GALLOWS HILL (002) r
CITY OI' SALEM, MASSACHUSE-rrs
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Bo, RD 01, 11-111AINI I
120 WAST-TINGTON STREFI T,4"' F,LOOIL
KIMBERLEYDRISCOI-T, '1'1 1- (978) 741-1800
MAYOR Fax (978) 745-0343
lraindinC&,salem com
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CERTIFICATE OF FITNESS
CERTIFICATE#440-11
DATE ISSUED: 10/21/2011
Property Located at: 6 Gallows Circle UNIT#
Owner/Agent: Soule &George Hoxha
Address: 57 Stonecleave Road
City/Town: Boxford, MA Zip Code: 01921 24 Hour Phone: 978-473-9779
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 oo upied.
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
i_
LARR1 RAMDIN
HEALTH AGENT COD NFORCEMENT INSPECTOR
• CITY OF SALEM, MASSACHUSE-I T'S
g BOARD OF HEALTH
120 WASHINGTON STREET,4... FI O()R
Te,I:.. (978) 741-1800
IQMI3EIUJ.:Y DRJSC10LL FAX(978) 745-0343
MAYOR 1.e Anu n N nSN J N.0001
HE,\1:1'11 AGISMf
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 l� l� d(ei f5 C;k i S(4or �'(A �l�7G UNIT#
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER ����JLrY G/�,f9 MANAGER/AGENT
NO P.O. BOX
ADDRESS CL–P,/,i�I ADDRESS
CITY, STATE, ZIP r 1 / . CITY, STATE,ZIP
PHONE BUSINESS PHONE(24HRS)
BUSINESS PHONE
i
TOTAL NUMBER OF ROOMS:._
ROOM USE: 1. 2. 3. 4. 5.
6. 7. 8. 9. 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 A,TTHE TIME OF INSPECTION
APPLICANT'S SIGNATURE 5i:?ri/ _ //��� �� DATE
Inspectors use only
Date on initial inspection: /0131/11 Date of reinspection: /06d, I
Date of issuance of certificate: 1 I Date fee paid:
Type of unit: Dwelling Other Check# —Check date: � /6 c1/ //
Notes:
I ,
Code E orcein nt Inspector