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ANDREW STREET CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH '.� 51 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 .� TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE# 179-05 DATE ISSUED: 3/10/05 Property Located at: 7 Andrew Street UNIT# 1 Owner/Agent: Michael Hill Address: 6 Albion Avenue City/Town: Stoneham, MA Zip Code: 02180 24 Hour Phone: 781-279-2323 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 JOA NE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 175-0-5 TEL. 978-741-1800 FAX 978-745-0343 STANLEY LISOVICZ, JR. ,JOANNE SCOTT, MPH, RS, CHO - MAYOR HEALTH AGENT APPLICATION FOR CERTIFICATE OF FITNESS IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM STANDARDS OFeF^IITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT I ���kW :3T UNIT# IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE MANAGER/AGENIT"iCY)Wl dill ADDRESS 17) Qnaa_w S ADDRESS �D9e- 1 CITY SaQw CITY ��U►"1 RESIDENCE PHONE_ BUSINESS PHONE (24 HRS.)a% BUSINESS PHONE TOTAL NUMBER OF ROOMS � 4 ROOM USE: 2.— 3. [Ce, 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. f APPLICANTS SIGNATURE _DATE INSPECTORS U9E ONLY DATE OF INITIAL INSPECTION 3 t Z �/ DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE:-j-zp-6- DATE FEE PAID: -3 �l�> TYPE OF UNIT: DWELLINOTHER_ CHECK # 7 CHECK DATE�3 ? NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 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, R5, CHO MAYOR HEALTH AGENT RELEASE In accordance with Massachusetts General Laws Chapter III Code of Massachusetts R,!gulations 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 or 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, !/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/cur absence during said inspection. TENANT/LESSEE — 11 ER/iFSSOR. -- -- ADDRESS P.DI?kESS OF DtJi?' 'I'0 BI. INSPECTE1i D 'i F' --- ----- r—� CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR .�.. SALEM, MA 01970 ,pB4 TEL. 978-741-1800 ' FAX 978-745-0343 _. STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 1/4/05 Melba Apartments LLC 6 Albion Avenue Stoneham, MA 02180 PROPERTY LOCATED AT 7 Andrew 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. For the Board of Health Reply to (Joanne Scott MPH, RS, C'I10 Pablo Valdez Health Agent Code Enforcement Inspector CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH c =. ,lp 120 WASHINGTON STREET, 4TH FLOOR i o 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#618-07 DATE ISSUED: 12/1312007 Property Located at: 7 Andrew Street UNIT#2 Owner/Agent: Melba Apartments Address: 6 Albion Avenue City/Town: Stoneham, MA Zip Code: 02180 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 qJOAMNE / J�SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR ? CITY OF SALEM MASSACHUSETTS BOARD OF HEALTH r 3 + 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�ivc4-e L,, aT UN\T IS THIS UNIT DESIGNATED AS RIG//HT LEFT FRONT BACK PLEASE CIRCLE /ONE OWNER/LESSER��/-�/bio AVA,-77LY1�-N ANAGER/AGENT No P.O. Box I No P.O. Box ADDRESS1 /�(!h i4 kA- ADDRESS CITY 37--60-eA44 • CITY OZ/ ?d RESIDENCE PHONE 7,y/ BUSINESS PHONE (24 HRS.) BUSINESS PHONE <. s TOTAL NUMBER OF ROOMS: FrR001," USE: 1. ���9 2./-'/- 3.-&."-4. Orr' C-4 fF 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/1_j / DATE-4J4 3 ri INSPECTORS USE ONLY DATE OF INITIAL INSPECTION l-I- - / 3 ro 7 DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE:/,A - /3-o;DATE FEE PAID:--L-,2-- - TYPE OF UNIT: DWELLINGL/OZTHER_ CHECK# rt O�CHECK DATE 13 `o7 NOTES: /\ CODE ENFORCEMENT INSPECTOR 9/28/98 a CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 05/20/2002 Hemlock Land LLC 40 Appleton Street Cambridge, MA 02138 PROPERTY LOCATED AT 7 Andrew Street UNIT # 3 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�O,R, THE BOARD OF HEALTH REPLY TO j9d'dd �orA�' CHO PABLO VALDEZ tJ Health Agent CODE ENFORCEMENT INSPECTOR I K CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,gMGPEH, RS,CHO NINE NORTH STREET Date: 06/Tl l/98NT Tei:((978 74-1800 Fax:(978)740-9705 James Bailey 81 Essex Street Salem, MA 01970 PROPERTY LOCATED AT 8 Andrew 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 o CITY OF SALEM, MASSACHUSETTS �" ,� BOARD OF HEALTH ,� 6 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 CERT.# 242-02 TEL. 978-741-1800 FEE $25.00 9e� FAx 978-745-0343 DATE: 05/03/2002 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 9 Andrew Street UNIT #: 1 OWNER/AGENT: Steve Wolfbera ADDRESS: 40 Appleton Street CITY/TOWN: Camabridcie, MA ZIP CODE: 02138 24 HOUR PHONE: 684-1636 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 �.s't� "�°1� .� ��?'r z =°L v`@"'�`� •� 3 r n++.� v r :"ter "�'"".'� ib '�' ".'•�`i' ",f � lj- � :'�'✓"4�''�'x ++'��,.•'�'�"•fIYkF i�u `d` a�"3 '^ .C3k'Y'�t �¢4 r x ,�...'t" 4. CITY OF SALEM, MASSACHUSETTS a�a.. BOARD OF HEALTH. • i 120 WASHINGTON STREET, 4TH FLOOR { SALEM, MA 01970 TEL. 978-741-1800 .. FAX 978-745-0343 STANLEY.�USOVICZ, JR. JOANNE.,SCOT-QMIP�H 1RS;1CH0 MAYOR „;'HEAlLTH4AGENTp} 71,— isS'.. } S ':'•. x , w .+.3` I APPLICATION FOR CERTIFICATE GF,FITNESS _ IN.ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11;F105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". / PROPERTY LOCATED AT /"/ A l� ET ( UNIT# IS THIS UNIT DESIGNATED AS RIGHT LEFT, FRONT-"BACK`wPLEASE CIRCLE ONE � 4 �o-.rRav� :i:ra z Sys tq 4F ,.3z ' ,� a2T"# OWNER/LESSEFieJL �n6C�Q2m!'�1 MANAGER/AGENT �C -� �i�.No PO Box =;= . `/ ' `•�oUP O Box`s pbT 1 ADDRESS, O IaO//�hJ� .11'ADDRESS 1- . I CITY eiv r C;.A, t ,CITY S;< �3 RESIDENCE PHONE BUSINESS PHONEj(24 HRS.) sof 610 '' �, 'a rz +.'`3 s k•t �gg x "x t : ## { C > z t < 5 AC " t3, * `Y BUSINESS PHONE J �'s r--� ° � ) . iki, ; 4�sag�,� ;�� •. xwx �e xy, t r'�-^�`tL r•� s;4 }" �.,iW, 44 K, at it ' ami rxjr � k TO7AL,NUMBER OF ROOMS ? It a� R my 4 3 I i.y c�n� '�' $n3'+'�'.�_a liter t�h § p "••i y s tn"`a ��.�r t'� k .+ "# , a:xa c 4- tROOMUSE 1 ' )''2 L "" ra1 s qa yr \e , �sWft t b .. tr £ ¢ F THERE IS ATWENTY FIVE($25.00)DOLLAR;FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OFzSALEM HEALTDEPA TMENT THIS FEE IS PAYABLE AT THE ' # TIME OF INSPECTION: I Z;;. { ° , APPIL TS SIGNATURE DATE INSPECTORS USE ONLY DATE OF INITIAL INSPECTION,,5 3" -d Z DATE OF REINSPECTION -DATE OF ISSUANCE OF;CERTIFI,CATE:'i- 3 9-17DATE FEE PAID: " TYPE OF UNIT: DWELLING, OTHER CHECK#: ? CHECK DATE`-- 4 A. t , CODE'ENFORCEMENT+INSPECTOR ` 9/28/98 : I 1 'k 3x'� � }P .S vfi l�1'.'r i f t 2a " 33a 4 � Y]•i� 41 ; # y' z' -� :.�r,9{,,.. s tv,'i'S w�#- 3 ♦L c� €.k t >F _ wQ -sk x � -` r � q 3t u S& +k p,t S� '� �x'1 �ar3 ��, '^"``4�w#�, �''is✓�.a �'�.a�r£ 'k:e '4.�" *€v �� �Y�%�r,X`S +M�ti �h� "+6r`\4 �+� a'� ?h,"T"Y"^ves'ti"€y�. � �x`� ....._�' .t * d+� q�.?�.�7 . =l. �'.,.' �.c ._ za4 �. s n'- ..;fin kN.s••.. s,,.,1yr .+,u..m r '�,��,:"a d S,s � Y. .x_-. 1 a co CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 CERT.# 241-02 TEL. 978-741-1800 FEE $25.00 FAX 978-745-0343 DATE: 05/03/2002 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 9 Andrew Street UNIT #: 2 OWNER/AGENT: Steve Wolfberg ADDRESS: 40 Appleton Street CITY/TOWN: Cambridge, MA ZIP CODE: 02138 24 HOUR PHONE: 684-1636 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 P3, CITY Or SALEM "MASSACHUSETTS. 4 BOARD OF HEALTH: 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 fi STAN LEY'U SOMI CZ, JR. JOANNE SCOTT, MPH,!RS,-CHO . L'4'� -MAYOR. HEALTH X��N' T APPLICATION FOR CERTIFICATE OF.,FITNESS N-I ACCORDANCE WITH STATE SANITARY COD I E CHAPTER ll; 105 CMR 410.000 M: INIMUM STANDARDS OF FITNESS FIR HUMAN HABITATION". PROPERTY LOCATED AT 91 re,WS, 0� UNIT#J, IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BAC K;PLEASE CIRCLE ONE 'OWNIEFVLESSER-) Me err MAN AGER/AGENT NoP.O.-Boix-l" ' ADDRESS CITY 4RESIDENCE:PHONE BUSINESS PHONE (24 HRS.) ' ; SINESS,%PHlON)i&d/7;4?--'f 2"g =' n TOTAL NUMBER 5F;RO0MS-*i','.' Z'v i �N MIE'S p, P4" 0 7 A� -V $ THEREIS.K.TWEN IVE 25.00 tE 13Y CHCK ORMONEY- PA�ABLE AT DOLLAR 0AYABL "tHtS FEE IEt , 4�"ORDER-,,.TO�,THECITY:OP19ALEMHEA�T" E)EPAR ENT PART k1--MTIME"OR- -INSPECT16h -T niffi IJNTAI"UV 4 'APPLICANTS SIGNIAT DATE tn_ INSPECTORS USE ONLY SPECTION DATE OF REINSPECTION �: - C) iDATE'OF-.�l§S6ANbEOr,CERTIFICATE:S -�3 DATEFEE PAID: '-fff Mal M- .4 itlttt i 1 4 C ;s� 1` ; *TYPE;OF:.UNit-"EI.WELLfNr.,,r�6THEk CH�EcK#;16 7 �4 CHECK DATE -A A." A IYar ^k^x -MW 9/28/9 R �4 "T 'fit. oil S.t t * co CITY OF SALEM, MASSACHUSETTS vg BOARD OF HEALTH 3 * 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 CERT.# 240-02FEE $25.00 TEL. 978-741-1800 �gMll'!e FAX 978-745-0343 DATE: 05/03/2002 STANLEY USOVICZ, JR. ,JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 9 Andrew Street UNIT #: 3 OWNER/AGENT: Steve Wolfberg ADDRESS: 40 Appleton Street CITY/TOWN: Cambridge, MA ZIP CODE: 02138 24 HOUR PHONE: 684-1636 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 '}. 'P' -t7 * y� r;p Nsf'pjman-,mm kgs' g. Aft xw 4� , .•5+° 5 t 1w41 4• s 7 4aaT ' e k 'n o' s • Asz ti -} s, €#Y s 3aee fy � f Plf;ra .: ,`' 4 µ � TF �; :.pa [ dxr iiF �d ✓, L E .. .. � x .ixaA . t '� S� Y3� av )5} ,F ", i - gx/ , �•} CITY OF SALEM, MASSACHUSETTSD, '/4 .? 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 CHOi. airy. - t.. y .: "MAYOR 3 .-r`as "HEALTH�AGENT j..y:}44' �,.'+ al 2ya , a ihftk.�.:w, a.pi_ i 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— "E''��� UNIT# 3' " IS THIS.UNIT DESIGNATED AS RIGHT LEFT: FRONT++BAC K PLEASE:CIRCLE ONE' � � a OWNERILESSEFi MANAGER/AGENT" No.F O Box ' N07P Cl YBox p . ADDRESS'L��Zl� � S� 'ADDRESS + CITY i _MlA CITY RESIDENCE PHONE BUSINESSPHONE (24 HRS) + a x+ S?^S f u' nArd K q 1+k g .y.,•..k 4,+ [ .`t 4"f .'F .'v't wti:_ s � '� rBUSINESS PHONE 12 i� 7 ���!v s"4 54f'a f Gdv}a4 # }"t 4 +u .�^ 'e 5 _ `,}]`. }�< <. TOTAL NUMBEWOF ROOMS Ory.cs£ sT .<. 3 5 :~ ' f 1 dh �� . AYE 3pJ{>^y.:! Y - ' ' ROOM USE- 1 2 ` L 34 w n 1 6 7 8 6 ' THERE ISATWENTY FIVE($25.00)DOLLAR FEE, PAYABLE'BY,CHECK,OR MONEY i -7 ' ORDER TO THE CITY QF SALEM HEALTH DEPARTMENT THIS`FEE IS PAYABLE AT THE > TIME OF INSPECTION.' APPLICANTS SIGNATURE DATE /3 INSPECTORS USE ONLY :i PATE OF INITIAL INSPECTION -3, .L DATE-OF..REINSPECTION 31, DATE OF ISSUANCE OF CERTIFICATE:S-'3 G c = DATE FEE;PAID: `q 3 �" TYPE OF UNIT: DWELLING)(OTHER CHECK#CHECK DATE '3a '� Z :NOTES: . ^s' CODEENFORCEMENTINSPECTOR fkN'Ly�i 'hv�AG ^o'�*'a�3'1�19 dam.,; d { h 1 r 't+tY! w >�a i `i{. •f ; .-t Y i ` F '�',-e Y`'"'k `YM a'aa +'^$�cMqk}"fF' Y %� k :d,.t',+ Wg° ' "k'hTi'If."ay. x'av a 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 May 1, 2003 James Bailey PO Box 3062 Salem, MA 01970 PROPERTY LOCATED AT 10 Andrew Street Unit#2 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 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. —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 ($20.00) 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 tenants' entire utility bills retroactive to the date of initial occupancy in cases in which cross-metering has been proven to exist. For the Board of Health Reply to Joanne Scott MPH, RS, CHO Pablo Valdez Health Agent Code Enforcement Inspector CITY OF SALEM,'MASSACHUSETTS rt3' BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR o' SALEM, MA 01 970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT June 11, 2003 James Bailey P. O. Box 3062 Salem, MA 01970 PROPERTY LOCATED 10 Andrew Street Unit#3 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 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. —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 ($20.00)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 tenants' entire utility bills retroactive to the date of initial occupancy in cases in which cross-metering has been proven to exist. For the Board of Health Reply to i' 4JoanneMPH, RS, CHO Pablo Valdez Health Agent Code Enforcement Inspector b Wr fy w( CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tel: (978)741-1800 04/02/2001 Fax: (978)740-9705 Lisa Suldenski 15 Andrew Street Salem, MA 01970 PROPERTY LOCATED AT 15 Andrew 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 the 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 One Week of receipt of this notice at 978-741-18.00,. 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. 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 eo exist. 4R THE BOARD Oy HEALTH REPLY TO Joanne Scott, MPH,RS,CHO PABLO VALDEZ HEALTH AGENT CODE ENFORCEMENT INSPECTOR it CERT.# 400-97 FEE $25.00 DATE: 06/26/97 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 15 Andrew Street UNIT #: 1 OWNER/AGENT: Lisa Suldenski ADDRESS: 15 Andrew Street CITY/TOWN: Salem MA ZIP CODE: 01970 24 HOUR PHONE: 745-4850 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: NbTE: THIS APPROVAL DOES NOT CERTIFY COMPLIANCE WITH THE STATE LEAD LAW FOR OCCUPANTS UNDER 6 YEARS OF AGE. FOR THE BOARD OF HEALTH t V .JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR x �mrr8 , CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970.3928 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 4 10.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT UNIT # "l OWNER/LESSER - idm sk MANAGER/AGENT ADDRESSSl � �J,�L� '� ADDRESS CITY c 4 1'1Q ry) �y CITY RESIDENCE PHONE 7 �( fj D BUSINESS PHONE (24 HRS.) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ` ' ROOM USE: I . �C Yt41^� 2.U�,�1 y'(4. 3._Z _-_4 . 5. 6. "'-� 7. g, THERE IS A TWENTY-FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM'H)?J1LTH DEP *TMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION Vi APPLICANTS SIGHATUREii` '' rnrn __ — ~�\=�d- 6 7 LQ DATE ((�/ INSPECTORS USE ONLY DATE OF INITIAL INSPECIION: (Q �G 7 DATE OF RELNSPECTION DATE OF ISSUANCE OF CERTIFICATE:/' �DATE FEE PAID: — TYPE OF UNIT: DWELLING I,- OTHER- NOTES: OTHERNOTES: CODE ENFORCEMENT INSPECTOR 3 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: 06/12/97 Fax:(508)740-9705 Lisa Marie Suldenski & Shawn Douglas Fitzgerald 15 Andrew Street Salem, MA 01970 PROPERTY LOCATED AT 15 Andrew Street UNIT # 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 1273, 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 705 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 CERT.# 17-98 FEE $25.00 1j �FA DATE: 01/14/98 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Fax:(978)740-9705 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 19 Andrew Street UNIT #: 2F OWNER/AGENT: Margaret B. Curtin ADDRESS: 16 Preston Beach Road CITY/TOWN: Marblehead, MA ZIP CODE: 01945 24 HOUR PHONE: 631-7178 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. qz)L"Cxt� FORTHE BOARD OF HEALTH JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR K � CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 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, .CRAPTER II, 105 CMR 4110.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". 11tt PROPERTY LOCATED AT� �p11/JYPi� UNIT #-2f OWNER/LESSER MS Mf2 tttttt' MANAGER/AGENT —_ ADDRESS eS J ADDRESS f CITY CITY RESIDENCE PHONEIP-�j+ BUSINESS PHONE (24 HRS,) BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: I.L`wi?Q 2 - UL 4a_-3. —.._4. d. 4jlL_ 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 TIM OF INSPECTION APPLICANTS SIGNATURE __ DATE �7Jl!tj 7 INSPECTORS USE ONLY DATE OF INITIAL INSPECTION: DACE OF REINSPECTION _ DATE OF ISSUANCE OF CERTIFICATE:yJfj & DATE FEE PAID: jJjy�gp TYPE OF UNIT: DWELLING V OTHERv rryj� ___ NOTES: CODE ENFORCEMENT INSPECTOR I R �I v m� 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: 08/08/96 Fax:(508)740-9705 Dennis & Margaret Curtin 16 Preston Beach Road Marblehead, MA 01945 PROPERTY LOCATED AT 19 Andrew Street UNIT # 1F 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 f Joanne Scott, MPH,RS,CHO PABLO VALDEZ HEALTH AGENT CODE ENFORCEMENT INSPECTOR Coff CERT.# 538-93 • a' FEE: _$ 25.00 DATE: 7/27/93 CITY -OF SALEM HEALTH DEPARTMENT BOARD OF HEALTH Salem, Massachusetts 01970 ROBERT E. BLENKHORN •9 NORTH STREET HEALTH AGENT - 508-741-1800 CERTIFICATE OF FITNESS PROPERTY LOCATED AT 19 Andrew Street UNIT E 1F OWNER/AGENT C. Morin/M. Curtin ADDRESS 5 Carlton Road CITY/TOWN Marblehead, MA ZIP CODE 01945 24 HOUR PHONE 617-631-4089 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 ROBERT E. BLENKHORN, C.H.O. HEALTH AGENT COD ENFORCEMENT INSPECTOR OFFIgE use ONLY DATE: C17Y OF SALEM HEALTH DEPARTMENT BOARD OF HEALTH _ c-,lcm. M-,5"chuSGtt' 01970 41009 ttORIH STRLLII 5�`_'-7t Lit;99 !?°i'LTGt.TI017 :Fpr CT77TFTC4T.. CF FITITS S ACCC4:UA2:CE 1dIi1 $T!-.Tc SJ,i:).:Chl:`." CO'iE , .Gi.�.liii! ;(;I- C7f: Ei0.000 STA•DD'-'DS OF FITL:LSS FOR IiSN.J•!i iL;lii.TATION" PROPERTY LQCATED AT J 4/V)-rc W jcj ire IIi+ZT OS7tiER/LESSER I C 1 MANAGER/AGENT ADDRESS S' y„ ADDRESS CITY CITY 'RESIDENCE PHO 1p Q8 BUSINESS PHONE (24 HRS.) BIISINESS PHONE1163/ -� TOTAL NUMBER OF ROOMS: - . ROOM-USE: 1. 2. 3. r ° 4. 1 5, 6. .7- 8. THERE IS A TRENTY--FIVE (25-00) DOLLAR 'FEE, PAYABLE BY CDECIC OR MONEY ORDER TO THE CITY OF SALEH BY-ALTEC DEPAPENT UPON COMPLIAN AND ISSUANCE OF CERTIFICATE_ APPLICANTS SIGNATURE DATE INSPECTORS USE ONLY DATE OF. INITIAL INSPECTION: 7-'d 7 DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: DATE. TEE PAID: TYPE OF UNIT: DWELLING OTHER "NOTES: CODE ENFORCEMENT INSPECTOR City of Salem, Massachusetts Board of Health 120 Washington Street, 4th Floor, Salem, Pt>kiliCHeahh Prevent.PrGmate.Protect. MA 01970 Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, RENS, CHO Mayor health@salem.com Health Agent CERTIFICATE OF FITNESS CERTIFICATE#: GHL-17-248 DATE ISSUED: 8/1712017 i Property Located at: 23 ANDREW STREET UNIT#1 i Owner/Agent: Albert Eisen Address: 58 Putnam Street City/Town; Beverly, MA Zip Code: 01915 24 Hour Phone:{97$}927-4831 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 li "Minimum g Standards of Fitness for Human Habitation". P 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, RENS, CHO HEALTH AGENT SANITARIAN I Cn Y OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREW,V'FLOOR T)R-I- (978)741-1800 IUMBERLEY DRISCOLL FAX(978)745-0343 MAYOR LRAMD1N@SALE4.00M I LARRY RAMDIN,RS/REHS,CHO,CP-FS HEALTH AGENT Application for Certificate of Fitness IN ACCORDANCE WMI STATE SANITARY CODE,CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION" FEE: $50.00 2'3 ���� PROPERTY LOCATED AT UNIT# Oyu LS��TIRS UNIT DLSIGNATIM AS RIGHT LEFP FRONT OR BA PLEASE COURCLE O OWNER&ESSER.r7 ��/� E/SES MANAGER/AGENT NO P.O.BOX ADDRESS �� ADDRESS CITY,STATE,ZIP BEJEL q y CITY,STATE, RESIDENCE PHONE p — 7� 1 —7/ BUSINESS PHONE(24HRS) BUSINESS PHONE TOTAL NUMBER OF ROOMS:_ ROOM USE: 1,bIJ/1116, 2. 3. 4. 315 5 6. 7. 8. 9. 10 THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BYONEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE IS P E THE PECTION APPLICANT'S SIGNATURE 5! DATE Q Inspectors use on] Date on initial inspection: (J Date of reinspection Date of issuance of certificate: Date fee paid- Type aidType of unit Dwelling—Other Check#,Check date: Notes: n� I11 Il L Lp�L �I �19Pt at( IC'ill �/Y1 I Code Enforcement Inspector i. < CITY OF SALEM, MASSACHUSETTS a BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970CERT.# 289-02 TEL. 978-741-1800 FEE $25 .00 FAx 978-745-0343 DATE: 05/30/2002 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 23 Andrew Street UNIT #: Two OWNER/AGENT: Albert Eisen ADDRESS: 58 Putnam Street CITY/TOWN: Beverly, MA ZIP CODE: 01915 24 HOUR PHONE: 927-4831 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. FO�D OF HEALTH JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR CITY OF SALEM, MASSACHUSETTS �8 0 �. BOARD OF HEALTH • + 120 WASHINGTON STREET, 4TH FLOOR . SALEM, MA 01970 TEL. 978-741-1800 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 Ii, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT 2 3 /7� T UNIT# )�U IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER ��E7?T /SEy MANAGER/AGENT X N ADDRESS S�iP���f ST ADDRESS CITY CITY RESIDENCE PHONE 97f.g?/-/cT3AUSINESS PHONE (24 HRS.) BUSINESS PHONE S.lfl'�T_ TOTAL NUMBER OF ROOMS: A-y1- ROOM USE: 1. m6_ 2. ?Cy. .O1 le 4. 5. X1Z 6. 7. 8. THERE IS A TWENTY-FIVE($25.00) DOEE, PAYAB6FeVCHECK OR MONEY ORDER TO THE CITY OF SALEaHE0;_TH DER R N FEE IS PAYABLE AT THE TIME OF INSPECTION. APPLICANTS SIGNATURE DATE INSPECTORS USE ONLY DATE OF INITIAL INSPECTION -5 'So -"� DATE OF REINSPECTION DATE OF ISSUANCE OF CEP.TIFICATE:S'"� �6`_DATE FEE PAID: T -3o �— TYPE OF UNIT: DWELLING/(OTHER— CHECK# 13 73 CHECK DATE �-30 o L NOTES: CODE ENFORCEMENT INSPECTOR 9/28/98 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH -�Y 120 WASHINGTON STREET,4'FLOOR TEL. (978) 741-1800 IOMBERLEY DRISCOLL Fax(978) 745-0343 MAYOR DGRBI°,NBAUM@SALG M.COM DAVID GREFN&\UM,RS A(:PING WAlm m i A(3F',NT CERTIFICATE OF FITNESS CERTIFICATE#420-10 DATE ISSUED: 8/27/2010 Property Located at: 23 Andrew Street UNIT#Three Owner/Agent: Albert Eisen Address: 58 Putnam Street City/Town: Beverly, MA Zip Code: 01915 24 Hour Phone: 927-4831 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 ��BOAF�D OF HEALTH DAVID GREENBAUM, RS ACTING HEALTH AGENT CODE ORCEMENT INSPECTOR • CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WAST-IINGTON STREET,4"'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGR1T,NBAUM(_,SALEM.COM DAVID GREENBAUM,RS 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." -7 FEE: $50.00 PROPERTY LOCATED AT 2.3J9)V,1 Elr/ S?7FZZ7- UNIT# *A67�� IS "THIS UNIT DISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE OWNER/LESSER /7�L E7T MANAGER/AGENT- NOP'0' GENTNOP.O. BOX ADDRESS —ADDRESS ����ZT ADDRESS CITY, STATE, ZIP �L���Zy �4�/%12�r CITY, STATE,ZIP RESIDENCE PHONE �� � y��/ BUSINESS PHONE (24HRS) J/9/�� BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1. 4. 5 6. 7. 8. 9. 10. THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR M91NEY ORDER TO THE CITY OF SALEM BOARD OF HEALTH THIS FEE IS PAYABLE AT T OF CTION APPLICANT'S SIGNATURE Inspectors use only Date on initial inspection: D Date of reinspection: Date of issuance of certificate: /O q Date fee paid: 6 k7 �V Type of unit: Dwelling ✓ Other Check# /"� I Check date: �a 7�/U Notes: ` -R/E/ &l 2 4K101 r hpCtf-/ h4er k C e E orcement Inspector CERT.# 233-96 3` FEE $25.00 DATE: 04/23/96 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 25 Andrew Street UNIT #: 3 OWNER/AGENT: Anne Pelletier ADDRESS: 31 Ravenna Avenue CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 744-6906 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 JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR A � INK CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970.3928 JOANNE SCOTT,MPH,AS,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 HUMANHABITATION".HABITAATION".. �-; PROPERTY LOCATED AT � S J7Jy�lc� fL/ V( UNIT # OWNER/LESSER )011-4-CTI 25;e MANAGER/AGENT ADDRESS 3/ RAV f /V Aye, ADDRESS CITY CITY RESIDENCE PHONE -% BUSINESS PHONE (24 HRS.) BUSINESS PHONE TOTAL NUMBER OF ROOMS: � � j��{, p ROOM USE: 1, lTU/�/y 2,6e F- & 3.LI ✓jN6 �t1V/A/ /� Q /,K 5. 6. 7. B. THERE IS A TWENTY-FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SAIM4 HEALTH DEPARTMENT THIS FEE IS PAYABLE, AT THE TIME OF INSPECTION APPLICANTS SIGNATURE4�jWf� _� y(�&&tL,� DATE 11 "- -� 3 INSPECTORS USE ONLY DATE OF INITIAL INSPECTION:J_:: j t �jDATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE: DATE FEE PAID:_;;?_ TYPE OF UNIT; DWELLING OTHER NOTES: CODE ENFORCEMENT INSPECTOR Y : a CERT.# 107-96 3 FEE $25.00 DATE: 02/27/96 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 25 Andrew Street UNIT #: 4 OWNER/AGENT: Anne Pelletier ADDRESS: 31 Ravenna Avenue CITY/TOWN: Salem. MA - ZIP CODE: 01970 24 HOUR PHONE: 744-6906 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 DEPARTiT'IENT 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 JOANNE SCOTT, MPH,RS,CHO 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 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 ATv� fV.D ! t� S M T OWNER/LESSER /f MANAGER/AGENT ADDRESS J/ 44VEAZAI9 od ZE, ADDRESS CITY .Sf / x/7'1 CITY _ RESIDENCE PHONE SQ S- ��5' `.-'G� 9f1 (� BUSINESS PHONE (24 HRS.) BUSINESS PHONE S tk e TOTAL NUMBER OF ROOMS: ROOM USE: 1. T N 2. (eNM3. 6DA-0M 5. 6. 7. 8. THERE IS A TWENTY-FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEH HEALTH DEPARTMENT THIS FEE //IISQQPAYABLE AT THE TIM OF INSPECTION APPLICANTS SIGNATUREa,� �/f. �/iCiC[/ � 7 DATE a.v27' 9 INSPECTORS USE ONLY DATE OF INITIAL INSPECTION: ?, /�7 DATE OF REINSPECTION _ DATE OF ISSUANCE OF CERTIFICATE:��r� ��6 DATE FEE PAID: _-7 TYPE OF UNIT: DWELLING OTHER NOTES: I 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 Kimberley Driscoll www.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 3/23/06 Fabio Pinto 29 Aborn Street Peabody, MA 01960 PROPERTY LOCATED AT 25 Andrew Street Unit 4 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. r the Board of Hea h Reply to oanne Scott MPH, RS, CHO Pablo Valdez Health Agent Code Enforcement Inspector ���e0N01T " CERT.# 349-01 :9 FEE $25.00 DATE: 07/26/2001 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO 120 Washington Street HEALTH AGENT Tel: (978) 741-1800 Fax:(978) 745-0343 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 26 Andrew Street UNIT #: 1st floor front OWNER/AGENT: Chester Chalpowski ADDRESS: 119 Water Street Apt. 65 CITY/TOWN: Beverly, MA ZIP CODE: 01915 24 HOUR PHONE: 764-5514 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 lee L JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR f g�CON01T� 3 4 & f] ,p C M ���/MINB SP C CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 120 WASHINGTON ST. 4TH f JOANNE SCOTT,MPH,RS,CHO I XKMp2h0RMXXR= HEALTH AGENT APPLICATION FOR CERTIFICATE OF FITNESS Tee(978)741-1800 Fax: (978)740-9705 IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". PROPERTY LOCATED AT :5 / NIT#_/ 7r� IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE t OWNER/LESSER [�A�7/� C� ��/�vS<,IOIANAGER/AGENT No P.O. Box No P.O. Box ADDRESSTI-9- G4 ADDRESS CITY _ �(�r'1/ CITY�CItJ� r RESIDENCE PHONEBUSINESS PHONE (24 HRS.) 9201'76/-53��� BUSINESS PHONE TOTAL NUMBER OF ROOMS:__.__ ROOM USE: 1. L-1l 2./3. F/6c 4. Pte` 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 SIGNATU DATE ` O INSPECTORS USE ONLY DATE OF INITIAL INSP CTION 7:e2& -yr/ DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE:7-x-6-30 (DATE FEE PAID: TYPE OF UNIT: DWELLING V///���OTHER_ CHECK# 6 (-7 CHECK DATE,?-7 C `off NOTES: Y�-vh c SvsA w �dows CODE ENFORCEMENT INSPECTOR 9/28/98 ' ¢ONWT n CERT.# 348-01 a FEE $25.00 �s, ..... DATE: 07/26/2001 MIIYB CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS, CHO 120 Washington Street HEALTH AGENT B Tel: (978)741-1800 Fax: (978)745-0343 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 26 Andrew Street UNIT #: 2nd floor front OWNER/AGENT: Chester Chalunowski ADDRESS: 119 Water Street #65 CITY/TOWN: Beverly, MA ZIP CODE: 01915 24 HOUR PHONE: 764-5514 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 9 / JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR 3 n � ��MINBSP CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 120 WASHINGTON ST. 4TH I JOANNE SCOTT, MPH,RS,CHO XMIX4XXXXMXREKKX HEALTH AGENT APPLICATION FOR CERTIFICATE OF FITNESS Tee (978)741-1800 Fav (978)740-9705 IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION". q PROPERTY LOCATED AT B4, y�� ST UNIT tla� Gv IS THIS UNIT DESIGNATED AS RIGHT ''L,,E��F//T FRONT BACK PLEASE CIRCLE ONE OWNER/LESSER a �f S/�/ANAGER/AGENT No P.O. Box ,cW_ No P.O. Box ADDRESST f g/.�//.F 5'T A� ADDRESS CITY eel y CITY RESIDENCE PHONE�9�/ BUSINESS PHONE (24 HRS.) �- 7,/,r-S_��/ BUSINESS PHONE TOTAL NUMBER OF ROOMS: ROOM USE: 1./_5np 2.AW 3A4. 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-D ARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. / f APPLICANTS SIGNAT ` DATE -7�` SPEC O S USE ONLY DATEOF114 IAL INSPECTION 7-,2- (9 --o ( DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE:7,-�>4, -O/ DATE FEE PAID: TYPE OF UNIT: DWELLINGYOTHER_ CHECK#_. CHECK DATE/-)_' NOTES: jr2 1=2 y - 2 e CODE ENFORCEMENT INSPECTOR 9/28/98 v� CERT.# 258-96 3 g; FEE $25.00 11t �F� DATE: 05/02/96 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 CERTIFICATE OF FITNESS PROPERTY LOCATED AT: 29 Andrew Street UNIT #: 2 i OWNER/AGENT: Catherine Bergeron ADDRESS: 29 Andrew Street CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 741-4997 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 OP 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 BOARDOF HEALTH JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR "�trrnh�a CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 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 � � Ic P G(/ UNIT I OWNER/LESSER "cf fjj/��/�J�u p p%�Pafv�jMANAGER/AGENT ADDRESS ADDRESS CITY 13.e-h6lcf CITY _ RESIDENCE PHONE_7 BUSINESS PHONE (24 HRS.) BUSINESS PHONE TOTAL NUMBER OF ROOMS ROOM USE: 1.-2. 3. 4 . 5. 6. 7. 8. THERE IS A TWENTY-FIVE (25,00) DOLLAR HE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM'HF.ALTH DEPARTMENT THIS FEE IS PAYABLE AT THE TIKE OF INSPECTION APPLICANTS SIGNATURE---. DATE� � � INSPECTORS USE ONLY DATE OF INITIAL INSPECTION: Jp (o DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE:L�-2 ,DATE FEE PAID: TYPE OF UNIT: DWELEINGn / OTHER NOTES: CODE ENFORCEMENT INSPECTOR u CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 3 a 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 03/27/2002- Chester & Mary Jane Chalupowski 19 Water Street #65 Beverly, MA 01915 PROPERTY LOCATED AT 30 Andrew Street UNIT # 2nd floor 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. THE BOARD HEALTH REPLY TO JR anne Sco t��MPH,RS,CHO PABLO VALDEZ Health Agent CODE ENFORCEMENT INSPECTOR ( M CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANIJE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT November 19, 1996 Tel:(508)741-1800 Fax:(508)740-9705 Chester Chalupowski , 11 Beckett Street Salem, MA 01970 Dear Sir/Madam: In accordace with Chapter III, Sections 127A and 127B, of the Massachusetts General Laws, 105 CMR 400.000: State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter It: Minimum Standards of Fitness for Human Habitation, an inspection was conducted of your property at 30 Andrew Street Apt.2 Rear conducted by Mark Tolman, Sanitarian of the Salem Health Department,on November 14, 1996. An inspection of the dwelling unit at the above address has revealed that it does not comply with the Massachusetts State Sanitary Code Chapter II: Minimum Standards of Fitness for Human . Habitation. Therefore, a Certificate of Fitness cannot be granted from the Code Enforcement Division of the Salem Health Department and the unit may not be rented or occupied until the noted violations have been corrected and a reinspection has been made. VIOLATIONS: SEE ENCLOSURE: ONE OR MORE OF THE NOTED VIOLATIONS MAY ENDANGER OR MATERIALLY IMPAIR THE HEALTH, SAFETY AND WELL-BEING OF THE OCCUPANTS. Please note that some of the necessary repairs may require permits from the Building, Plumbing, Electrical, Fire or other City Departments. These must be obtained before the work is commenced. FOR THE BOARDEALTH REPLY TO JOANNE SCOTT MARK TOLMAN HEALTH AGENT SANITARIAN CERTIFIED MAIL P 544 343 408 Este es un documento legal importante. Puede que afecte sus derechos. Enclosure CITY OF SALEM HEALTH DEPARTMENT 1 ! Nine North Street { Salem,Massachusetts 01970 Enclosure Chester Chalupowski 11 Beckett Street All windows must have stone windows. Scrape ceiling and repaint. Replace tiles in bathroom. Door molding must be repaired on front.door of unit.. i CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH,AS,CHO NINE NORTH STREET HEALTH AGENT Tei:(508)741-1800 APPLICATION FOR CERTIFICTE OF FITNESS Fax:(508)740-9705 IN ACCORDANCE WITH STATE SANITARY' CODE, CHAPTER 11, 105 CMR 410.000 "MINIMUM STANDARDS OF FITNESS FOR HUM9N HABITATION". PROPERTY LOCATED i-.T2 'Y"tA t-^ OWNER/LESSER` �Ckc�1u� ��WY1C( MANAGER/AGENT' —. .._... ADDRESS I�r.(&Ut I 5� ADDRESS CITY �j lJl { 1A FJ "t D CITY -- 'RESIDENCE PHONE `!' BUSINESS PHONE (24 HRS.) BUSINESS PHONE TOTAL NUMBER OF ROOMS: 3 ROOM USE: 1. [, AWt, 2. L"9- 3. :1544� 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 DEP TMENIS THE TIRE OF INSPECTION DATE APPLICANTS SIGNATURE pg T THIS FE ` �PAYABLE� I` � O� INSPECTORS USE ONLY DATE OF INITIAL INSPECTION: j/ /yf14 DATE OF REINSPECTION DATE OF ISSUANCE OF CERTIFICATE:—_ DATE FEE PAID:— � TYPE OF UNIT: DWELLING_ OTHER ✓ oil 'u'ti`aQ s --sF (.c..<. / .�+Yya � it� t�✓m I /' NOTES: .bey V� titre 0�3 L.nt1� 4i[ Y-r�a ..b ' T Y CODE ENFORCEMENT INSPECTOR f � 3 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: 09/12/96 Fax:(508)740-9705 26 Through 30 Andrew Street Realty Trust, Chester Chalupowski 11 Becket Street #3 Salem, MA 01970 PROPERTY LOCATED AT 30R Andrew Street UNIT # 2 Rear 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. SFE 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: 12/05/95 Fax:(508)740-9705 Chalupowski Realty Trust, Chester Chalupowski, Trustee 11 Becket Street #3 Salem, MA 01970 PROPERTY LOCATED AT 30R Andrew Street UNIT # 2R 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 f-om 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 O/F/ HEALTH REPLY TO Joanne Scott, MPH,RS,CHO PABLO VALDEZ HEALTH AGENT CODE ENFORCEMENT INSPECTOR µ h CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tei:(978)741-1800 Date: 06/15/98 Fax:(978)740-9705 Robin A. Harvey 4 Winter Island Road Salem, MA 01970 PROPERTY LOCATED AT 35 Andrew 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 BOARDOF HEALTH REPLY TO 44� 4f_ i��''�l Joanne 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 W W W.SALEM.COM Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO Mayor HEALTH AGENT CERTIFICATE OF FITNESS CERTIFICATE#246-06 DATE ISSUED: 5/1/06 Property Located at: 35 Andrew Street UNIT#2 Owner/Agent: Neal Stoker-Harbor Rental & Realty Inc. Address: 111 Derby Street 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 BOARD OF HEALTH qv-x - - l/ JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CODE ENFORCEMENT INSPECTOR .'- 'CITY OF SALEM,MpSSACHUSEi'1'S BOARD OF HEALTH J • 1.20 WASHINGTON STREETS 4TH FLOOR SAI..EN. MA 01970 TEL. 978-741-1800 (/ 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 HABITATION". PROPERTY LOCATED AT J`a / l7?A1�fG(� UNIT k IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE -� OWNERILESSER�IQ[� � _MANAGER/AGENT'L��01'' � PG(� ,. 7)IC, No P.O. Box No P.O.Box ADDRESS ADDRESS { CITY _ CITY ,/) ,}_ RESIDENCE PHONE _ BUSINESS PHONE (24 HRS.)qll�f/�U�?9 BUSINESS PHONE TOTAL NUMBER OF ROOM&_p _ �y ROOM USE: IW( 2 0�1\ 3.���IG([ _4. � 5. .6. �7. S. THERE IS A TWENTY-FIVE($25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM LTF PARTMENT THIS FEE IS PAYABLE AT THE TIME OF INSPECTION. j•;)" ) . 1 - ') i ) / 00 APPLICANTS SIGNATURE _ I-T _IN, PEE ONLY DATE OF INITIAL INSPECTION.,-3d _DATE OF REINSPECTION. J f G DATE OF ISSUANCE OF CERTIFICATE 17 C' DATE FFF PAID 3 -30 O TYPE- OF UNIT G, DWELLIN )/ OTHER CHECK If 2 (olK CI PECK DATE > � 3 9 � d NOTES /7/4 Gv-,� — J'/fc:_'/ .1te' CODE ENFOIIGI-MI'N1 Wt;ll CTOH CITY OF SALEM BOARD OF HEALTH Establishment Name: N� iZ Q S Date: D - D �' Page: of Rem code C-Critical Item DESCRIPTION OF VI ATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified .PLEA PRINT CLEARLY - fir & 1 A 1A r- _ r iA fcq U r 10,4 1S1 4 (' Q vim, Discussion With Person in Charge: Corrective Action Required: ❑ No ❑_ Yes have read this report, have had the opportunity to ask questions and agree to correct all Cl Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins p ❑ Re-inspection Scheduled ❑ Emergency Suspension ¢ocomply with all mandates of the Mass/Federal Food Code. I understand that ncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure 4fourlood permit. ❑ voluntary Disposal ❑ Other: 3-501.14(C) PHFs Received at'Petnperaturrs Violations Related to Foodborne illness Interventions and Risk Accord ing to I-a w Cooled to Factors(items 1-22) (Cont.) 41'.F/45`'F Within 4 Hours. * PROTECTION FROM CHEMICALS 3-501.15 Ccwhn�Methods for PHFs 5 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PtlFs Maintained at or below 590.004(F) 41'/45° F' 15 Poisonous or Toxic Substancesces 3-302.74 ProtectionPoisonous from Unapproved Additives* 3-501.16(A) Hot PHFs Maintained at or above 140°F. 7-101.11 Identifying Information-Original 3-501.1.(i(A) Roasts Held at or above 130°F. Containers" 7-102-11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.1 1 Separation-Storage" 3-501.19 Time as a Public Health Control', 7-20211 Restriction-Presence and Use* 590.004(H) Variance Re uirentent 7-202.12 Conditions of Us,- T203.J I se"R203t1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Satnttzers,Criteria-Chemicals, POPULATIONS(HSP) _ 7-204.12 Chemicals for wishing Produce,Criteria* '21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warnink labels* 7-204.14 inA eats,Criteria" eurize�dEdas* 7-205.1] incidental ental Food Contact Lubricants* 3-801-I1(B) Use of Past 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. 7-206.12 Relent Bait Stations'' 3-801.11(0 Uoo erred Fcrai Packa*e Not Re-served- 7-306.13- Tracking Powders,Pest Control and Monitorinn* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Fads]-hat are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate -401.1.1'(1)(2) Eggs- 155Pl.S Sec. Pathogens `*`ore -001 B cs-hnmeohate Service 145'F15sec* 3-302.13 1 Pasteurized Eggs Substitute for flaw Shell 3-401.11(')(2) Comminuted Fish,Meats&Game Eggs* Animals- 155'F 15 sec. '* - SPECIAL REQUIREMENTS 3-401.11(13)(1)(2) PorkandBeef Romt-130'F121mm* 3-401.11(A)(2) Ratites,Injected Means 155'F 1.5 590.009('}(9) Violations of Section 590.009(A)-(U)in sec.* catering, mobile food,temporary and 3-401..1.1(A)(3) Poultry,Wild Game,Stuffed PHFs, residentialkitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec.s, above if related to foodborne illness 3-401.11(0(3) Whole-muscle, Intact Beef Steaks ,interventions and risk factors. Other 1450F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3401-I1(A)(1)(b) All Other PHFs- 145'F 15 see. * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHI's 1650F 15 sea. * (Items 23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* .foodborne illness interventions and risk factors listed above, can be 3-403.1 i(C) Commercially Processed RTE Fail- found in the fnllowing sections of the Food Cade and 105 CMK 140°F* 590.000. 3-403.i 1(13) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 590.000 Roasts` and Personnel FC--2 .003 r ane sment _ 1g Proper Cooling o9 PHFs 24. Food and Food Protection __ FC-3 .004 25 _ Equipment and Utensils _ FC 4 .005__ 3-501.14(') Cooling Cooked PHFs from 140`F to 26. Water,Plumbinot and Waste FC-5 .006 7WF Within 2 Hours and From 70'F 27. Ph sical Facill FC-6 .007 to 41'F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC_- 7 , .008 3-501.14(B) Cooling PHFs Made Front Ambient 29__ S ©tial R ulrements ___- _ .009 Temperature Ingredients to41OF/45'F 30 _-_ _Other. Within 4Ilours* su =m c.z,d, '^Denotes critical item in the rederal 1999 Food Code or 105 CMA 590.000-