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WILLSON STREETWILLSON STREET Kimberley Driscoll Mayor CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 5/18/06 Herbert & Cynthia Mallard 7 Willson Street Salem, MA 01970 PROPERTY LOCATED AT 7 Willson 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. 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. Fr the Board of He th 'Joanne Scott MPH, RS, CHO Health Agent Reply to Pablo Valdez Code Enforcement Inspector JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CERT.# 185-97 FEE $25.00 DATE: 03/27/97 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 C41Jsy1//;11N1Y4_011111111) M9101,L PROPERTY LOCATED AT: 7 Willson Street OWNER/AGENT: Herbert Mallard ADDRESS: 7 Willson Street I CITY/TOWN: Salem, MA ZIP CODE: 01970 UNIT #: I 24 HOUR PHONE: 825-1742 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 410.400 (B): DWELLING UNIT (X) AND 410.400 (C): ROOMING UNIT ( 1 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 qv_v_ lx� JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT Q_4� CODE ENFORCEMENT INSPECTOR CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 / t5.91 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 AT 7 Lil UNIT OWNER/LESSER /--e-q A ea 7 A Alli L/i a MANAGER/AGENT ADDRESS CITY RESIDENCE PHONE / 7' BUSINESS PHONE ADDRESS CITY BUSINESS PHONE (24 HRS.) TOTAL NUMBER OF ROOMS: 3 ROOM USE: I. 2. 3. 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 SIGNATURi2 �� � �rZa1 DATE_3�7 _ LNSPECTORS USE ONLY DATE OF INITIAL INSPECTION: rJ 7 DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE:_ 7 `7 ! DATE FEE PAID: 3'd 7 7 TYPE OF UNIT: DWELLING OTHER NOTES: CODE ENFORCEMENT INSPECTOR KIMBERLEY DRISCOLL MAYOR JOANNE SCOTT, HEALL TH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4` FLOOR TEL. (978) 741-1800 FAx (978) 745-0343 7SCOP1SALEP4 COM CERTIFICATE OF FITNESS CERTIFICATE # 402-08 DATE ISSUED: 8/19/2008 Property Located at: 7 Willson Street UNIT # 2 Owner/Agent: Herbert Mallard Address: 7 Willson Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-930-6669 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 � / � 9 'JOT OANNE SCT, MPH, RS, CHO , �'#A °Gi HEALTH AGENT CODE tNF6RT INSPECTOR KIMBERLEY DRISCOLL MAYOR JOANNE SCOTT, HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 47 FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 1SCOTr SArasx. COM qua-� 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 7 "l/ 1 f 5 D n 5-r UNIT#-_ IS THUS UNIT DISIIG�fNAT%ED AS JRIGHT LEFT FRONT OR BACK, PLEASE CIRCLE ONE OWNER/LESSER j T ! J(3 / i9lla �Q MANAGER/ AGENT NO P.O. BOX ADDRESS ADDRESS ?9I— CITY, STATE, ZIP S g f e R'% 1'" 1 A 0 l 4;'0 CITY, STATE, ZIP, RESIDENCE PHONE jZ -7 y0 6040 BUSINESS PHONE (24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS:— ROOM OOMS:ROOM USE: 1. be a f00M 2. &ea 0001 �L CH�1 a L; V Jv1gP-00y1 THERE IS A FIFTY ($50) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE IS PAYAW AT THE /TTIME OF n G r✓ APPLICANT'S SIGNATURE Y' DATE n ! 015 Inspectors use only Date on initial inspection: $ 1 n, -o Date of reinspection: Date of issuance of certificate: Date fee paid: 5r—) Q -d SP Type of unit: Dwelling ✓ Other Check # ) 0 -Q %� rode(Enfoi ement Inspector Kimberley Driscoll Mayor City of Salem, Massachusetts Board of Health 120 Washington Street, 4th Floor, Salem, MA 01970 Tel. (978) 741-1800 Fax. (978) 745-0343 health@salem.com CERTIFICATE OF FITNESS CERTIFICATE #: GHL-17-220 DATE ISSUED: 7/27/2017 Property Located at: 11 WILLSON STREET UNIT #2 Owner/Agent: Alexander Moutsoulas Address: 5 Pine Street City/Town: Peabody, MA Zip Code: 01960 lu PublicHealth Prevent. Prnmol e. Prounl. Larry Ramdin, MPH, REHS, CHO Health Agent 24 Hour Phone: (978) 314-4191 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. Larry Ramdin, MPH, REHS, CHO HEALTH AGENT EGagakis SANITARIAN • CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4T" FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX (978) 745-0343 MAYOR LRAMDIN@SALEM.COM LARRY RAMDIN, RS/REHS, CHO, CP -FS HEALTH AGENT £mast ' C1M6l-iso') lqs@, 4 ✓e . cow, 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 �' IISO'4 ST , UNIT# IS THIS UNIT DISIGNNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE OW ESSER /7��XGfNde� MANAGER/ AGENT 51� as Oiv^c *' NO P.O. BOX 1 ADDRESS irJvl e ST ADDRESS CITY, STATE, ZIP MA ' C)l q6o CITY, STATE, ZIP RESIDENCE PHONE 17 �' 3 /y. Y/q� BUSINESS PHONE (24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: 1 ROOM USE: 1. &A 2. 3. 4. ISI / 5. lAll ni 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 TE -7. Z5'I7 Inspectors use only Date on initial inspection: � /a 5(1 % Date of reinspection: Date of issuance of certificate: Date fee paid: I% Type of unit: Dwelling Other Check # a 1 Check date: —r Code iVorcko4ntlnspector CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT AU_ PROPERTY LOCATED AT: 21 Willson Street OWNER/AGENT: Gail A. Palombo ADDRESS: 21 Willson Street #1 CERT.# 10-98 FEE $25.00 DATE: 01/08/98 UNIT #: 2 CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 740-0532 NINE NORTH STREET Tel: (978) 741-1800 Fax: (978) 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 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 qvl"C_x� "1.1� JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 ld F 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 AT � OWNER/LESSER 6 A (L A I I I't i..OH6D ADDRESS 1, 0 1 �1,( J KA - .,RESIDENCE CITY iq (--��� 1 7�' A- RESIDENCE PHONE '�-57�/ ��<7: 2 qo- 0 S 3 Z BUSINESS PHONE ff ! �' / - v'S a `I( saw s� TOTAL NUMBER OF ROOMS: ROOM USE: 1.2.3 5. hngrttl 6. 7 MANAGER/AGENT ADDRESS CITY UNIT # 2 BUSINESS PHONE (24 HRS.) ..8. THERE IS A TWENTY-FIVE (25.0)0) DO FEE, AY LE BY CHECK OR MONEY ORDER TO THE CITY OF SALEH HEALTH DE NT FEE IS A ABLE AT THE TI)KL OF fIN PE ION APPLICANTS SIGNATURE _DATE v -- INSPECTORS USE ONLY DATE OF INITIAL INSPECTION:���= �-YDA'TE OF REINSPECTION _ DATE OF ISSUANCE OF CERTIFICATE: � ( F DATE FEE PAID; TYPE OF UNIT: DWELLING/ OTHER NOTES: CODE ENFORCEMENT INSPECTOR KIMBERLEY DRISCOLL MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4' FLOOR TFL. (978) 741-1800 Fax (978) 745-0343 Ixamdinia"�.salem.com CERTIFICATE OF FITNESS CERTIFICATE # 21-14 DATE ISSUED: 1/30/2014 Property Located at: 23 Willson Street UNIT # 1 Owner/Agent: Mareedan Cheever Address: 8 Kinsman Street City/Town: Beverly, MA Zip Code: 01915 24 Hour Phone: 781-596-4559 IV PublicHealUl Prevent. Promote. Protect. LARRY RAMDIN, RS/RElfS, (1110, CP -PS HFAL171 AGENT 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 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. j{�R THE BOA OF HE LTH LARRY RAMDIN / U HEALTH AGENT SANITARIAN KMIBERLEY DRISCOLL MAYOR CITY OF SALEM, IVMASSACHUSETI S BOARD OF HEALTH 120 WASHINGTON STREET; a FLOOR TEL (978) 741-1800 FAX (978) 745-0343 lramdin@salem.com V. gvq PtlblicNeauh R Mn4 F"mo n. P t<ct. LARRY RAMDIN, RS/RENS, CHO, CP -FS 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 IS THIS UNIT DISIGNATED AS RIGHT LENT FRONT OR BACK PLEASE CIRCLE ONE OWNER/LESSER mC, &-01c 1-, Ck&&V'�— MANAGER/AGM NO P.O. BOX ADDRESS ADDRESS CTfY;. STATE, ZIP MO– 0 19 1 � CHY, STATE, ZIP RESIDENCE PHONE USINESS PHONE (24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. THERE IS A FIFTY ($50) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE IS PAYABLE AT THE TIME OF INSPECTION APPLICANT'S Inspectors use onluse only 1-.30 -� j N Date on initial inspection: I -. '� � H Date of reinspection: Date of issuance of certificate: l ' 'Z$'')\� Date fee paid: Type of unit: Dwelling `� Other Check #_21 Check date: Notes: CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 23 Willson Street OWNER/AGENT: Merle Cheever ADDRESS: 23 Willson Street CITY/TOWN: Salem, MA ZIP CODE: 01970 CERT.# 194-02 FEE $25.00 DATE: 04/17/2002 UNIT #: 1 Right 24 HOUR PHONE: 745-0196 AN INSPECTION OF YOUR VACANT DWELLING/ROOMING UNIT AT THE ABOVE ADDRESS HAS BEEN APPROVED AND IS IN COMPLIANCE WITH 105 CMR 410.000: MASSACHUSETTS STATE SANITARY CODE, CHAPTER II, "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" THEREFORE, THIS CERTIFICATE IS ISSUED BY THE CODE ENFORCEMENT DIVISION OF THE SALEM BOARD OF HEALTH AND THE UNIT MAY NOW BE RENTED AND/OR OCCUPIED. MAXIMUM NUMBER OF OCCUPANTS, BASED ON 105 CMR 410.000: MASSACHUSETTS STATE SANITARY CODE, CHAPTER II, "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" SECTION 410.400 (B): DWELLING UNIT (X) AND 410.400 (C): ROOMING UNIT MINIMUM SQUARE FOOTAGE FOR SLEEPING PURPOSES: . NOTE: THIS APPROVAL DOES NOT CERTIFY COMPLIANCE WITH THE STATE LEAD LAW FOR OCCUPANTS UNDER 6 YEARS OF AGE. FOR MORE INFORMATION CALL 978-741-1800. FOR THE BOARD OF HEALTH JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • ! 120 WASHINGTON STREET, 4TH FLOOR C$ SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. ,JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 23 Willson Street OWNER/AGENT: Merle Cheever ADDRESS: 23 Willson Street CITY/TOWN: Salem, MA ZIP CODE: 01970 CERT.# 194-02 FEE $25.00 DATE: 04/17/2002 UNIT #: 1 Right 24 HOUR PHONE: 745-0196 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, 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. FOR MORE INFORMATION CALL 978-741-1800. FOR THE BOARD OF HEALTH JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR o g� v i STANLEY USOVICZ, JR. MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA O1970 TEL. 978-74 1 -1 800 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 -4 3 W r �'S/J r7 UNIT # /II', 0,52- IS oZ IS THIS UNIT DESIGNATED A RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER i'11er� Ghe'tVltMANAGER/AGENTm Iiiu, G A.P-!✓t- No P.O. Box No P.O. Box ADDRESS_ 2 3 u% ADDRESS 23 J� CITY a CITY -S 61 /.,1- RESIDENCE .,1 RESIDENCE PHONE 5 7 ?-_74S7046USINESS PHONE (24 HRS.) BUSINESS PHONE C .7? `7 40 - C/ 33 TOTAL NUMBER OF ROOMS: 9 - ROOM ROOM USE: 1. k l4 2./�. b'd 4. e1 r �( R 7 R 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 SIGNATUREDATE - % - 02 - INSPECTORS USE ONLY DATE OF INITIAL INSPECTION t -7 o ? DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: - L DATE FEE PAID: � 7 Z Z' TYPE OF UNIT: DWELLING OTHER_ CHECK # ( CHECK DATE - ( 7 -o CODE ENFORCEMENT INSPECTOR t :e: n STANLEY USOVICZ, JR. MAYOR 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 RELEASE In accordance with Massachusetts General Laws Chapter III; Code of Massachusetts Regulations 410.000 et. seq.; State Sanitary Code Chapter II and Article XIII of rite i;ity 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 agen�s from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. T'NANTIT _� 6N 111;-41l7 / J 7 ADDr,FSS -- ----- DAPS NNER/LESSOR. ADDRESS ADDRES'S OF UNIT TO BE INSPECTED Kimberley Driscoll Mayor City of Salem, Massachusetts Board of Health 120 Washington Street, 4th Floor, Salem, MA 01970 Tel. (978) 741-1800 Fax. (978) 745-0343 Iramdin@salem.com CERTIFICATE OF FITNESS CERTIFICATE #: GHL-16-134 DATE ISSUED: 4/26/2016 Property Located at: 23 WILLSON STREET UNIT #2 Owner/Agent: Jerry Kot Address: 19 Tamarack Lane Cityrrown: Peabody, MA Zip Code: 01960 O PublicHealt 1 Prevent. Promote. Protect. Larry Ramdin, MPH, RENS, CHO Health Agent 24 Hour Phone: (781) 588-3024 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. FOR THE BOARD OF HEALTH Larry Ramdin, MPH, REHS, CHO HEALTH AGENT d SANIT AN KIMBERLEY DRISCOLL MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4p1 FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 lramdin@salem.com IJ PublicHealth Prevent. Promote, Protect, LARRY RAMDIN, RS/1U,'1-1S, 0-10, (T -FS W."At,'n-i 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 23 U/ L/ S 0.� S T 5 fl L Ell A/ /T UNIT# .2 IS THIS UNIT DISIGGNATED AS RIGHT LEFT FRONT OR BACK. PLEASE CIRCLE ONE OWNER/LESSER J RZ Y /<07- MANAGER/ AGENT NO P.O. BOX _ ADDRESS Jy /A/'9A/�k(.11 L.0 ADDRESS CITY, STATE, ZIP 1,6W 130f9 ! /%A Cil ?6 0 CITY, STATE, ZIP. RESIDENCE PHONE BUSINESS PHONE BUSINESS PHONE 7,9 / "— 7 - 9' 3 0,2 L/ TOTAL NUMBER OF ROOMS: ROOM USE: 1. 2. 3. 4. 5. 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 lam' � kOl— DATE /f Inspectors use only Date on initial inspection: OV292P01-6 Date of reinspection: Date of issuance of certificate: O c ZSg I Date fee paid: Type of unit: Dwelling Other Check #Check date:�S�2r7� C d orcemen Spector KIMBERLEY DRISCOLL MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEAL"FH 120 WASHINGTON STREET, 4"t FLOOR TELL. (978) 741-1800 FAx (978) 745-0343 Iramdin(a salem.com Release PublicHealth Prevent. Promote. Protect, LARIl]' 1Z AMDIN, RS/REl-IS, CI 10, CP -FS Hi.;,\L 'H AGI.±N'I' 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 Date Updated 523/11 Owner/Lessor Address Address on unit to be inspected CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH 120 WASHINGTON STREET, 4" FLOOR TEL. (978) 741-1800 KIIv1BERLEY DRISCOLL FAX (978) 745-0343 MAYOR DGREBNBAUM&ALE:M.COM DAVID GRF'ENBAum, RS ACTING HFAI:.TI-I AGENT CERTIFICATE OF FITNESS CERTIFICATE # 142-11 DATE ISSUED: 5/11/2011 Property Located at: 23 Willson Street UNIT # 2 Owner/Agent: Merle Cheever Address: 23 Willson Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-596-4559 An inspection of your vacant Dwelling/Rooming Unit at the above address has been approved and is incompliance 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 Tim HEALTH G DAVID REENBAUM, RS ACTING HEALTH AGENT CODE ENFORCEMENT INSPECTOR """Certiflcate issued on condition that all radiator covers be put on radiators. "m irAffyr f 41la-' radtOur J �� U0( o-) PQ �ltG�orC ��►ntr� KIMBh;R,LE[Y DRI SCOH, MAYOR DAVID GREENB, U'M, R8 ACTING HI .\I:FH Acr.\1' CIn' OF SALE I, 'NIASSACHUSETTS BUiRU OF III \U1TJ 7211��'\SF11\t It>NSARI I '1'7,OOR T6 -I- (97 H) 741-1800 h v� ()78) 745-0343 t)tRP�'V ttu'�I(ri`::\l.lc�t CO`{ 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 I ( FEE: $50.0,0j/ `S" t PROPERTY LOCATED AT l// LIQ Sc� omfL, �t 4 V 1970 UNIT# IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK, PLEASE CIRCLE ONE ro OWNER/LESSERMQ(-,0, cVG6 '"l am MANAGER/ AGENT ADDRESS r),3 IIIS6� 5-F ADDRESS CITY, STATE, ZIP �t- 'v I I q D CITY, STATE, ZIP q RESIDENCE PHONE I7z "cl Q- BUSINESS PHONE (24HRS) l �� / b^ � S 0/ BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 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 TE5:.—_./ Inspectors use only Date on initial inspection: I I I Date of reinspection: Date of issuance of certificate: S 11 11 Date fee paid: s // // / Type of unit: Dwelling Other Check # J U I Check date: Cod Enfol cement Inspector ICIMBERLEY DRISCOLL MAYOR DAVID GRE ;NBAUM ACTING HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4"" FLOOR TEL. (978) 741-1800 FAx (978) 745-0343 DGRI:i IiNI3AU M@SAI.P. M.CQM CERTIFICATE OF FITNESS CERTIFICATE # 269-10 DATE ISSUED: 6/7/2010 Property Located at: 34 Willson Street UNIT # 3 Owner/Agent: Tamy Mendez Address: 34 Wilson Street City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-836-7547 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 AU Y, DAVID GREENBAUM !/ ACTING HEALTH AGENT CODE E F RCEMENT INSPECTOR KIMBERLEY DRISCOLL MAYOR DAVID GREENBAUM, ACTING HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4"' FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 DGRELNnAUMQSALFM. 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 'ROPERTY LOCATED AT (� I W 113w\) 6-t . I NTT# CA, IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE )WNER/LESSER- �7 s./ �ty�.,c, MANAGER/AGENT O P.O. BOX —T 'TTY, STATE, ZIP_/�/� � /S� CITY, STATE, ZIP ®L ZA 7 ESIDENCE PHONE t% .27�— SY y, D S 61 BUSINESS PHONE (24HRS) Swim 9 USINESSPHONE 9-�—o23q—�,(L��2L,y OTAL NUMBER OF ROOMS: OOM USE: HERE IS A FIFTY ($50) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM DARD OF HEALTH THIS FEE IS PAYABLE AT THE TIME OF INSPECTION PPLICANT'S ate on initial inspection: I (7 Date of reinspection: ite of issuance of certificate: (01-7710 Date fee paid: (P 7h +pe of unit: Dwelling --o flier 9 Check # C� � 3 Check date: �© C( )tes: WA 10 4I�-CJkVA . rkO ('b 1/) rr rhrn A- An/71/,o in / Sj' ode E rc nent Inspector CITY OF SALEM, IVIASSACHUSE'TTS BOARD OF HEALTH 120 WASHINGTON STRE)3,T, 4"' FLOOR TEL. (978) 741-1800 KIMBE'RLEY DRISCOJI, FAY (978) 745-0343 MAYOR ncai+i+Nlsnuti(�sni.rcnl.a�M DAVID GR ,'LNImuiN%RS AG HNG, FII?AI XI l AuL M, CERTIFICATE OF FITNESS CERTIFICATE # 587-10 DATE ISSUED: 12/29/2010 Property Located at: 38 Willson Street UNIT # 1 Owner/Agent: Walter O'Neil Address: 98 Keslar Avenue City/Town: Lynn, MA Zip Code: 01905 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 „! t Iff f� DAVID GREEA RS ACTING HEALTH HEALTH AGENT CODE ENFORCEMENT INSPECTOR I4MBERLEY DRISCOLL NLWOR 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 1)<aaatNitAU%I@S,u,l;N4.COSI 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 IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR OWNER/LESSER W p -L4 E= Z n 1 1�� 1 MANAGER/ AGENT NOP .O. BOX ADDRESS q2 (f ADDRESS CITY, STATE, ZIP L,, 07h 0% I C! CITY, STATE, ZIP ONE RESIDENCEPHONE 28)-5-99-9a9'? BUSINESSPHONE (24HRS) 0-697-0/% BUSINESS PHONE 7%g -r 9-2" ng ()'3 1 TOTAL NUMBER OF ROOMS:hi a � ROOM USE: 4 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 Date on initial Inspectors use only Date of reinspection: Date of issuance of certificate: Date fee Type of unit: 'Uk Dwel'ling Otheaar--� Check # add( d, Notes: 'W /I (fi oJ/-- (//1(U✓ iJ � <ii i k, d( V _ C Enfo cement Inspector mold KIMBERLEY DRISCOLL MAYOR DAVID GREENBAUM, RS ACTING HF Lfi f AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASI-11NGTON STREET, 4°1 FLOOR Tom_. (978) 741-1800 FA,x (978) 745-0343 rxaiiar.Nisnuat(�snia:m�. CO:�L Release In accordance with Massachusetts General Laws Chapter I 11; 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 Address Date Owner/Lessor Address Address on unit to be inspected CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH s 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 �0y1Ne TEL. 978-741-1800 STANLEY J. USOVICZ, JR. FAx 978-745-0343 MAYOR WWW.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE # 592-05 DATE ISSUED: 9/23/05 Property Located at: 38 Wilson Street UNIT # 1&2 Owner/Agent: Walter O'Neil Address: 98 Keslar Avenue City/Town: Lynn, MA Zip Code: 01901 24 Hour Phone: 781-599-8297 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 HJ=ACTH JOANNE 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 HEALTH AGENT APPLICATION FOR CERTIFICATE OF FITNESS a oo L/) q IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT 3$ W 1 ISO r\ UNIT #_ V IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER WAL-irQolf)vd MANAGER/AGENT, No P -O. Box No P.O. Box ADDRESS %S &6)ar, a t,< ADDRESS CITY CITY mqq RESIDENCE PHONE Al `S99" M) BUSINESS PHONE (24 HRS.) BUSINESS PHONE m-692-OqZ TOTAL NUMBER OF ROOMS: 6 ROOM USE: 1. rnn--��h 2.�'ut�_ A)_3.J4__4.�C�P-60 5X�_6._&6m 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 �V //f�J�, J _DATES INSPECTORS USE ONLY DATE OF INITIAL INSPECTION �'�/_TiS .DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE!T� t f DATE FEE PAID:_ TYPE OF UNIT: DWELLING�IOTHER_ CHECK # UQ CHECK DATE NOTE�i—%LTVLT = L` _%� &-\ ----- — CODE ENFORCEMENT INSPECTOR 9/28/98 • ( CITY OF SALEM, MASSACHUSETTS - BQARD (')F HF,Auni 120 WASHINGTON STREET, 4." FI:.00R TEL (978) 741-1800 KIMBEK, :Y DRISCOI:,L FAX (978) 745-0343 MAYOR DGREkNBAUMG( SAI.ISM.COM DA v iD Gm: irN BA u,%% RS AC'1'1NG HrSA).CI-I AGISNI' CERTIFICATE OF FITNESS CERTIFICATE # 586-10 DATE ISSUED: 12/29/2010 Property Located at: 38 Willson Street UNIT # 2 Owner/Agent: Walter O'Neil Address: 98 Keslar Avenue City/Town: Lynn, MA Zip Code: 01905 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 I DAVID GREENBAU S "I ACTING HEALTH AGENT CODE ENFORCEMENT INSPECTOR t KIMBERLEY DRISCOLL MAYOR DAVID GREENBAUM, RS .ACTING HEAIm-I AGENT S6 b - o CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON' TREET, 4"" FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 1D(;R1TNl3All 1g_SA1.1 1. 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 3 $ C L) '% 1160 n <A- o 4 P6119, UNIT#_�2 IS THIS UNIT DISIGNATTED `AS RIGHT LEFT FRONT OR BACK, PLEASE CIRCLE ONE OWNER/LESSER W 4LdER n 1 � ICti 1 MANAGER/ AGENT NO P.O. BOX I_ ADDRESS/c f G UC ADDRESS CITY, STATE, ZIP Lyhn MQ (3/90.5— CITY, STATE, ZIP r RESIDENCE PHONE 26%- 5Y9- �o2Q % BUSINESS PHONE (24 s) BUSINESS PHONE 9)S-69)--491)3 1 TOTAL NUMBER OF ROOMS: nnfR1+^ ROOM USE: 1. kN')C)'CT\ 2.L // iyt!� ?n 3. I,Xct60M 14. �f>7n )- 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 PA ABLE AT E TIME OF INSPECTION APPLICANT'S SIGNATURE i� U DATE-�9 o10%0 Inspectors use only Date on initial inspection:_ / Date of reinspection: Date of issuance of certificate: c� V/0 Date fee paid: Id Jd q /O Type of unit: DwellliIn ✓OIther Check # I1 Checkl date: 13 Id Notes: 1) l➢ /`G�l bolI . rorvr� ,; iie m end-G,�/ d— Inspector ICM ERLEY DRISCOLL MAYOR DAVID GREENBAUM, RS ACTING HE.ALTH AGENT _ CITY OF SALEM, MASSACHUSETTS BOARD (.)F HEALTH 120 WAST-IINGTON STREET, 4"' FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 D(1RI!FNI;AUM(!f'AL.HM. COM 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 Date Owner/Lessor Address Address on unit to be inspected