ARBELLA STREET r�..� CITY OF SALEM, MASSACHUSETTS
�2! BOARD OF HEALTH
s 9 120 WASHINGTON STREET, 4TH FLOOR
o SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343 _
STANLEY J. UISOVICZ, JR. .JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
1/20/05
Charles & Sara Adams
8 Arbella Street
Salem, MA 01970
PROPERTY LOCATED AT 8 Arbella 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.
Fo the Board of HealthReply to
JJ ann�MPH, RS, CHO Pablo Valdez
Health Agent Code Enforcement Inspector
s@
@pjMME
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET
HEALTH AGENT Tei:(978) 741-1800
09/11/2000 Fax:(978) 740-9705
Demi Tzortzis
3 Hoover Avenue
Peabody, MA 01960
PROPERTY LOCATED AT 8 Arbella 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 2-33`4,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.
4oORScARD HEALTH REPLY TO
anneo , 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
STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
1/20/05
Charles & Sara Adams
8 Arbella Street
Salem, MA 01970
PROPERTY LOCATED AT 8 Arbella Street Unit 2
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 Heal! 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: 11/25/96 - Fax:(508)740-9705
Roland Penley -
21 Arbella Street
Salem, MA 01970
PROPERTY LOCATED AT 21 Arbella 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.
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
9oanne Scott, MPH,RS,CHO PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
4,,,. 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
CERTIFICATE OF FITNESS
CERTIFICATE# 197-06
DATE ISSUED: 4/20/06
Property Located at: 23 Arbella Street UNIT# 1
Owner/Agent: Thomas & Barbara Karademos
Address: 92 West Shore Drive
City/Town: Marblehead, MA Zip Code: 01945 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
JOAf E SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
80ARO OF 14EALTH
+ 120 WASHIHGT m STREET.4TH FLOOR
SALEM,MA 01970
TEL, 979-741-1900
FAX 979745-0349
STANLEY Usovicz,in. JOANNE SCOTT, MFH, 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 HArBITATIIOOW.
PROPERTY LOCATED AT #
IS THIS.UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNERILESSER ttdt!�±&tjt � �MANAGER/AGENT wig, ^'1 l-idPY�t�S
No P.O. Box No P.O.Box
ADDRESS q7 S�v/'e P,-. ADDRESS_—V
CITY_ C[Tci rr nt v _. CITY _
RESIDENCE PHONE 2&1= 63t-2' Z"%USWESS PHONE (24 HRS.)----
BUSINESS
RS.)__ _BUSINESS PHONE
TOTAL NUMBER OF ROOMS:__ ,9
ROOM USE: 1.
THERE IS A TWENTY-FIVE(525.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY
ORDER TO THE CITY OF SALEM HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE
TIME OF INSPECTION. %�J�,
APPLICANTS SIGNATURE _t � �. _ U —.DATE
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATF .ob DAI I_ FEi- PAID I/," - d-w _a 'e'
TYPE OF UNIT: DWELLING Y O'iIiER CHECK sl Cl 16CK DATE
NOIFS \
CO}I- FNI01ICI-f0i NI 1N,WI t:1011
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
3/23/06
Thomas Karademos
62 Village Street
Marblehead, MA 01945
PROPERTY LOCATED AT 23 Arbella Street Unit Rear
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.
F the Board of Health, Reply to
oanne Scott MPH, RS, CHO Pablo Valdez
Health Agent Code Enforcement Inspector
CITY OF SALEM, MASSACHUSETTS
.ye m31. BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01 970
Aq
1 `
CERT.# 451-99
FEE $25.00
DATE: 08/13/99
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: 23 Arbella Street UNIT #: Rear
OWNER/AGENT: William Xarademos
ADDRESS: P.O. Box 238
CITY/TOWN: Marblehead, MA ZIP CODE: 01945 24 HOUR PHONE: 929-1674
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 ' HE 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
,rte
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT APPLICATION FOR CERTIFICATE OF FITNESS Tel:(978)741-1800
Fav(978)740-9705
i IN ACCORDANCE WITH STATE SANITARY CODE,CHAPTER It, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION",
PROPERTY LOCATED AT 61L� 1s St UNIT oAltr
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER 1 t t �MANAGERIAGENT
No P.O.Box o P.O. Box
ADDRESS_, _. �3 ADDRESS
CITY V kM64 j Ima )/� CITY
RESIDENCE PHONE :7�J ' Q�°f `t'{z BUSINESS PHONE (24HRS.)
BUSINESS PHONE S
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. r p2,.
5� ��"� 6__a 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 �� / DATE_ :_t3=..
INSPECTORS USE ONLY
PATE OF INITIAL INSPECTION S� - 1 �? � DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: S�-I DATE FEE PAID:
TYPE OF UNIT: DWELLING OTHER_ CHECK# I�CHECK DATE 3
NOTES:
1 _
CODE ENFORCEMENT INSPECTOR 912$198
I
OND
3 �
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET
HEALTH AGENT 11/28/2000 Tel:(978)741-1800
Fax:(978)740-9705
William Karademos
23 Arbella Street
Salem, MA 01970
PROPERTY LOCATED AT 23 Arbella Street UNIT # 2
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
978-741-1800, 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.
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.
FOR THE BOARD OF HEALTH REPLY TO
�JoaT1T1� tt, CHO PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
i
�OWOIT
CERT.# 262-99
yP "; FEE $25 .00
DATE: 05/20/99
��/M1N6W
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: 23 Arbella Street UNIT #: 2
OWNER/AGENT: William Karademos
ADDRESS: P.O. Box 238
CITY/TOWN: Marblehead, MA ZIP CODE: 01945 24 HOUR PHONE: 221-0064
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
130ANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
n �
i
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH, RS, CHO NINE NORTH STREET
HEALTH AGENT APPLICATION FOR CERTIFICATE OF FITNESS Tel: (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 7 ! 11 beck S� - UNIT#2
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER 6)A1164 Kpj/ a<, MANAGER/AGENT Wi��ic�h+ /cid meg"
No P.O. Box No P.O. Box
ADDRESS P/�n iid)f Z 30 ADDRESS
CITY CITY
RESIDENCE PHONE 72g'A -5IM—BUSINESS PHONE (24 HRS.) V Z? -_4106f
BUSINESS PHONE 2&- 124—
TOTAL NUMBER OF ROOMS:__y�
ROOM USE: 1. . (c�Jl� 2. 3. Yl\ 4. Wt
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. p
APPLICANTS SIGNATURE �' _DATE ��1 _
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION �� DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATES_d� k DATE FEE PAID:�;__C;�'V
TYPE OF UNIT: DWELLINK OTHER_ CHECK# d2 CHECK DATE t
NOTES: �i�
CODE ENFORCEMENT INSPECTOR 9/28/98
1
• .,,� ,
-'�'
r ���.e �3 � ���
/ �Y - J �� '
i
i�
will
v
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT 03/19/99 Tel:(978)741-1800
Fax: (978)740-9705
George & Karen Tanch
23 Arbella Street
Salem, MA 01970
PROPERTY LOCATED AT 23 Arbella Street UNIT # 2
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
978-741-1800, 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.
A $25.00 check payable to the City of Salem is required for each unit inspected at the
time of inspection.
A property owner is required to pay gas and electricity for residential tenants if there
is not a written letting agreement stating the tenant is responsible for those utilities
and if the meter(s) records electricity and gas use which is not used exclusively by
that tenant. The Department of Public Utilities has billed property owners for their
tenants' entire utility bills retroactive to the date of initial occupancy in cases in
which cross-metering has been proven eo exist.
FOR THE BOARD OF HEALTH REPLY TO
oanne Scott, M O PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CERT.# 226-94
yi
ri
FEE: ..$ 25.00 ..
DATE: 4/7/94
CITY OF SALEM HEALTH DEPARTMENT
BOARD OF HEALTH
Salem, Massachusetts 01970
- - - 9 NORTH STREET
508-741-1800
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT 23 Arbella Street UNIT / 2 (Front)
OWNER/AGENT George Tanch
ADDRESS 23 Arbella Street
CITY/TOWN Salem, MA ZIP CODE 01970 24 HOUR PHONE 741-0054
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
1
CODE ENFORCEMENT INSPECTOR
ACTING HEALTH AGENT
OFFIg8 USE ONLY
,�.$phi d
y Q � _ CER}•
GATE:
CITY OF SALEM HEALTH DEPARTMENT
BOARD OF HEALTH
.. Salem, Massachusetts 01970
it08E .8�MHORIi 9 NORTH STREEZ
ItALTH AGENT
506J�/ 1800 APPLICATION FOR CERTIFICATE OF FITNESS
IN ACCORDANCE WITH STATE SANITARY!CODE, CHAPTER II, 105 CMR 410.000 "MINIMUM
STANDARDS OF FITNESS FOR HUNAN HABIT\ATION'".
PROPERTY LOCATED AT 3 N '1� �I.�Sr. UNIT / �oA/7)
OWNBR/LBSSER �e o rrn P. �Ityy� MANAGER/AGENT
ADDRESS 3 ( V Q Q.,,� ADDRESS
CITYCITY
=RESIDENCE PHONE-1 4 1 �,.0G S BUSINESS PHONE (24 HRS.)
.
BUSIRESS PHONE
TOTAL NUMBER OF ROOMS: + ,
ROOM USE: 1. 2. 3. 4. (�
5. �6. 7. 8.
THERE IS A TWENTY—FIVE (75.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY -ORDER To THE
CITY OF SALEM HEALTH DEPARTMENT UPON COHPLAND IS$IIAHCE OF CERTIFICATE.
APPLICANTS SIGNATUEB C� C -. WI DATE
INSPECTORS A ONLY
DATE OF INITIAL INSPECTION: -4 DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: y c. `� DATE FEE PAID:
TYPE OF UNIT: DWELLING( OTHER
NOTES:
�
CODE ENFORCEMENT INSPECTOR
CO�WtI
1+ J
+tOUmrt
CITY OF SALEM HEALTH DEPARTMENT
BOARD OF HEALTH
Salem, Massachusetts 01970
9 NORTH STREET
508-741-1800
DATE: March 29, 1994
George T. & Karen M. Tanch
23 Arbella Street
Salem, MA 01970
PROPERTY'LOCATED AT 23 Arbella Street UNIT 0 2
DEAR SIR/MADAM:
It has come to our attention, that you are about to allow rental of 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.
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 400.000: State Sanitary Code, Chapter I:
General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chap-
ter II: Minimum Standards of Fitness for Human Habitation, and in accordance with
Chapter II, Article XIII of the City of Salem Code of Ordinances, 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 upon issuance of Certificate.
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 8a.m. - 4p.m. , Thursday 8a.m. - 7p.m. , or Friday 8a.m. to
noon to schedule an appointment for an inspection.
SEE ENCLOSED SECTION 105 CMR 410.354 METERING OF GAS & ELECTRICITY
Very tttuly'yours,
FOR THE BOARD OF HEALTH REPLY TO:
PABLO VALDEZ
Code Enforcement Inspector
ACTING HEALTH AGENT
co CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
s A
" 120 WASHINGTON STREET, 4TH FLOOR
�P SALEM, MA O 1970
TEL. 978-741-1800
' FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHOI
MAYOR HEALTH AGENT
7/26/05
John Vitale
26 Arbella Street
Salem, MA 01970
PROPERTY LOCATED AT 26 Arbella 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.
or the Board of Health Reply to
Joanne Scott MPH, RS, CHO Pablo Valdez
Health Agent Code Enforcement Inspector
i
m CERT.# 475-00
_ FEE $25.00
DATE: 07/20/2000
��9e�IMINB
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: 26 Arbella Street UNIT #: 1
OWNER/AGENT: John Vitale
ADDRESS: 26 Arbella Street
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 745-3765
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
00% N�IT�
n
C q
70
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET
HEALTH AGENT APPLICATION FOR CERTIFICATE OF FITNESS Tel (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 oZ(P fW�01 A SWPQ T- SxQm UNIT#
o kq-7 o
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER o n L V �� MANAGER/AGENT
XN
ADDRESS ab A �e ���1�SK�T ADDRESS
CITY �O k Vy\ MN O M:70 CITY
RESIDENCE PHONE ��Ig�I`S53?6S BUSINESS PHONE (24 HRS.) I '8SG ZZ9 2!OS-
13USINESS PHONE I =FSS 0 2-2°1 "- 2-0g- 4
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. 2. 3. 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 DEPARTMENT THIS FEE IS PAYABLE AT THE
TIME OF INSPECTION. \
APPLICANTS SIGNATURE •Vv` =Q12 DATE 7 >2 O
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION - y DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: 7- o--fl-Z DATE FEE PAID:- -ate
TYPE OF UNIT: DWELLING/OTHER CHECK#3S6 CHECK DATE 72 Y v�
NOTES:
CODE ENFORCEMENT INSPECTOR 9/28/98
Jul 17 ,00 03: 55p Joanne Scott Salem BOH 978 740 9705 P 1
S '
CITY OF SALEM BOARD OF HEALTH
Salem,Massachusetts 01970-3928
JOANNE SCOTT,MPH,R5,CNO NINE NORTH STREET
HEALTH AGENT Tel:(508)741.7800
Fac:(509)740-9705
RELEASP
En accordance with Massachusetts General Laws Chapter III ; Code of Massachusetts
Regulations 410.000 et. seq. ; State Sanitary Code Chapter IT and Article RII1 ul'
die 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 helow in accordnnec with the
aforementioned statutes, regulations and ordinances,
l:t tl-'e event it is Aeces38ry that said inspar. rian be done in my/our sbasnce, iJcae
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 authorised age„tc•
frorti any loss or injury sustained of wilartvcr nature and doacripcioo occasioned
by my/our absence during said inspection.
SCR
ADDRESS SvQQ i 1. ot°i`� nrouISS` 4 (c.'^ ey 01970
S FIt0' _
ADDRESS OF uNPr To BE INSPECTi i)
OATF.
y �v��CONUIT,�Q'
s
9e�IMINE 1�� .
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
2
JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET
HEALTH AGENT 06/26/2000 Tel:(978)741-1800
Fax:(978)740-9705
John Vitale
26 Arbella Street
Salem, MA 01970
PROPERTY LOCATED AT 26 Arbella 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
978-741-1800, 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.
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.
FOR THE BOARD OF HEALTH REPLY TO
oanne�S o t, MHO PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
City of Salem, Massachusetts lu
n Board of Health
120 Washington Street, 4th Floor, Salem, PPub11CHeatkh
MA 01970
Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, REHS,CHo
Mayor Iramdin@salem.com Health Agent
CERTIFICATE OF FITNESS
CERTIFICATE #: GHL-15-301
DATE ISSUED: 9/25/2015
Property Located at: 30 ARBELLA STREET UNIT#1
Owner/Agent: Michele Errie
Address: 32 Arbella Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone:(787)786412
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 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
Larry Ramdin, MPH, REHS, CHO
HEALTH AGENT SANITARIAN
CITY OF SALEM, MASSACHUSETTS
t� BOARD OF HF.ALTH
120 WASHINGTON STREET',4"'FLOOR
TEL. (978) 741-1800
KIM 3ERLFY DRISCOLL FAX(978)745-0343
MAYOR J R AMDIN@S AU M CQM
LARRY RAMDTN,RS/RE11S,010,(T-1
HEALTIT AGTiNT '
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: $50. O
PROPERTY LOCATED AT h 0 UNIT#j-
IS THIS UNIT DISIGN TED AS RIGHT LEFT FR NT OR$BACK.PLEASE CIRCLE ONE
OWNER/LESSER ( ANAGER/AGENT
NO P.O.BOX
ADDRESS__°����'JCLf l ` et: ADDRESS
CITY, STATE,ZIP {�� /�� 1 CITY, STATE,ZIP tT V
RESIDENCE PHON �� `[ 3tU f t BUSINESS PHONE(24HRS)g
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ll
ROOM USE: 11.&W--K2. Y-11, 3 AV A 4yA W. j::]dV1
6 7 8. 9. 10.
THERE IS A FIFTY($50)DOL FEE, AY BY CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS F E I Y (LE T TIME OF INSPECTION C
APPLICANT'S SIGNATURE dli DATE ll
Inspectors use only
Date on initial inspection:6112=t/9n) S' Date of reinspection:
Date of issuance of certificate:09/2112415- Date fee paid:0�2LLaS
Type of unit: Dwelling--v/ Other Check#_ t Check slate:_01.121 z-5"
Notes: 0509- }
COfnxrcement,ofpector
I
Inspection of 0,- . urfnY,+M"Aj Date OV2,k/ Time 3-11j-512.WJ512.W
Name t- i 1pAddress 3nAr-� kQ)-�'-� 54rc,A
Owner m lr- .�r_ _ f- Tel. No. =17 5-7 q q2-
fF
Type of Inspection t Grid;CAA,., of f i 4h(,SS Inspector
Remarks and Violations are listed below: r L bI
K� lGI1t.YI 6r) k aS 0. I L no LrnCA4k 4 A.fih .
B0.JL�Aa(M W I nL W La$ cL-4ta�r iY1 4 e scre.c.HEA� .
rnp M w,l pdgw L$ 2 L L n I DG I C
1
c,VL15 YeW- 1!?,fi DL✓'nex I,o4 weir L4!l 4
in r nn m S !/_ W In w w i T i'n lq Q
v
11nnv�wtu,� Ytrc naSSLGI („s {lAn nweyrr ali VrnL+t A5' M1,5+ 4ecnCyler`-Fec�
Report Received by:
.CO
< 5i
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT,MPH, RS,CHO NINE NORTH STREET
HEALTH AGENT 08/03/2000 Tel:(978)741-1800
Fax:(978)740-9705
Brian & Barbara Keenan
31 Arbella Street
Salem, MA 01970
PROPERTY LOCATED AT 31 Arbella Street UNIT # 2
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
978-741-1800, 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.
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.
FOR THE BOARD OF HEALTH REPLY TO
4�,01)�
' Joanne Scott, MPH,RS,CHO PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
.co CITY OF SALEM, MASSACHUSETTS
$v '� BOARD OF HEALTH
s w,
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#537-05
DATE ISSUED: 8/22/05
Property Located at: 36 Arbella Street UNIT#2
Owner/Agent: Dimitrios Orfanos
Address: 21 Meadow Drive
City/Town: Middleton, MA Zip Code: 01949 24 Hour Phone: 617-552-3051
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 ))/
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
o CITY OF SALEM, MASSACHUSETTS
-/ BOARD OF HEALTH
• 120 WASHINGTON STREET, 4TH FLOOR ^/y
3 /
SALEM, MA 01970
TEL. 978-741-1600
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 HUMANHABITATION".
_`
PROPERTY LOCATED AT L, ELLA fl UNIT# Z,
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONTBACK PLEASE CIRCLE ONE
OWNER/L-&SSEf?VjMg� Woff RtANAGER/AGENT
No P.O. Box11 No P.O. Box
ADDRESS 2f �e_.Ckde-)u) DQ. ADDRESS
CITY M/Qg ccc��e2Vl VV\Ck 99 CITY
RESIDENCE PHONE77 77l�-//MBUSINESS PHONE (24 HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: 7
ROOM USE: 1._00'154 2. CIA. 3._�g?V. 4. 13 efel
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 / / DATE
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION R-I 6 _4' _.DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE ') �DATE FEE PAID: Q-'
TYPE OF UNIT: DWELL!y _OTHER__ CHECK# )--V CHECK DATE k-�) �S
NOTES:
CODE ENFORCEMENT INSPECTOR 9/28/98