APPLEBY ROAD CITY OF SALEM, MASSACHUSETTS lu
BOARD OF HEALTH
120 WASHINGTON STREETp 41"FLOOR PI1bI1CI;CAII'h
Pre�"m.1'rom"m.Pmlec,.
T?f.. (978) 741-1800 R\x(978) 745-0343
KfM13f;RLFY DRISCOLL Iramdinllsalcm.com
LARRl'R;ANIDIN,RS/IiI?I fS,CI10,CP-ISS
MAYOR Hic;u;fi I A(;FNT
CERTIFICATE OF FITNESS
CERTIFICATE#235-14
DATE ISSUED: 7/10/2014
Property Located at: 19 Appleton Street UNIT# 1
Owner/Agent: Suzanne Wilkins
Address: 19 Appleton Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:
Pursuant to the requirements of City of Salem ordinance Chapter 2 Article IV Division3, Section
705: Certificate of fitness of rented dwelling unit, apartment or tenement. An inspection of your
vacant Dwelling/Rooming Unit at the above address has been approved and is in compliance with
105 CMR 410.000: Massachusetts State Sanitary Code, Chapter II" Minimum Standards of
Fitness for Human Habitation".
Therefore, this Certificate is issued by the Code Enforcement Division of the Salem Board of
Health and the unit may now be rented and/or occupied.
Maximum Number of occupants, must comply with 105 CMR 410.000.
Certificate valid for one year from date of issuance or until the current tenant vacates, whichever
is later.
This Certificate of Fitness is valid only if there is a valid Certificate of Occupancy.
WR THE BOARD OF HEALTH
LARRY RAMDIN
HEALTH AGENT SANITARIAN
CITY OF SALEM, MASSACHUSETTS
BOARD OF H&1LTH
120 WASHINGTON STREET,4"'FLOOR NbIICHealth
0[ao-cat.P+omatc.Proittt.
TFL. (978) 741-1800 FAX(978) 745-0343
KIMBERLEY DRISCOLL Iramdsalem.com
MAYOR LARRY R\NIDIN,RS/RFAIS,CII0,CP-FS
HE,1LTIi 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 l Cl -':�+ UNIT#
IS THIS UNIT DIAIHATED AS RIGHT LEFT FRONT OR BACK PLEASE CIRCLE ONE
OWNERILESSERSU n tN P_ �i Ll
NO P.O. BOX MANAGER)AGENT
ADDRESS—1q Appl ei-nv + ADDRESS
CITY, STATE,ZIP SC.L f m CITY, STATE,ZIP mc�c,5
RESIDENCE PHONE��1� ` �io U 1 BUSINESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: to
ROOM USE: Lhz,Ay-ac , 23.bmji, 4 G11Cr 5 iyint�
6. Gajj� 7. 8. 9. 10
THERE IS A FIFTY($50)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE IS PAYABLE AT THE TIME OF INSPECTION
APPLICANT'S SIGNATURE,n r ti a 1 i ) Q� DATE l �I c� l 10 1y
Inspectors use only
Date on initial inspection: rrrd t a��� Date of reinspection:
Date of issuance of certificate: Date fee paid:_ _
Type of unit: Dwelling Other Check# ' Check date:
Notes:
... rr
Code nfo , ment Inspector
t onmr CITY OF SALEM, MASSACHUSETTS
,Svc �m BOARD OF HEALTH
Z 120 WASHINGTON STREET, 4TH FLOOR
i �rFa SALEM, MA 01970
9qp� TEL. 978-741-1800
FAX 978-745-0343
KIMBERLEY DRISCOLL JSCOTT@SALEM.COM
MAYOR
JOANNE SCOTT
HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE #283-08
DATE ISSUED: 6/13/2008
Property Located at: 25 Appleby Road UNIT#
Owner/Agent: Paul Montero
Address: 120 Washington 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 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.
FOq THE BOARD OF HEALTH
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT ENFORCEMENT INSPECTOR
• CITY OF SALEM, MASSACHUSETTS -
BOARD OF HEALTH
120 WASHINGTON STREET,4"'FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAx(978) 745-0343
MAYOR JSCO'IT .sAIIF,M.COM `1
JOANNE SCOTT,
HEALTH AGENT
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"MINIMUM STANDARDS OFFITNESSFOR HUMA HABITATION."
PROPERTY LACATED AT 2 o.,i`l n�t Jg4 91< Paw n�m Ar�IQ Q!Sip UNIT#
NIT D ^NATED A RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSE MANAGER/AGENT
NO P.O. BOX
ADDRESSADDRESS
CITY,STATE,ZI1 �<�� A.�R DiS�o CITY,STATE,ZIP
RESIDENCE PHONE C as)82 8 109, BUSINESS PHONE(24HRS)
BUSINESSPHONEffi_9B� Z8
TOTAL NUMBER OF ROOMS:__ //
ROOM USE: 1441✓lno 2. lxi/ch&i 3 -odor 4. 5. r-(n=�, \
6. 7. 8. 10
THERE IS A TWENTY-FIVE($25)DOLLAR FEE,PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF
SALEM BOARD OF HEALTH T FEE S PAYABLE AT THE TIME OF INSPECTION
APPLICANTS SIGNATUR LU n DATE �'n,��
_ Inspectors use only ^(�Ol�
0 1�
Date on initial inspection: r� o Date of reins echoII: �3 Q ��Af!{
p I I
Date of issuance of certificate: Date fee paid:
Type of unit- Dwelling Other Check# Check date:
s� c�VW2Ytftort
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CITY OF SALEM, MASSACHUSETTS
• • BOARD OF HEALTH
120 WASHINGTON STREET,4:"FLOOR
TF-L. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR ]SCOITna SAI.a.M.COM
JOANNE SCOTT,
HEALTH AGENT
Release
In accordance with Massachusetts General Laws Chapter 111; Code of Massachusetts Regulations 410.000 et. Seq. ;
State Sanitary Code Chapter II and Article XIII of the City of Salem Ordinance, undersigned owner/lessor and
tenant/lessee of a unit of residential property, hereby authorize the Salem Board,of Health or its authorized agents to
inspect the residence identified below in accordance with the aforementioned statutes, regulations and ordinances.
In the event it is necessary that said inspection be done in my/out absence. I/we expressly authorized the same and for
my/our successors and assigns hereby release and discharge the City of Salem, Salem Board of Health and its
authorized agents from any lose or injury sustained of whatever nature and description occasioned by my/out absence
during said inspection.
q,cct6 an DLIII0✓I -rJ
Tenant/Lessee caner/Lessor
Address Address
25 D�
- q `� c,,,, 14A o/9 7'b
Address on�'be iusected
Date