IUMBERLEY DRISCOLL MAYOR LiAI2RY R.ANIDIN, IiS/RP.I IS, CI 10, 01-1-S Illi,\I;I'll A(;FNf CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 130 WASHINGTON STREET, 4.° FLOOR TEL. (978) 741-1800 FAx (978) 745-0343 LItANIUINnsAL EUCONI 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. Tenant/Lessee Address Address Address on unit to be inspected Date Updated 523/11