BENTLEY STREET City of Salem, Massachusetts
IV
r {
m Board of Health
120 Washington Street, 4th Floor, Salem, PublicHealth
MA01970 Prevent. Promote. Protect.
Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, RENS, CHo
Mayor Iramdin@salem.com Health Agent
CERTIFICATE OF FITNESS
CERTIFICATE #: GHL-16.144
DATE ISSUED: 4/19/2016
Property Located at: 4 BENTLEY STREET UNIT#1
Owner/Agent: Donna Bryant
Address: 35 Bush Hill Road
City/Town: Sherborn, MA Zip Code: 01770 24 Hour Phone:(508) 655-2815
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
F-�
Larry Ramdin, MPH, RENS, CHO
HEALTH AGENT SANITARIAN
0 MCONDl¢,t�,e
City of Salem, Massachusetts10
3 Board of Health
120 Washington Street, 4th Floor, Salem, PublicHeaI'th
MA 01970 Prevent. Promote. Protect.
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-16-144
DATE ISSUED: 4/19/2016
Property Located at: 4 BENTLEY STREET UNIT#1
Owner/Agent: Donna Bryant
Address: 35 Bush Hill Road
City/Town: Sherborn, MA Zip Code: 01770 24 Hour Phone:(508) 655-2815
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
0,—A4LA,--, Z�Z�Cde_
Larry Ramdin, MPH, REHS, CHO
HEALTH AGENT SANITARIAN
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
-� 120 WASHINGTON STREET,4`"FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOIJ- FAX(978) 745-0343
MAYOR DGEENBAUMSALEM.COM
DAVID GREENBAUM, `
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."
QQ�� 1 l FEE: $50.00
PROPERTY LOCATED AT `C I BVI?�II 6 ft:�: UNTT#
IS TRIS UNIT DISI ATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE1A
A V)i0
OWNER/LESSERR YIJI&J f)CUamCiaaW MANAGER/AGENT Aeprkk IFCQ
NO P.O. BOX {�
ADDRESS 35 f (dsh Nis i f 1 c ADDRESS 111 IJ S�Ce,'1
CITY, STATE, ZIP 5h w ph �,Mo 4, 0 I Z 7 O CITY, STATE, ZIP
- Q OI QZQ
RESIDENCE PHONE 20 o '65 �� 9'15 BUSINESS PHONE(24HRS) q?�- O 5, -06 0
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: S
ROOM USE: 1.pX.11 OM 2. 641601'I'1 3.t 1t/N 1'dM4.MAtyl 5 AzgM
6. 7. 8. V 9. 10
THERE IS A F IFTY($50)DOLLAR FEE, PAYABLE BY CHECK OR MONEY t!tORDER TO THE CITY OF SALEM
BOARD OF HEAL.TH.:THIS FEE ISP Y TIME OF INSPECTION t /
APPLICANT'S SIGNATURE DATE"[ '�4 [D
Insnectors use only
Date on initial inspection: ���(�6 Date of reinspection:
Date of issuance of certificate: Date fee paid:
Type of unit: ]Dwelling Other Check# 502 9 Check date:
Notes:
C e E o eo.e tinspector
o CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
fisti,„g TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
7/25/05
Nicholas Osgood
4 Bentley Street
Salem, MA 01970
PROPERTY LOCATED AT 4 Bentley 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 He th Reply to
Joanne Scott MPH, RS, CHO Pablo Valdez
Health Agent Code Enforcement Inspector
nn11 VREE�T
CITY OF SALEM BOARD OF HEALTHSalem, Massachusetts 01970-3928JOANNE SCOTT,MPH,RS,CHO NINE NORTH
HEALTH AGENT Tel:(508)741-1800
Date: 03/25/96 Fax:(508)740-9705
Four Bentley Street Realty Trust, Anne Carey, Trustee
4 Commercial Street
Marblehead, MA 01945
PROPERTY LOCATED AT 4 Bentley Street UNIT # 2 Q
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,
(FFOJ�.R. THE BOARD OF HEALTH REPLY TO
(Joanne Scott, MPH,RS,CHO PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
u CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
• 120 WASHINGTON STREET, 4TH FLOOR
3
SALEM, MA 01970 CERT.# 202-02
TEL. 978-741-1800 FEE $25.00
FAX 978-745-0343 DATE: 04/12/2002
STANLEY USOVICZ, JR. ,JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 4 Bentley Street UNIT #: 3
OWNER/AGENT: Nicholas Osgood
ADDRESS: 4 Bentley Street, Apt. 1
CITY/TOWN: Sales, MA ZIP CODE: 01970 24 HOUR PHONE: 741-0525
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
n,-
CITY OF SAL::::.:, Cv„- .6ACHUSE:T T S
?6 d,
BOARD OF HEALTH
3 . 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 11, 105 CMR 410.000
"MINIMUM STANDARDS OF/FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT UNIT#
�b
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE .-
OWNER/LESSER A-' I< OJ�yoaek MANAGER/AGENT
No P.O. Box - No P.O. Box
ADDRESS `1 Q�Fa/�� j+ i��� J _ADDRESS
CITY CITY
RESIDENCE PHONE BUSINESS PHONE (24 HRS.) 74/ -J93t
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: 7
ROOM USE: 1. 13cd. n 2. 14,q-4, 3.
5.-6.-7. 8.
THERE IS A TWENTY-FI�}DOLLAR FEE, PAYABLE BY CHECK OR MONEY
ORDER TO THE CITY OF M HEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE
TIME OF INSPECTION.
APPLICANTS SIGNA lJs - DATE s Z o s
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION(�=/ 2 T L DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE:'�f 2-0--L DATE FEE PAID: `74
TYPE OF UNIT: DWELLING)�_OTHER_ CHECK# y 7 CHECK DATE
NOTES: Chi
CODE ENFORCEMENT INSPECTOR 9/28/98
+t1y, CITY OF SALEM, MASSACHUSETTS
..1l. BOARD OF HEALTH
s $ 120 WASHINGTON STREET, 4TH FLOOR
�Fq 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#113-08
DATE ISSUED: 317/2008
Property Located at: 6 Bentley Street UNIT#2
Owner/Agent: Cheryl Tuttle
Address: 9 Mariners Lane
City/Town: Marblehead, MA Zip Code: 01945 24 Hour Phone: 631-3652
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 OFFHEALTHJ ANT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS n
BOARD OF HEALTH /r, [
• • 120 WASHINGTON STREET, 4TH FLOOR V
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 UNIT NO T BACK PLEASE CIRCLE Z
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRCLE ONE
OWNER/LESSER MANAGER/AGENT
No P.O. Box No P.O.Box
ADDRESS_ / ADDRESS
K
CITY Q19_Io ,VCl 2 CITY h&ft _a_ 9y4.0
RESIDENCE PHONE BUSINESS PHONE (24 HRS.)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:__
ROOM USE: 1._ ZZ 2._VtL_3._ _f�4. 6fC_
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 __DATE_
INSPE ORS USE ONLY
DATE OF INITIAL INSPECTION S ECTION v DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE:3 DATE FEE PAID:__=z P
TYPE OF UNIT: DWELLINGOTHER_ CHECK # _ CHECK DATE
NOTES:
CODE ENFORCEMENT INSPECTOR 9/28/98
TO
081ta /(--5-9 7 Time /:90
WHILE
�YOU
7 WERE OUT
M �"
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Area Code Number Extension
TELEPHONED q, PLEASE CALL
CALLEDTOSEEYOU WILLCALLAGAIN
WANTS TO SEE YOU URGENT
RETURNED YOUR CALL
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AMPAD 23-21•200 SETS
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3
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET
HEALTH AGENT Tel:(978)741-1800
Date: 09/18/97 Fax:(978)740-9705
10 1/2 Bentley Street Realty Trust c/o Michael Hurney, Trustee
1 W. Orchard Street
Marblehead, MA 01945
PROPERTY LOCATED AT 10 1/2 Bentley 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
qa_#_1C_x1C1/'
Joanne Scott, MPH,RS,CHO PABLO VALDEZ
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
e 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#684-06
DATE ISSUED: 11/9/2006
Property Located at: 14 Bentley Street UNIT#2nd floor front(right)
Owner/Agent: Philip F. Swiniuch
Address: 14 Bentley Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 741-1841
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
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
CITY OF SAMM, MASSACHUSETTS /
130ARD OF HEALTH
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 It, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABIITTATION°. // //
ft
PROPERTY LOCATED AT S _.UNIT #19n4 Y•v
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER&ESSPAill 12��f cue__ _MANAGER/AGENT_
No P.O. Bax No P.O.Box
ADDRESS S __ ADDRESS
CITY--c al2,ar1 j CITY_-- —__.
RESIDENCE PHONE__?,Z�,- _ jj kOUSINESS PHONE (24 HRS.)_,—___,
BUSINESS PHONE—_-_—--
TOTAL
_—
TOTAL NUMBER OF ROOMS:
ROOM USE:
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.
APPLICANTS SIGNATURE _~ �
1WPECTOR$ 11SE dNLY
DATE OF INITIAL INSPECTION %_ _ DATE OF REINSPECTION
DATE OF ISSUANCE OFCERTIFICATE/1 f 10(,9 DATE FEE PAID
TYPE OF UNIT: DWELLING OTHER CHECK 11 CHECK DATE
NOTES:. _.. .
CODE FNFORCEM17NT INSPECTOR 9128'98
co 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 JSCOTT@SALEM.COM
MAYOR
JOANNE SCOTT
HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#248-08
DATE ISSUED: 5/29/2008
Property Located at: 14 Bentley Street UNIT#2nd floor rear
Owner/Agent: Philip F. Swiniuch
Address: 14 Bentley Street
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 741-1841
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
J NNE SCOTT, MPH, RS, CHO *'!C
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 ISCO'rr e SAI.rM11.COM
JOANNE SCOTT,
HEALTH AGENT
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMA HABITATION."
PROPERTY LACATED AT `���N L ' 1uj (— UNIT# ?"� •"
IS THIS UNNITDISIGNATED AS RIGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER3H/N (1
P I• J UI'Iy I U e.H MANAGER/AGENT
NO P.O. BOX !1
ADDRESS ILI Io�r�T�eY �fi ADDRESS
CITY,STATE,ZIP 19LOL90w {N 5143 0 !47° CITY,STATE,ZIP
RESIDENCE PHONE / ,7 & 7` j, 143y i BUSINESS PHONE (24HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: Sr
ROOMUSE: 1. j!4fje h 2. ad Qit 3. Kn
ed Aw 4. &J Qrs 5.11/117p �v6"
6. 7. 8. 9. 10.
THERE IS A TWENTY-FIVE($25)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
APPLICANTS SIGNATURE_ �,& r c�i DATE
Inspectors use only
Date on initial inspection: � 1— Date of reinspection:
Date of issuance of certificate: ' Date fee paid:
Type of unit: Dwelling Other Check#�lpl/l Check date: W30.165<
Notes: kAo-)+ wtnl 6u.�% ` 6' .ugyt onit cue nc* Lr)dl'j0zorfealy - pwher
I,.till_ -�jXiha wihdaW3.
06de Enforcement Inspector
��CONUIT
n
CERT.# 549-00
FEE $25.00
DATE: 08/24/2000
�Q7MfNB
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: 14 Bentley Street UNIT #: 4 Right
OWNER/AGENT: Philip F. Swiniuch
ADDRESS: 14 Bentley Street
CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 741-1841
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
v c,
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
' -
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000 Fax:(978)740-9705
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT l �/ Sf
a� UNIT#-I
IS THIS UNIT DESIGNATED AS IGH LEFT FRONT BACK PLEASE CIRCLE ONE
OWNE ESSER �lli.,� / SWl�✓lL)c H MANAGER/AGENT
No Box No P.O. Box
ADDRESS
Q/l`I �J������ ADDRESS
CITY U aArm CITY 'A 11 VPl7/,?7 0
RESIDENCE PHONE 7LI 484 I BUSINESS PHONE (24 HRS.)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: b�
ROOM USE: 1. K,T 2. (3 R 3.
5.46.-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 DATE 2/C 2004
SPEC TO14S USE ONLY
DATE OF INITIAL INSPECTION 8'a b ' DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: DATE FEE PAID: R
TYPE OF UNIT: DWELLING OTHER_ CHECK# R 3 CHECK DATE-dam' a
NOTES:
CODE ENFORCEMENT INSPECTOR 9/28/98
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
i 120 WASHINGTON STREET, 4TH FLOOR
. SALEM, MA 01970 CERT.# 144-03
FEE $25.00
TEL. 978-741-1800 DATE: 04/03/2003
FAX 978-745-0343
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
PROPERTY LOCATED AT: 16 Bentley Street UNIT #: 1
OWNER/AGENT: Harbor Rental
ADDRESS: 111 Derby Street
. CITY/TOWN: Salem, MA ZIP CODE: 01970 24 HOUR PHONE: 741-9378
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 NOR BUILDING RELATED CODES. FOR MORE
INFORMATION CALL 978-741-1800.
FOR THE BOARD OF HEALTH
r JOANNE SCOTT, MPH,RS,CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
u CITY OF SALEM, MASSACHUSETTS ��-
��6 BOARD OF HEALTH
3 120 WASHINGTON STREET, 4TH FLOOR
e 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 XG �2 .v7LC �j y UNIT#�
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER/ /LI2ZD e,N L MANAGER/AGENT
No P.O. Box No P.O. Box
ADDRESS ��� /J,�� � y _ ADDRESS
CITY S,J',k,±!y 7lt /�/r2 2-0 CITY
RESIDENCE PHONE BUSINESS PHONE (24 HRS.)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: L
ROOM USE: 1._ /�- 2. —3. 4f 1-5
5 _6. T. 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 SIGNATUREDATE 3 �J
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION!j- 3 - b 3 DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE: Y- 3 d 3 DATE FEE PAID. - "c S
TYPE OF UNIT: DWELLIN�(OTHER_ CHECK# / b CHECK DATEY�S
NOTES:
CODE ENFORCEMENT INSPECTOR 9/28/98
C
.�ONWT
2
����MIIY6
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
01/29/2001
Henry Peper
1 Gregory Street
Marblehead, MA 01945
PROPERTY LOCATED AT 16 Bentley 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.
OR THE BOARH REPLY TO
oann � P
,CHO PABLO VALDEZ
Health Agent CODE ENFORCEMENT INSPECTOR
v
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET
HEALTH AGENT Tel:(978)741-1800
!
01/28/2000 Fax:(978)740-9705
Henry Peper
1 Gregory Street
Marblehead, MA 01945
PROPERTY LOCATED AT 16 Bentley 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.
OR THE BOARD F H TH REPLY TO
'}{ ;�
' Joanne Sc tt, MPH,RS,CHO PABLO VALDEZ
Health Agent CODE ENFORCEMENT INSPECTOR
CERT.# 830-96
FEE $25.00
DATE: 11/29/96
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: 16 Bentley Street UNIT #: 3
OWNER/AGENT: Henry Peoer
ADDRESS: 1 Gregory Street
CITY/TOWN: Marblehead, MA ZIP CODE: 01945 24 HOUR PHONE: 631-4827
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,CHOG—
HEALTH AGENT �C E E - RCE MENT INSPECTOR
r
a
G3b{
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970=3928
JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT Tel:(506)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 ! (,9 CUJ// S� UNIT /
OWNER/LESSER /4t1Lr_yr MANAGER/AGENT
ADDRESS1 Q r (!�/ ADDRESS
CITY (,i_q �CT d-t q f! CITY
RESIDENCE PHONE (y I < �y . L�� BUSINESS PHONE (24 HRS.)
BUSINESS PHONE —
TOTAL NUMBER OF ROOMS: 4�
ROOM USE: 1. 2. 3. 6A 4 .
—7. 8,
THERE IS A TWENTY-FIVE (25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE
CITY OF SALEM'HEALTH DEPARTMENT TH. FEE IS PAYABLE AT THE TIME OF IINNSSPEC�TJION f
APPLICANTS SIGNATURE DATE
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION:_C,4/n, DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE:_ /- DATE FEE PAID:
TYPE OF UNIT: DWELLING ke' OTHER
NOTES:
CO,PC-,nFOR9EWNT INSPECTOR,,---
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-'jK8 `.A..
JOANNE SCOTT,MPH,RS,CHO t '` NINE NORTH STREET
HEALTH AGENT ` Tel:(508)741-1800
Fax:(508)740.9705
RELEASE
In accordance with Massachusetts General Laws Chapter III ; 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 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, I/we
expressly authorize the same and formY/our successors and assigns hereby release
and discharge the City of Salem, Salem Board of Health and its authorized agents
from any 'loss or injury sustained of"whatever nature and description occasioned
by my/our absence during said inspection-:.
Ai_ t
9'I` . . Z.
TENANT/LESSEE OWNER/LESSOR
l v,.4 Le ►2 Qv---, 5--
ADDRESS ADDRESS ��
ADDRESS OF UNIT TOB INSPECTED
DATE
i