WALL STREETI � 1 Ll
KUMBERLBY DRISCOL.L
MAYOR
CITY OF SALEM, MASSACHUSETTS
BOARD OF HFALTH
120 WASHINGTON STREET, 4"' FLOOR
TEL. (978) 741-1800 FAx (978) 745-0343
Ltamdin a,salem.com
CERTIFICATE OF FITNESS
CERTIFICATE # 78-13
DATE ISSUED: 2/27/2013
Property Located at: 5 Wall Street UNIT # 1
Owner/Agent: All County Select Property Management
Address: 100 Cummings Ctr. Ste 434 -JJ
City/Town: Beverly, MA Zip Code: 01915 24 Hour Phone: 978-704-8200
1P
PablicHea i
Prevent. Promote. Protect.
L mIRY RAMDIN, RS/RNIS, CI 10, CP -FS
HG;AI:1'I 1 AC:i J,,,Nf
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 ll" 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
HEALTH AGENT
'i
m � m
KIMBERLEY DRISCOLL
MAYOR
LARRY RAMDIN, RS/111:'I-IS, CHO, CP -PS
HEAL CI I A(;I-SNP
CITY OF SALEM, MASSACHUSETTS
I o mm 01 HEALTH
H
120 WASH ING IONS 1 1ZET I , 4" ' F LOOK
TIL. (978) 741-1800
FAx (978) 745-0343
] RAMDIN&SALEN.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 S boill S'T 5-414,
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT
BACK, PLEASE CIRCLE ONE
OWNER/LESSER A/ 8ov.7jy SFZcc7 / i61- /Y6, ITMANAGER/ AGENTDFv6J C141,MM-Al
NO P.O. BOX
ADDRESS /00 C&14,gi416 - C-R. SiE -'/34,3Z;-ADDRESS
CITY, STATE, ZIP �CYlrwy CITY, STATE, ZIP 0 / 9/s
RESIDENCE PHONE BUSINESS PHONE (24HRS) 979 - 70 y - V-06
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: VlaS )9,47-#
ROOM USE: 1. /<? 4*,v2. ✓. 9/f 3. f3EfD 4. RFD 5. r'3AT//RA0A
6. 7. 8. 9. 10.
"-kr6
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 SIGNA
111J VlM1.lV1J UJN Vlllx �% �1
Date on initial inspection: e2 " 6 -.2013 Date of reinspection: O� /
Date of issuance of certificate: Date fee paid:
Type of unit: Dwelling—Other—Check #_Check date:
3