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116 Lafayette Street #104 Rooming House Inspection 8-20-2018 ..c t� RELEASE In accordance with the State Sanitary Code Chapter II; Chapter 2-705 of the City of Salem Ordinance; Mass General, Laws, Chapter 140, Section 25; Mass General Laws, Chapter 148, Section 4; and CMR 780.115.6 the undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health, Salem 'Licensing Board, Salem Fire Prevention, Salem Building Inspector and other City departments or their 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/our 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, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and their authorized agents from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. Tenant/Lessee Owner/Lessor Address J Address [41 � Address of unit to be inspected V Date RELEASE In accordance with the State Sanitary Code Chapter II; Chapter 2-705 of the City of Salem Ordinance; Mass General Laws, Chapter 140, Section 25; Mass General.Laws, Chapter 148, Section 4; and CMR 780.115.6 the undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and other City departments or their 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/our 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, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and their authorized agents from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. T�1 J i ) l 4", 4Tren t/Lesse Owner/Lessor 1 IRS Address ` Address Address of unit to he inspected Date RELEASE In accordance with the State Sanitary Code Chapter II; Chapter 2-705 of the City of Salem Ordinance; Mass General Laws, Chapter 140, Section 25; Mass General Laws, Chapter 148, Section 4; and CMR 780.115.6 the undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and other City departments or their 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/our 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, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and then authorized agents from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. Utu 11 ( I ( '1, Aenant/Lesse Owner/Lessor Address Address f Address of unit to be inspected Date RELEASE In accordance with the State Sanitary Code Chapter II; Chapter 2-705 of the City of Salem Ordinance; Mass General Laws, Chapter 140, Section 25; Mass General Laws, Chapter 148, Section 4; and CMR 780.115.6 the undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and other City departments or their 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/our absence. I/we expressly authorized the same and for my/our successors and assigns hereby release and discharge the City of Salem, Salern Board of Health, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and their authorized agents from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. q: enan essee Owner/Lessor Address Address l Address of unit be inspected _ U 7//�r Date RELEASE In accordance with the State Sanitary Code Chapter 11; Chapter 2-705 of the City of Salem Ordinance; Mass General Laws, Chapter 140, Section 25; Mass General Laws, Chapter 148, Section 4; and CMR 780.115.6 the undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and other City departments or their 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/our 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, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and their authorized agents from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. YGIeA fl. L. ' ,-, - ats4 Tenant essee Owner/Lessor ` Address Address Address of ui t to be inspected JI-7 i Date RELEASE In accordance with the State Sanitary Code Chapter 11; Chapter 2-705 of the City of Salem Ordinance; Mass General Laws, Chapter 140, Section 25; Mass General Laws, Chapter 148, Section 4; and CMR 780.115.6 the undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and other City departments or their 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 zny/our 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, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and their authorized agents from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. �,--e-a- Tenant/Lessee Owner/Lessor Address Address ,II ftc. / 6 Address of uni to be inspected f�!/ L7 - Date RELEASE In accordance with the State Sanitary Code Chapter II; Chapter 2-705 of the City of Salem Ordinance; Mass General Laws, Chapter 140, Section 25; Mass General Laws, Chapter 148, Section 4; and CMR 780.115.6 the undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and other City departments or their 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/our 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, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and their authorized agents from any loss or injury sustained of whatever nat and description occasioned by my/our absence during said inspection. I LL Tenant/Lessee Owner/Lessor I U��2 � t l �G Address Address III LC1S yef4t 5 -f 4' 2—ct f Address of unit to be inspected Date RELEASE In accordance with the State Sanitary Code Chapter II; Chapter 2-705 of the City of Salem Ordinance; Mass General Laws, Chapter 140, Section 25; Mass General.Laws, Chapter 148, Section 4; and CMR 780.115.6 the undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and other City departments or their 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/our 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, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and their authorized agents from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. N a, 4" essee Owner/Lessor CGS '�. Address Address /'/ Ll3fa efie st #Z aZ- Address of unit to be inspected Date RELEASE In accordance with the State Sanitary Code Chapter I1; Chapter 2-705 of the City of Salem Ordinance; Mass General Laws, Chapter 140, Section 25; Mass General Laws, Chapter 148, Section 4; and CMR 780.115.6 the undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and other City departments or their 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/our 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, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and their authorized agents from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. Tenant/Lessee Owner/Lessor I tit 2 r " I l Address Address Address of unit to be inspected Date RELEASE In accordance with the State Sanitary Code Chapter II; Chapter 2-705 of the City of Salem Ordinance, Mass General Laws, Chapter 140, Section 25; Mass General Laws, Chapter 148, Section 4; and CMR 780.115.6 the undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and other City departments or their 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/our 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, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and then authorized agents from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. a'a) N., Tenant/Lessee Owner/Lessor f � 7 I G fin- Address ,. Address La�a y eke s f 1*-20 7 Address of unit to be inspected Date RELEASE In accordance with the State Sanitary Code Chapter II; Chapter 2-705 of the City of Salem Ordinance; Mass General Laws, Chapter 140, Section 25; Mass General Laws, Chapter 148, Section 4; and CMR 780.115.6 the undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and other City departments or their 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/our 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, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and their authorized agents fi-om any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. Tenant/Lessee Owner/Lessor tdl-01 Address Address �-Wayelk Address of unit to be inspected Date RELEASE In accordance with the State Sanitary Code Chapter II; Chapter 2-705 of the City of Salem Ordinance; Mass General, Laws, Chapter 140, Section 25; Mass General Laws, Chapter 148, Section 4; and CMR 780.115.6 the undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and other City departments or their 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/our 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, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and their authorized agents from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. Tenant/Lessee Owner/Lessor Ja Address Address ,. 16 LI}�0. e eft sF, " 2- Address of unit to be inspected 4 Date RELEASE In accordance with the State Sanitary Code Chapter 11; Chapter 2-705 of the City of Salem Ordinance; Mass General Laws, Chapter 140, Section 25; Mass General Laws, Chapter 148, Section 4; and CMR 780.115.6 the undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and other City departments or their 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/our 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, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and their authorized agents from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. J4,J / Tenant/Lessee Owner/Lessor Address Address l l to Lo Sa y e tfe s T. Address of uni to be inspected 17 Date RELEASE In accordance with the State Sanitary Code Chapter I1; Chapter 2-705 of the City of Salem Ordinance; Mass General. Laws, Chapter 140, Section 25; Mass General Laws, Chapter 148, Section 4; and CMR 780.115.6 the undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health, Salem Licensuig Board, Salem.Fire Prevention, Salem Building Inspector and other City departments or their 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/our 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, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and then authorized agents from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. . e . Tenant/Lessee Owner/Lessor Address kJ Address t Na d a eta l 0307 Address of ui t to be inspected Date RELEASE In accordance with the State Sanitary Code Chapter II; Chapter 2-705 of the City of Salem Ordinance; Mass General Laws, Chapter 140, Section 25;Mass General Laws, Chapter 148, Section 4; and CMR 780.115.6 the undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and other City departments or their 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/our 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, Salem Licensing Board, Salem Fire Prevention, Salem Builduig Inspector and then authorized agents from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. Tenant/Lessee Owner/Lessor 12- Address �. Address LixS.ye-ffe 5-t '� 3 i 2— Address of unit to be inspected r7 F Date RELEASE In accordance with the State Sanitary Code Chapter II; Chapter 2-705 of the City of Salem Ordinance; Mass General Laws, Chapter 140, Section 25; Mass General Laws, Chapter 148, Section 4; and CMR 780.115.6 the undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and other City departments or their 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/our 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, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and their authorized agents from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. ?IV ) I` Want/Less Owner/Lessor w Address `.� Address �I� (.afa W-e ��, 3r5 Address of unit to ble inspected Cam , del j , Date RELEASE In accordance with the State Sanitary Code Chapter II; Chapter 2-705 of the City of Salem Ordinance; Mass General Laws, Chapter 140, Section 25; Mass General Laws, Chapter 148, Section 4; and CMR 780.115.6 the undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and other City departments or their 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/our 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, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and their authorized agents from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. L Tenant/Lessee Owner/Lessor L Address Address /4 Lafa ycfk sf- *31 � Address of unit to be inspected 4�T 17 1)?- Date RELEASE In accordance with the State Sanitary Code Chapter II; Chapter 2-705 of the City of Salem Ordinance; Mass General Laws, Chapter 140, Section 25; Mass General Laws, Chapter 148, Section 4; and CMR 780.115.6 the undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the Salem Board of Health, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and other City departments or their 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/our 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, Salem Licensing Board, Salem Fire Prevention, Salem Building Inspector and their authorized agents from any loss or injury sustained of whatever n4ture and description occasioned by my/our absence during said inspection. Tau Tenant/Lessee Owner/Lessor �l �Av& �3i g �� .-� 87 Address Address 1 � y-e#(? Address of unit to be inspected Date