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ALBION STREET (002) st City of Salem, Massachusetts 6 Board of Health 4 Stu; 120 Washington Street, 4th Floor, Salem, Prevent.PubiC�Health MA 01970 Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, REHS, CHO Mayor health@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE#: GHL-16-464 DATE ISSUED: 11/23/2016 Property Located at: 2 ALBION STREET UNIT#1 Owner/Agent: Dean Sousa Address: 2 Albion Street#4 City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(978) 569-6176 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 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. Note: This approval does not certify compliance with the state lead law for occupants under 6 years of age. I Larry Ramdin, MPH, REHS, CHO HEALTH AGENT SANITARIAN I t. • CITY OF SALEM, MASS-A(;IIUSEYfS BOARID OF HEALTH. 120 WAST-IINGTON STREET,4T'FLOOR TEL.(978) 741-1800 KI NTBERLEY DRISCOLL FAx(978) 745-0343 MAYOR LRAMDINdSALEM.COM LARRY R AMDIN,RS/REH S,CHO,CP-FS HF.At.TH AGENT �nSSol�ia��C,kou.con1 Application for Certificate of Fitness IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARD F F E FOR S O TIN SS O HUMAN HABITATION" i`_ FE//E:��$50.00 A A PROPERTY LOCATED AT (I6U*V S+ lNl l I— — Mc� UNTf# IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT O BAC LEASE CIRCLE ONE OWNER/LESSER be-cdA Sousc , MANAGER/AGENT NO P.O.BOX �l tt�N1,, C_ u ADDRESSa k i Q/A S+ P't C,0Iii 2Q ApI I ADDRESS CITY,STATE,ZIP SC.(,E(n� mG OA�-)Q CITY, STATE,ZIP RESIDENCE PHONE (A —&('A(o BUSINESS PHONE(24HRS) BUSINESS PHONE // � TOTAL NUMBER OF ROOMS: l0 nn ROOM USE: LV;�_(YA 2.� i�A�RM 3.&x kr dJ ,- 4.&df&0''` SjOA'a'^'� 6. ra2I''` 7. 8. 9. 10. THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CTTY OF SALEM BOARD OF HEALTH THIS FEE IS PAYABLE AT THE TIME OF INSPECTION APPLICANT'S SIGNATURE ��— DATE �l �a (O Inspectors use only Date on initial inspection: Date Date of reinspection: Date of issuance of certificate: Date fee paid: 11 12-212=Q Type of unit: Dwelling Other Check#_ ZTCheck date: I V22/.2 g 4C Notes: Coe , ement Insp ctor 3 ^1 T CITY OF SALEM, MASSACHUSETTS o ; BOARD OF HEALTH 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 #36-07* DATE ISSUED: 1/30/2007 Property Located at: 2 Albion Street UNIT#2 Owner/Agent: Cheryl Verrett Address: 190 Green Street City/Town: Marblehead, MA Zip Code: 01945 24 Hour Phone: 781-639-0509 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 If' 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 JOANNE SCOTT. MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR uopCITY 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 Kimberley Driscoll HEALTH AGENT Mayor APPLICATION FOR CERTIFICATE OF FITNESS IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT�, A491otl ST-._ _ UNAONEE IS THIS UNIT DESIGNATED AS RIGH LEFT FRONT BACK PLEASE CIRCLOWNER/LESSERZ�C -tLJIC!Zle T`r� MANAGER/AGENT No P.O. Box No P.O.Box ADDRESSPOJTS0 ADDRESS CITY_ __ CI1Y. 4y— .©�M_667 RESIDENCE PHONE-1-0"- -OSdO_BUSINESS PHONE (24 HRS-) 1-qS3-ZS1 �- BUSINESS PHONE. TOTAL NUMBER OF ROOMS:_. ROOM USE: 5. THERE IS A TWENTY- {525.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CIT OF S EM HEALTH DEP RTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTAN. APPLICANTSSIGNATU ��, _DATE �' �•� INSPECTORS USE ONLY DATE OF INITIAL INSPECTION ¢i_, 6 7 _DATE OF REINSPECTION_____ _. DATE OF ISSUANCE OF CERTIFICATE: _ '�._'F7?DATE//FEE PAID:_ TYPE OF UNIT, DWELLING _OTHERCHECK #(ll_ _-_CHECK DATE CODE ENFORCEMENT INSPECTOR 9/2£3/98 CITY OF SALEM, MASSACHUSETTS o ® 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#217-07 DATE ISSUED: 5/14/2007 Property Located at: 2 Albion Street UNIT#4 Owner/Agent: Cheryl & Dennis Verrette Address: 190 Green Street City/Town: Marblehead, MA Zip Code: 01945 24 Hour Phone: 508-873-3707 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 J NNE 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. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO - Kimberley Driscoll HEALTH AGENT Mayor APPLICATION FOR CERTIFICATE OF FITNESS IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" PROPERTY LOCATED AT )� �J�e Imo_ UNIT q_ IS THIS UNIT DES AT pS RIGHT LEFT FRONT BACK PLEASE CIRCLE O Op 100 OWNER/LESSER MYI �MANAGER/AGENT No P.O. Box No P.O. Box ADDRESS IClC)C`SY.I�W61 . ADDRESSD. 6CX X302 CITY _ CITY M I/ �� �n p� RESIDENCE PHONE ' �15 ' JD USINESS PHONE HRS.) BUSINESS PHONE �22 1 � \� q63 TOTAL NUMBER OF ROOMS:,V U3a . X02 ROOM USE 1 kt �YL2 .1tUIt� Ypp1�_ be-Cl 00' IM 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.` APPLICANTS SIGNATURE✓6 _ _ / N Com=DATE J)'--4/ INSPECTORS USE ONLY DATE OF INITIAL INSPECTION __/ 't -° DATE OF REINSPECT ON, 7 p 7 DATE OF ISSUANCE OF CERTIFICATES DATE FEE PAID. TYPE OF UNII DWELLING OTHER CHECHECK D 1 F S NOTES CODE ENI ORCEMEN i INSPECTOR CITY OF SALEM, MASSACHUSETTS • • BOARD OF HEALTH 120 WASHINGTON STREET,C FLOOR TEL. (978) 741-1800 KIMI3ERJEY DRISCOLL FAx(978) 745-0343 MAYOR 11)ION NE SSLHM.COM JANET DIONNE SENIOR SANITARIAN CERTIFICATE OF FITNESS CERTIFICATE#432-08 DATE ISSUED: 91412008 Property Located at: 5 Albion Street UNIT#2 Owner/Agent: June C Dunleavy Address: 5 Albion Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: An inspection of your vacant DwellingiRooming 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 o�Fi n�essToi- ul�man HaEtation--'— 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 V there is a valid Certificate of Occupancy. FOR TZBDOF HEALTH J N T DIONNE tttttt SENIOR SANITARIAN COW ENF09CEMENT INSPECTOR • CITY OF SALEM, MASSACHUSETTS ' BOARD OF HEALTH 120 WASHINGTON STREET,4`FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAY(978)745-0343 MAYOR isco'rrCa�s�LeM.COM JOANNE SCOTT, HEALTH 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." FEE: $50.00 PROPERTY LOCATED AT ltd. !�/O l+� �� UNIT# C9, IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CHICLE ONE \ OWNER/LESSER. Q/0 T -A�MANAGER/AGENT NO P.O. BOX - ADDRESS -0J..bI6N S ADDRESS CITY, STATE,ZIP �Sj 7q�m CITY, STATE,ZIP fi RESIDENCE PHONE / 7k 7qq 0 BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: r rt � nmp? eAO 4. 5. . 6M ROOM USE: 1. \ I Che,y 2. Iy n16 3 � In � llmn �Qb 6�Reo�7 8 9 10.8 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 AT THE TIME OF INSPECTION APPLICANT'S SIGNATURE DATE l Inspectors use onl�use onl r7� v y Date on initial inspection: (0fog I og Date of reinspection: Date of issuance of certificate: Date fee paid: Type of unit: Dwelling Other Check#Check date: Notes: i Code hnforcement Inspector • CITY OF SALEM, MASSACHUSETTS j BOARD OF HEALTH 120 WASHINGTON STREET,4°'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR isco'rr e SAU M.COM- JOANNE Scm-r, HEALTH AGENT 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 Owner/Lessor Address Address Address on unit to be inspected Date September 4, 2008 Board Of Health Salem, Ma TO Whom-It May Concern: I hereby authorize the Salem Board Of Health to enter my apartment and examine it for the purpose of issuing a Certificate of Fitness and release them from all loss and damage of its contents. Yours truly, Laureen Sweeney 5 Albion Street, Apt 2 Salem, Ma 01970 I HP Fax Series 900 Fax History Report for Plain Paper Fax/Copier Joanne Scott Salem BOH 978 745 0343 Sep 05 2008 11:12am Last Fax D= II M bw Identification Duration F= Result Sep 5 11:11am Sent 919787449614 0:24 1 OK Result: OK - black and white fax tONIXT� ���GMINg CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tel: 978 741-1800 09/11/2000 fax:(978)740-9705 Patricia Rennick 49 Endicott Street Peabody, MA 01960 PROPERTY LOCATED AT 8 Albion Street UNIT # House Dear Sir/Madam: It has come to our attention, that you may be considering renting a dwelling unit at the above address. In accordance with Chapter 11, Article XIII of the City of Salem Code of Ordinances, Section 2-334,titled "Certificate of Fitness, " each dwelling unit must be inspected and certified prior to allowing occupancy. The inspection will be conducted in accordance with 105 CMR; State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.000; State Sanitary Code, Chapter II: Minimum Standards of Fitness for Human Habitation. Please notify us if you do not intend to rent the unit . Please contact this department within 24 hours of receipt of this notice at 978-741-1800, to schedule an appointment for an inspection. Our office hours are Monday thru Wednesday from 8:00 a.m. - 4 :00 p.m. Thursday 8:00 a.m. - 7:00 p.m. and Friday 8 :00 a.m. - 4 :00 p.m. Failure to comply with this procedure, may result in a fine of Twenty (20) dollars per day for every day that the dwelling unit is occupied without a Certificate of Fitness. A $25 .00 check payable to the City of Salem is required for each unit inspected at the time of inspection. A property owner is required to pay gas and electricity for residential tenants if there is not a written letting agreement stating the tenant is responsible for those utilities and if the meter(s) records electricity and gas use which is not used exclusively by that tenant. The Department of Public Utilities has billed property owners for their tenants' entire utility bills retroactive tothedate of initial occupancy in cases in which cross-metering has been proven to exist . R THE BOARD O HEALTH REPLY TO oanneLS ,, MPO PABLO VALDEZ Health Agent CODE ENFORCEMENT INSPECTOR 4� CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 11/12/99 Fax:(978)740-9705 Patricia Rennick 49 Endicott Street Peabody, MA 01960 PROPERTY LOCATED AT 8 Albion Street UNIT # House Dear Sir/Madam: It has come to our attention, that you may be considering renting a dwelling unit at the above address. In accordance with Chapter 11, Article XIII of the City of Salem Code of Ordinances, Section 2-334,titled "Certificate of Fitness,." each dwelling unit must be inspected and certified prior to allowing occupancy. The inspection will be conducted in accordance with 105 CMR; State Sanitary Code, Chapter 1: General Administrative Procedures and 105 CMR 410.000; State Sanitary Code, Chapter II: Minimum Standards of Fitness for Human Habitation. Please notify us if you do not intend to rent the unit. Please contact this department within 24 hours of receipt of this notice at 978-741-1800, to schedule an appointment for an inspection. Our office hours are Monday thru Wednesday from 8:00 a.m. - 4:00 p.m. Thursday 8:00 a.m. - 7:00 p.m. and Friday 8:00 a.m. - 4:00 p.m. Failure to comply with this procedure, may result in a fine of Twenty (20) dollars per day for every day that the dwelling unit is occupied without a Certificate of Fitness. A $25.00 check payable to the City of Salem is required for each unit inspected at the time of inspection. A property owner is required to pay gas and electricity for residential tenants if there is not a written letting agreement stating the tenant is responsible for those utilities and if the meter(s) records electricity and gas use which is not used exclusively by .that tenant. ,, The.Department of Public Utilities .has.billed .property owners for their tenants' entire utility bills retroactive to the date of initial occupancy in cases- in which cross-metering has been proven to exist. THE BOARD HEALTH - REPLY TO Voanne Scott, MPH,RS,CHO PABLO VALDEZ Health Agent CODE ENFORCEMENT INSPECTOR mr� CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET H LTH q ENT Tel:(978)741-1800 Date: /11/�8 Fax:(978)740-9705 David Carnevale 12 Albion Street Salem, MA 01970 PROPERTY LOCATED AT 12 Albion Street UNIT # 1 Dear Sir/Madam: It has come to our attention, that you may be considering renting a dwelling unit at the above address. It is incumbent upon you as owner(s) to contact the City of Salem Health Department to apply for a CERTIFICATE OF FITNESS before any vacant dwelling unit is rented or occupied, or to notify us of your intent for this unit. Each dwelling unit must be inspected and certified by the Salem Health Department prior to allowing occupancy in accordance with Chapter 111, Sections 127A and 127B, of the Massachusetts General Laws, 105 CMR 400 .00; State Sanitary Code, Chapter 1 : General Administrative Procedures and 105 CMR 410 .000; State Sanitary Code, Chapter 11: Minimum Standards of Fitness for Human Habitation, and in accordance with Chapter 11, Article XIII of the City of Salem Code of Ordiances, Section 2-334, Certificate of Fitness. There is a twenty-five (25) dollar fee payable by check, or money order to the City of Salem Health Department. This fee is payable at the time of inspection. Inspection will not be performed without receipt of payment. Failure to comply with this procedure, will result in a fine of twenty (20) dollars per day for every day that the dwelling unit is occupied without approval of the Code Enforcement Division of the Salem Health Department . Contact this department within 24 hours of receipt of this notice. (508) 741-1800 Monday thru Wednesday from 8 :00 a.m. - 4 :00 p.m. Thursday 8:00 a.m. - 7 :00 p.m. or Friday 8:OC a.m. to noon to schedule an appointment for an inspection. SEE ENCLOSED SECTION 105 CMR 410 .354 METERING OF GAS & ELECTRICITY Very truly yours, FOR THE BOARD OF HEALTH REPLY TO Joanne Scott, MPH,RS,CHO PABLO VALDEZ HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Date: 03/08/96 Fax:(508)740-9705 David Carnevale & Henry Bertolon 106 Hale Street #1 Beverly, MA 01915 PROPERTY LOCATED AT 12 Albion Street UNIT # 1 Dear Sir/Madam: It has come to our attention, that you may be considering renting a dwelling unit at the above address. It is incumbent upon you as owner(s) to contact the City of Salem Health Department to apply for a CERTIFICATE OF FITNESS before any vacant dwelling unit is rented or occupied, or to notify us of your intent for this unit. Each dwelling unit must be inspected and certified by the Salem Health Department . prior to allowing occupancy in accordance with Chapter 111, Sections 127A and 127B, of the Massachusetts General Laws, 105 CMR 400.00; State Sanitary Code, Chapter 1: General Administrative Procedures and 105 CMR 410.000; State Sanitary Code, Chapter 11: Minimum Standards of Fitness for Human Habitation, and in accordance with Chapter 11, Article XIII of the City of Salem Code of Ordiances, Section 2-334, Certificate of Fitness. There is a twenty-five (25) dollar fee payable by check, or money order to the City of Salem Health Department. This fee is payable at the time of inspection. Inspection will not be performed without receipt of payment. Failure to comply with this procedure, will result in a fine of twenty (20) dollars per day for every day that the dwelling unit is occupied without approval of the Code Enforcement Division of the Salem Health Department. Contact this department within 24 hours of receipt of this notice. (508) 741-1800 Monday thru Wednesday from 8:00 a.m. - 4:00 p.m. Thursday 8:00 a.m. - 7 :00 p.m. or Friday 8:00 a.m. to noon to schedule an appointment for an inspection. SEE ENCLOSED SECTION 105 CMR 410.354 METERING OF GAS & ELECTRICITY Very truly yours, FOR THE BOARD OF/� REPLY TO Joanne Scott, MPH,RS,CHO PABLO VALDEZ HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITU OF SALEM, MASSACHUSETTS BOARD OF HEALTH • • 120 WASHINGTON STREET, 4TH FLOOR CERT.(# 585-03 SALEM, MA 01970 - FEE $25.00 TEL. 978-74 1-1800 DATE: FAX 978-745-0343 11/28/03 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 1 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 12 ALBION STREET UNIT #: 2 OWNER/AGENT: DAVID CARNEVALE ADDRESS: 24 PRINCE STREET CITY/TOWN: BEVERLY, ZIP CODE: 01915 24 HOUR PHONE: 9784815-7295 AN INSPECTION OF YOUR VACANT DWELLING/ROOMING UNIT AT THE ABOVE ADDRESS HAS BEEN APPROVED AND IS IN COMPLIANCE WITH IOS 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, BASED ON 10S 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 NOR BUILDING RELATED CODES. FOR MORE INFORMATION CALL 978-741-1800. FO THE BOARD OFHEALTH JOANNE SCOTT, MPH,RS✓,CCCHO /i' ae� �� HEALTH AGENT J FREY VAUGHAN CODE ENFORCEMENT INSPECTOR 3 WINDOWS NEED ADJUSTMENTS TO PREVENT SLAMMING. KITCHEN SINK BACKSPLASH NEEDS REPAIR. REPLACE BROKEN TOILET COVER. (OWNER STATED STAIRWAY WOULD BE PAINTED AFTER TENANT MOVES IN) / aCITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR //63 SALEM, MA 01970 TEL. 978-741-1800 ,J FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT APPLICATION FOR CERTIFICATE OF FITNESS IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN R MA HABITATION'. PROPERTY LOCATED AT Va >'*r\310 UNIT#� IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER Z)AQCc� Cra r.,e aI2 MANAGER/AGENT No P.O. Box No P.O. Box ADDRESS - -4 ?(z\,cP- S} ADDRESS CITY 5;j Q 2 q CITY ^ A • O\9lS RESIDENCE PHONE 91 -- L o'C S- BUSINESS PHONE (24 HRS.) 9D B - 8\S-1 a �S BUSINESS PHONE TOTAL NUMBER OF ROOMS: (O •a . ROOM USE: 1. �\���� 2. ir�v�:,'+ 3. �e�2o-�+4. "oi-h ' r 5.PSPr* .. 6. own 7. 8. 7 THERE IS A TWENTY-FIVE($25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SAL LT P T THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. APPLICANTS SIGNATURE DATE t o INSPECTORS USE ONLY DATE OF INITIAL INSPECTION //1 alOJ DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: "lei DATE Fy- PAID: //ISe /0? a TYPE OF UNIT: DWELLING /OTHER— CHECK# d060 CHECK DATE a S �11� NOTES: .7 G.i uc�o r Livaer� T/ oiaue Jr �G/ 7e:Ale�!/�S.fiK/ A SO G9li� eile I�fIA%1_7 /�[049� .CII/tO�LN Ta.41- CGOE FORCEME1IT INSPECTOR 9/28/98 (DI✓tific STia7W ��;,2L yfi Lu1v(.� (1c �.9r.,T�A' �F7v . T.9tiT ��ret�.I /N ) v��COPll11T CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS, CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 07/26/2000 Fax:(978) 740-9705 John Derby 11 1/2 Albion Street Salem, MA 01970 PROPERTY LOCATED AT 13 Albion Street UNIT # 2 Dear Sir/Madam: It has come to our attention, that you may be considering renting a dwelling unit at the above address. In accordance with Chapter 11, Article XIII of the City of Salem Code of Ordinances, Section 2-334,titled "Certificate of Fitness, " each dwelling unit must be inspected and certified prior to allowing occupancy. The inspection will be conducted in accordance with 105 CMR; State Sanitary Code, Chapter I: General Administrative Procedures and 105 .CMR 410.000; State Sanitary Code, Chapter II: Minimum Standards of Fitness for Human Habitation. Please notify us if you do not intend to rent the unit. Please contact this department within 24 hours of receipt of this notice at 978-741-1800, to schedule an appointment for an inspection. Our office hours are Monday thru Wednesday from 8:00 a.m. - 4 :00 p.m. Thursday 8:00 a.m. - 7:00 p.m. and Friday 8:00 a.m. - 4 :00 p.m. Failure to comply with this procedure, may result in a fine of Twenty (20) dollars per day for every day that the dwelling unit is occupied without a Certificate of Fitness. A $25.00 check payable to the City of Salem is required for each unit inspected at the time of inspection. A property owner is required to pay gas and electricity for residential tenants if there is not a written letting agreement stating the tenant is responsible for those utilities and if the meter(s) records electricity and gas use which is not used exclusively by that tenant. The Department of Public Utilities has billed property owners for their tenants' entire utility bills retroactive to the date of initial occupancy in cases in which cross-metering has been proven to exist. F R THE BOARD OF HEALTH REPLY TO a ne �0^� O PABLO VALDEZ ealth Agent CODE ENFORCEMENT INSPECTOR 0 v� 3 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Date: 03/13/98 Fax:(978)740-9705 Kevin & Barbara Brown 6 Olsen Road Peabody, MA 01960 PROPERTY LOCATED AT 13 Albion Street UNIT # 1 Dear Sir/Madam: It has come to our attention, that you may be considering renting a dwelling unit at the above address. It is incumbent upon you as owner(s) to contact the City of Salem Health Department to apply for a CERTIFICATE OF FITNESS before any vacant dwelling unit is rented or occupied, or to notify us of your intent for this unit. Each dwelling unit must be inspected and certified by the Salem Health Department prior to allowing occupancy in accordance with Chapter 111, Sections 127A and 127B, of the Massachusetts General Laws, 105 CMR 400.00; State Sanitary Code, Chapter 1: General Administrative Procedures and 105 CMR 410.000; State Sanitary Code, Chapter 11 : Minimum Standards of Fitness for Human Habitation, and in accordance with Chapter 11, Article XIII of the City of Salem Code of Ordiances, Section 2-334, Certificate of Fitness. There is a twenty-five (25) dollar fee payable by check, or money order to the City of Salem Health Department. This fee is payable at the time of inspection. Inspection will not be performed without receipt of payment. Failure to comply with this procedure, will result in a fine of twenty (20) dollars per day for every day that the dwelling unit is occupied without approval of the Code Enforcement Division of the Salem Health Department. Contact this department within 24 hours of receipt of this notice. (508) 741-1800 Monday thru Wednesday from 8:00 a.m. - 4 :00 p.m. Thursday 8:00 a.m. - 7 :00 p.m. or Friday 8 :00 a.m. to noon to schedule an appointment for an inspection. SEE ENCLOSED SECTION 105 CMR 410.354 METERING OF GAS & ELECTRICITY Very truly yours, FOR THE BOARD OF HEALTH REPLY TO Joanne Scott, MPH,RS,CHO PABLO VALDEZ HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS n BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR r SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 12/23/04 Duarete & Maria Machado 14 Albion Street Salem, MA 01970 PROPERTY LOCATED AT 14 Albion Street Unit Dear Sir/Madam: It has come to our attention, that you may be considering renting a dwelling unit at the above address. In accordance with Chapter 11, Article XIII of the City of Salem Code of Ordinances, Section 2- 334,titled "Certificate of Fitness," each dwelling unit must be inspected and certified prior to allowing occupancy. The inspection will be conducted in accordance with 105 CMR 410.000; State Sanitary Code, Chapter 11: Minimum Standards of Fitness for Human Habitation. Please notify us if you do not intend to rent the unit. Please contact this department within 24 hours of receipt of this notice at 978-741-1800, to schedule an appointment for an inspection. Our office hours are Monday thru Wednesday from 8:00 a.m. —4:00 p.m. Thursday 8:00 a.m. to 7:00 p.m. and Friday 8:00 a.m. — 12:00 p.m. Failure to comply with this procedure, may result in a fine of Twenty ($20.00) dollars per day for every day that the dwelling unit is occupied without a Certificate of fitness. A$25.00 check payable to the City of Salem is required for each unit inspected at the time of inspection. A property owner is required to pay gas and electricity for residential tenants if there is not a written letting agreement stating the tenant is responsible for those utilities and if the meter(s) records electricity and gas use which is not used exclusively by that tenant. The Department of Public Utilities has billed property owners for their tenant's entire utility bills retroactive to the date of initial occupancy in cases in which cross-metering has been proven to exist. For he Board of Health Reply to Jo ane Scott MPH, RS, CHO Pablo Valdez Health Agent Code Enforcement Inspector CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#74-05 DATE ISSUED: 2/2/05 Property Located at: 14 Albion Street UNIT#2 Owner/Agent: Duarte Machado Address: 14 Albion Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 741-4838 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. FO HE BOARD OF HEALTH JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS ..7l��� BOARD OF HEALTH • • 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 j TEL. 978-741-1800 � FAX 978-745-0343 -- STANLEY USOVICZ, JR. _ JOANNE SCOTT, MPH, RS; CHO MAYOR HEALTH AGENT IC T APPL A ION 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 AXiDL) E UNIT# IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT•BACK•PLEASE CIRCLE ONE OWNER/LESSER bUa,fE M® Ch?)CJ MANAGER/AGENT_71- 0a 1'C No P.O. BoxA No P.O. Box ADDRESS /y �1�6 GAJ U ADDRESS CITY �_T9/e-kyi CITY RESIDENCE PHONE c�,F- '/W- Ye0f BUSINESS PHONE (24 HRS.) BUSINESS PHONE_ TOTAL NUMBER OF ROOMS: S ROOM-USE: 16?JrOtlr 2.�b+t 3.deo/rOd 4. 4A*A �. 5.A k4el; . 6.64 m'�. 8. 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. APPLICANTS SIGNATURE ' INSPECTORS USE ONLY DATE OF INITIAL INSPECTION/-)`> o`3 DATE OF REINSPECTION________ DATE OF ISSUANCE OF CERTIFICATE)-�, DATE FEE PAID:_ - _Y-2 TYPE.OF UNIT: DWELLI _OTHER_.__. CHECK # � CHECK DATE NOTES:_, _ CODE ENFORCEMENT INSPECTOR 9/28/98 _,r CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • • 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-,0343 STANLEY LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO - MAYOR HEALTH AGENT RELEASE In accordance with Massachusetts General Laws Chapter III Code of Massachusetts Regulations 410.000 et. seq. ; State Sanitary Code Chapter 1L and Article hill 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 author- ized 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/our absence, i= /we expressly authorize the same and for my/our successors and assigns hereby release and discharge the City of Salem, Salem Board of Health and its authorized frow any loss or injury sustained of whatever nature and description occasioned by my/out absence during said inspection. ai_rcr a . fe Q c T.°.ltil: T L SSE OWNER/irSSOR. - -- i.bo » ;t>itiG SS/ ' — — --------- O( nd _Pdd/Z. ADDRESS OF UNIT 'ro BE Ii:SPECTED 02 S- O-S +p, 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#512-07 DATE ISSUED: 10/15/2007 Property Located at: 18 Albion Street UNIT# House Owner/Agent: John &Ann Thibeault Address: 44 Greenbrook Road City/Town: S. Hamilton, MA Zip Code: 01982 24 Hour Phone: 468-7336 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 f- J NNE SCOTT, MPH, RS, CHO f HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS L '��0� BOARD OF HEALTH V • • 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO Kimberley Driscoll HEALTH AGENT Mayor 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 L2 9 , � UNIT#_ IS THIS UNIT DESIGNATED AS RICHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNERILESSERQiN/l4�YYi- O�D�r��D � MANAGER/AGENT No P.O. Box r1No P.O. Box ADDRESS 4( fP- �MQ h p -/Q �ADDDRESS CITY,a9 b� !)11� i. 019 %`iTY RESIDENCE PHONE BW&&EEPHONE (24 HRS.) q_ -B 3 9 S PHONE g 9 lic 7 jj- TOTAL NUMBER OF ROOMS: � ROOM USE: 12. V 34 ��Loa vie/ 5. 6. h.a�7. 8. 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. / APPLICANTS SIGNATURE �'ilAiL 1/Ll . 4A.(�-DATE / O -/�- 7 INSPECTORS USE ONLY DATE OF INITIAL INSPECTION A J/ (/,,7 _DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: 10 iS e� DATE FEE PAID:_/c//9 TYPE OF UNIT: DWELLINGL/ THER CHECK # CHECK DATE /D/gle2 NOTES: SQL HG\)ZS ,r.Th2A %NN Sly r>a Q, 1,4 �'aTa�. Mei, NenF,� a v?aa��e�b� � 1-caxso;�._1.�"•. COD— E�CEMENT INSPECTOR 9/28/98 w CITY OF SALEM, MASSACHUSETTS • ; BOARD OF HEALTH a 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 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 Owner/Lessor Address Addres Address on unit to be inspected 17 Date I CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 - STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#552-04 DATE ISSUED: 12/21/04 Property Located at: 20 Albion Street UNIT# Owner/Agent: Jason Huegel Address: 17 East Street City/Town: Middleton, MA Zip Code: 01949 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 n 70ANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE EN ORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • 120 WASHINGTON STREET, 4TH FLOOR 3 SALEM, MA 01970 TEL. 978-741-1800 J FAX 978-745-0343 STANLEY USOVICZ„1R. JOANNE SCOTT, MPH,PH, IRS, CHO MAYOR 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 7_�o A ( i� S I 1UNIT#_ IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER7: j At IQ_ � MANAGERGENT No P.O. Box l 'te /A r' No P.O. Box ADDRESS JnDI�4St C� ADDRESS CITY fftMT>(Q,o)n, iCaA CITY RESIDENCE PHONE BUSINESS PHONE (24 HRS.) BUSINESS PHONE TOTAL NUMBER OF ROOMS: L / ROOM USE: 1. !1// 2. /")m ei r 4. 4 5. _6._ _7. 8. 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. APPLICANTS SIGNATURE JVO L DATE INSPECTORS USE ONLY DATE OF INITIAL INSPECTION /1Zl"4s/ DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: Y DATE FEE PAID: 12I Z614 - TYPE OF UNIT: DWELLING _e/OTHER_ CHECK# _CHECK DATEA NOTES: AlWiSA i l"_ 140, I.NVei c& Fen 2 a4- 2- r vmwowe_r�� � a�vs_Icrl- oViE _ALWA Af CODE ENFO CEMENT INSPECTOR 9/28/98 9 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL. (978) 741-1800 IQMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR D(,Itr.[;NBAUM@SAI,rm.com DAVID GREkNBAUM ACE'ING 1-1I3AI.T1 i AGEN'r CERTIFICATE OF FITNESS CERTIFICATE#342-10 DATE ISSUED: 7/20/2010 Property Located at: 20 Albion Street UNIT#3 Owner/Agent: Emenagildo Pacheco Address: 27 Albion Street#2 City/Town: Salem, MA Zip Code: 01970 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 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 130 � OF HEALTH DAVID GREENBAUM ACTING HEALTH AGENT CODE EN CEMENT INSPECTOR 4 � CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH �. 120 WASHINGTON STREET,4"'FLOOR i TEL.(978)741-1800 I{IMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGREENDAUM SALEM.COM .DAVID GREENBAUM, ACTING HEALTH 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." FLEE: $50.00 ) WPERTY LOCATED AT N 6 S"1 UNIT# 3 -_ IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK.PLEASE CIRCLE ONE WNER/LESSEREEDJYI �06eJ QO �8CNE�OMANAGERtAGENT )P.O. BOX 3DRESS ADDRESS o/ l Mb(v- 1 cL TY, STATE,ZIP–S G I(� CTTY, STATE, ''SIDENCE PHONE �' -AS (3 / BUSINESS PHONE(24HRS) JSINESS PHONE )TAL NUMBER OF ROOMS: �)OM USE: 1 ll kL-ef) 2 �Q* 3 beck 4 W S. L0(fJ 6 L-(V 7 X -fOOM 8. 9. 10. ERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BARD OF HEALTH THIS FEE IS PAYABLE AT THE TIME OF INSPECTION PLICANT'S SIGNATURE T/Y�A�?0 /� Y_/���j v / DATE— ItMectors use only e on initial inspection: d / Date of reinspection: - •of issuance of certificate:_ 010 /0 Date fee paid: a e of unit: DwellingO� flier Check#_a�—(PCheck date: ::7 ,30// 0 es: U Vulul .. In ISG �i1 �{ In ffitifS rr 0 lhck ba.f". mG A v� C te, b,aCr. 4,P V1 b]Ve- e ee cement Inspector CITY OF SALEM a HEALTH DEPARTINEHT ❑ MpWED - LEFT NO ADDRESS p� ma6p a J ry NINE NORTH STREET ATTEMPTED - NOT KNOWN I T'�'� SALEM, MASSACHUSETTS 01970-3928 a�k[i�lr❑ UNCLAIMED ❑REFUSED as =rttR 16.5.POSTA J ❑ VACANT ❑NO MAILBOX , 8415454 ❑ DECEASED MIM0 INSUFFICIENT ADDRESS SFNOF9 ❑ FORWARDING ORDER EXPIRED I ❑ NO SUCH STREET ❑NUMBER �~ (PEEL OFF-UPDATE CUSTOMER LIST) Amy M. Newton 27 Albion Street Salem, MA 01970 t •a`' • LI Y 7 iij-' i ar.Iv 22 .1'111 Iti16�iY'll(i lil�'i{sii 16�41)113�lfiUlx,Yli�t'll{11(111��