32 Perkins Street #2 Certificate of Fitness Application 2-15-2018 r� CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
' 120 WASHINGTON STREET,4TH FLOOR
TEL. (978)741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR 1.RAMDINL0VSALEM.00M
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: .S50.00
PROPERTY LOCATED AT 32 Perkins Street UNIT# 2
IS THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER Congress St.Residences. MANAGER/AGENT NSCDC-Peabody Properties,Inc.
NO P.O.BOX
ADDRESS 106 Lafayette Street ADDRESS 96 Lafayette Street
CITY, STATE,ZIP_. Salem,MA 01970 CITY, STATE,ZIP_ Salem, MA 01970
RESIDENCE PHONE BUSINESS PHONE(24HRS)_ 978-745-4961
BUSINESS PHONE 978-745-8071
TOTAL NUMBER OF ROOMS: 4
ROOM USE: 1.Liv.Room 2.Kitchen 3. Bedroom 4.Bedroom 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 YABLE 4T THE TIME OF INSPECTION
APPLICANT'S SIGNATURE _DATE 2/12/18
Inspectors use only
Date on initial inspection: 1 Date of reinspection:
Date of issuance of certificate: Date fee paid: 01
Type of unit: Dwelling Other Check# 1J,0 Check date. 1 a,
Notes:
4, 0-
Code E ce nt Inspector