1000 Loring Ave #B-096 and #A-095 Certificate of Fitness Application 2-13-2018 ca
CITY OF SALEM, MASSACHUSETTS
y� 1 BOARD OF HEALTH
\ 120 WASHINGTON STREET 4''-`FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR LRnMniN )SALEM.COM C,10
LARRY RAMDIN,RS/REHS,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 AT 1000 LORING AVENUE UNIT# B-096
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER LORING TOWERS MANAGER/AGENT YVETTE VALERIO
NO P.O.BOX
ADDRESS 1000 LORING AVENUE ADDRESS
CITY, STATE,ZIP SALEM, MA 01970 CITY, STATE, ZIP
RESIDENCE PHONE BUSINESS PHONE(24HRS)
BUSINESS PHONE 978-745-2055
TOTAL NUMBER OF ROOMS: 1
ROOM USE: 1.Livin room 2.Kitchen 3.13athroom 4.Bedroom 5.Bedroom
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 f J
APPLICANT'S SIGNATURE v L DATE
Inspectors use only
Date on initial inspection: < �0 _ Date of reinspection:
Date of issuance of certificate:_ _ Date fee paid:
Type of unit: Dwelling Other Check#_ Check date:
Notes:
n
Code f ,r ent Inspector
. 6
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
I 120 WASHINGTON STREET,4'FLOOR
TEL. (978) 741-1800
K NMERLEY DRISCOI-L FAX(978) 745-0343
MAYOR LRANIDIN@SALEM.CONI
LARRY RAIVIDIN,RS/REHS,CHO,CP-FS �11� D
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 1000 LORING AVENUE UNIT# A-095
IS THIS UNIT DISIGNATEO AS RIGHT LEFT FROM OR BACK,PLEASE CIRCLE ONE
OW-NER/LESSER LORING TOWERS MANAGER/AGENT YVETTE VALERIO
NO P.O.BOX
ADDRESS 1000 LORING AVENUE ADDRESS
CITY, STATE;ZIP SALEM.. MA 01970 CITY, STATE,ZIP
RESIDENCE PHONE _ BUSINESS PHONE(24HRS)
BUSINESS PHONE 978-745-2055
TOTAL NUMBER OF ROOMS: 2
ROOM USE: 1.Livin,sroom 2.Kitchen 3.13athroom 4.Bedroom S.Bedroom
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
1 E
APPLICANT'S SIGNATURE.? DAT t U J
J Inspectors use only
Date on initial inspection: 3 a _ _ Date of reinspection:
Daie of issuance of certificate: _ Date fee paid:
Type of unit: Dwelling -Other----Check# _Check date: —
Notes:
Code r r^.ent Inspector