1 BLOCK HOUSE SQUARE • s
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
-120 WASHINGTON STREET,4"'FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR DCREENBAUM@SALBM.com
DAVID GREENBAUM
ACTING HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#577-09
DATE ISSUED: 11/12/2009
Property Located at: 1 Block Nouse Square UNIT# 1 L
i
Owner/Agent: Luz Villarreal
Address: 150 Boston Street#2
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.
FOR THE BOARD OF HEALTH
DAVID GREENBAUM w
ACTING HEALTH AGENT CCPg ENFO C NT INSPECTOR
CITY OF SALEM, MASSACHUSETTS n /^fin
BOARD OF HEALTH � 1�(�/
120 WASHINGTON STREET,4T"FLOOR ///
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR nciu ENB QM@SAL LM.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."
FEE: $50.00
PROPERTY LOCATED AT / C 'JI-� LLS !•(_Q Ir e__ UNIT# �--
// ,IS THIS IU T DIIrIGNATED AS R GH T LEFT FRONT R BACK.PLEASE CIRCLE ONE
OWNER/LESSER '1 Z V I ! el, YK' f MANAGER/AGENT
ADDRESS IT&� / KSS I.A�j"• Z l� ADDRESS
CITY, STATE,ZIP (��Gt Q M/ r/t/`A � ���� CITY, STATE,ZIP
RESIDENCE PHONE I7 —b3 d BUSINESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUMBER By-,
ROOMS: �/3
ROOM USE: 1. B � 2 Kt L4W P,4. 5
6. 7. 8 9 10
THERE IS A FIFTY($50)DOLLAR FEE, PAYABLE BY.CHECK OR MONEY ORDER TO THE CITY OF SALEM
BOARD OF HEALTH THIS FEE I A THE TIME OF INSPECTION
APPLICANT'S SIGNATURE ✓ ¢,� DATE
Inspectors use only
Date on initial inspection: (I'('a.I(xT Date of reinspection:
Date of issuance of certificate: Date fee paid:
Type of unit: Dwelling Other Check# yQn Check date: 1. 112-
P IQs �V, I h , T--
I Notes: CIJ' ��W
v
C&etnforeement Inspector
1i
CITY OF SALEM9 MASSACHUSETTS
BOARD OF HEALTH
i R
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA O 1970
TEL. 978-74 t-1800
FAX 978-745-0343
KIMBERLEY DRISCOLL JSCOTT@SALEM.COM
MAYOR
JOANNE SCOTT
HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE # 121-08
DATE ISSUED: 3/11/2008
Property Located at: 1 Block House Square UNIT# 1R
Owner/Agent: Luz Villarreal
Address: 150 Boston street#2
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 744-7809
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
INNE TT, MPH, RS, CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
4
CITY OF SALEM, MASSACHUSETTS
• : BOARD OF HEALTH I�
120 WASHINGTON STREET,4°'FLOOR
TEL. (978)741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR Isco rr e sn acnf.COM
JOANNE SCOTT,
HEALTH AGENT
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"MINIMUMM STANDARDS OF FITNESS FOR HUMA HABITATION."
PROPERTY LACATED AT J� l 0 C D c4S e v Q ���'t'� AAA" `A UNIT# .
IS THIS U'N1T I IGNATED AS IGHT LEFT FRONT OR BACK,PLEASE CIRCLE ONE
OWNER/LESSER 2- t/ �a'n MANAGER/AGENT
NO P.O. BOX
ADDRESS Q STcypn tYt�� Ak1 ADDRESS
CITY,STATE,ZIP '^c7� �� r� CITY,STATE,ZIP
RESIDENCE PHONE"I I ° b�� b BUSINESS PHONE(241IRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS: � I- (�
ROOM USE: L �� 2.� 3. "/I 4- 14. 5.
6. 7. 8. 9. 10.
THERE IS A TWENTY-FIVE($25)DOL AR FEE, PAYABLE BY CHECK OR MONEY ORDER TO THE CITY OF
SALEM BOARD OF HEALTH THIS F ' IS PYAB E AT THTTE OF INSPECTION2APPLICANTS SIGNATURE V ' DATE ✓ - 1
Inspectors use only
Date on initial inspection: O Date of reinspection:
Date of issuance of certificate: -Gd - Date fee paid:_ --5
Type of unit: Dwellingther Check# Check date: 7
Notes:
Code Enforcement Inspector
City of Salem, Massachusetts10
+ +.
Board of Health
m 120 Washington Street, 4th Floor, Salem, PubliCHeatth
MA 01970 Prevent. Promote. Protect.
Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, REHS, CHO
Mayor health@salem.com Health Agent
CERTIFICATE OF FITNESS
CERTIFICATE#: GHL-16-490
DATE ISSUED: 12/16/2016
Property Located at: 1 BLOCK HOUSE SQUARE UNIT#21-
Owner/Agent:
2LOwner/Agent: Luz Villarreal
Address: 1 Block House Square
City/Town: Salem, Ma Zip Code: 01970 24 Hour Phone:
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.
Note: This approval does not certify compliance with the state lead law for occupants under 6 years of age.
Larry Ramdin, MPH, REHS, CHO
HEALTH AGENT SANITARIAN
( 11 ase en4,; ` Ce4, --cx4e 0 - Ft-7ir-e rs 40
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH -
120 WASHINGTON STREET,4".FLOOR
TEL (978)741-1800
KIMBERLEY DRISCOLL FAX(978)7450343
MAYOR LRAMD]Nna sAcaM.C(
LARRY RAMDIN,RS/RF.IiS,CHO,CP-FS
Hmmi AGENT
Application for Certificate of Fitness
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER 11, 105 CMR 410.000
"NIINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION"
q 7p� ff FEE: $50.00
PROPERTY LOCATED AT ! [�t�G(` HUy e. Stu ,C-C— UNIT#
IS THIS U
NIT DISIGNATRD AS RIGHT��OR B_A('K PLEASE CIRCLE F ONE
OWNERAMSER 1--k2- 1/ 1 l��l rte'R MANAGER/AGENT
ADDRESS *,Su l S9 ADDRESS
4
C1TY, STATE,ZIP sd ((;v 1 O� CITY,STATE,ZIP
RESIDENCE PHONE BUSINESS PHONE(24HRS)
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ROOM USE: 1. 2. Livl'njwvwi3. I i ni'n�rst 4`. -Wr1T-1 5. 6•'Ax'6"'1
6. R}c<b,zT-� 7. P,=-ro-tN 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 PAYA4LE 4THE TIME OF INSPECTION
l j�� /
APPLICANT'S SIGNATURE f I14 ` DATE /Z`is, Clr
j
Inspectors use only
Dale on initial iuspection:Drcc 1512aQ Date of reinspection: r
Date of issuance of certificate:Der�� , ZO1 lx Date fee paid: D-r—c�'(J-)- !M11
Type of unit: Dwelling Other Check#_Check date: cc j C 4
Notes:
Col E orceme t or ' ^ ) q
— 1 '0
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTONSALEM, MA 019700TH FLOOR
TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE#206-04
DATE ISSUED: 05/13/2004
Property Located at: 1 Block House Square UNIT#2R
Owner/Agent: Luz Villarreal
Address: 150 Boston Street#2
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-884-6388
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 IP'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 0F HEALTH
//
JOANNE SCOTT MPH RS CHO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
v�,gON01T / 10 / -
Ilk -10 (19
a �
I ��a
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 FATNESS( FOR HU AN HABITATION".
PROPERTY LOCATED AT ( cKr1' UNIT# h
IS THIS UNIT DESIGNATED
r As RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNERILESSER_L2 V l ed Vl1 A MANAGER/AGENT
No P.O. BoxL p� No P.O. Box
ADDRESS 15V dgD� bn aJ • #�� ADDRESS
.CITY
M44 Q 147-?o CITY
RESIDENCE PHONE "///��2 D7511/hq BUSINESS PHONE (24 HR Ik? T
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
b+ems•./ L -( dns>s�
ROOM USE: 1.
THERE IS A TWENTY-FIVE($25.00)DOLLAR FEE, PAYABLE BY CHECK OR MONEY
ORDER TO THE CITY OF SALEM HEALTH EPARTMENT THIS FEE IS PAYABLE AT THE
TIME OF INSPECTION. ,, D
APPLICANTS SIGNATURE c �-� DATE
INS E O S SE ONLY
DATE OF INITIAL INSPECTION i"/ 'V DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE:S-1 3 —0'/ DATE FEE PAID: 5_ J J 3 Q
TYPE OF UNIT: DWELLINGTHER CHECK# CHECK EC DATE -
_
NOTES:
CODE ENFORCEMENT INSPECTOR 9/28/98
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
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 author-
ized agents to inspect the residence identified below in accordance with the
aforementioned statutes, regulations and ordinances.
In the event it is necessary Lhat said inspection be done in my/our absence, i/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 agents
from any loss or injury sustained of whatever nature and description occasioned
by my/`our absence during said inspection.
cc
TENANT/LESSEE 0' NER/i.E SCR
�/�' 9b
0
AD SS V 1 ^, ADDRESS
I Iv
ADDRESS OF UNIT TO BE INSPECTED
DATE
,.?eECIAL SERVICES CUSTOMER INVOICE Pagel of 2 No. 2686-87936
Store 2686 SALEM,MA Phone: (978 1 741-9299 VALIDATION AREA
60 TRADERS WAY Salesperson: BL42T2
SALEM, MA 01970 Reviewer:
This is only afQUOTE for the merchandise and services printed below. This becomes an Agreement upon payment
and an endorsement by a Home Depot register validation.
.. ....... .......nT...
Name Home Phone R!!R'Y n—!,!! A
CAI 17C Tr,"'Y ''-s
. .. 2.
ILLARREAL LUZ (978) 825.9169•
TnTAI
Ad"'us 1 BLOCKHOUSE SQ. Work Phone (978) 884-6388 i32
• Company Name AtiT H C.P D F r! 7 A
SALEM
• City SALEM Job Description ANDERSON SCREENS
State MA z'P 01970 County ESSEX
'QUOTE is valid for this date: 0510512004
We the t to limit the quantities of
MERCHANDISE AND SERVICE SUMMARY mererWsaenr�iesesol�vocustomerg.
CUSTOMERi'Pic
REF#W02 SKU#5115-664 Customer Pickup I Will Call
S.O.MERCHANDISE TO BE PICKED UP: SID BROCKWAY SMITH REF#SOI ESTIMATED ARRIVAL TE:0511912004
W W-1, SKU t TY
...........
50101 � 212-235
1.00T EA CW24 ICW24 /CW24 GLASS Y $36.29 $36.29
SIZE 24X43 3/16"
S0102 212-235 1.00 EA C34 /C34 /C34 GLASS Y $35.71 $35.71
SIZE 19 3/4"X 43 3/16"
T7
50103 212-235 3.00 EA CN235 /CN235 Y 529.98 $89.94
—
SIZE 16 1/4"X 36
SCHEDULED PICKUP DATE: Will be scheduled upon arrival of all SID Merchandise $161.94
TOTAL CHARGES O1 ALL MEIRCA . RVICES.
$161.94
SALES TAX $8.10
TOTAL $170.04-
BALANCE DUE $170.04
END OF ORDE
...................
WILL-CALL MERCHANDISE PICK-UP
Will-Call items will be held in the store for 7 days only.
psv 1 of 2 No. 2686-87936 1 Customer Copy (9801) 0100131179