COLUMBUS SQUARE CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
a 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#763-05
DATE ISSUED: 12/29/05
Property Located at: 3 Columbus Square UNIT# 1
Owner/Agent: Peter Haywood
Address: 4 Columbus Square
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 744-3789
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
JO NE SCOTT, MPH, RS, CHO
HEALTH AGENT CODE rNFORCEMENT INSPECTOR
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
• • 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
Fax 978-745-0343 ` G//Y®'e �`/"J•Vl
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 -2 C0 I U ,S UNIT# t
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER S . NaUIWc( MANAGER/AGENT
No P.O. Box No P.O. BOX
ADDRESS ADDRESS
CITY So U CITY
RESIDENCE PHONE TA ?4`13>85 BUSINESS PHONE (24 HRS.) _-)40�q�
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ROOM USE: t. 2.?ed 3. L\Y 4b I
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 SIGNATUR • t DATE
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION 62-2R-OS DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE:IZ M-O5 DATE FEE PAID: 11-- 28-a3
TYPE OF UNIT: DWELLINGY OTHER_ CHECK#,3b4 _CHECK DATE 12.2a S
NOTES: FIw SI{Tkya :&jUe 1.01D - IZ'L?n 11
-------------------
CODE NFORCEMENT INSPECTOR 9/28/98
A
CITY OF SALEM9 MASSACHUSETTS
BOARD OF HEALTH
- ppp 120 WASHINGTON STREET, 4TH FLOOR
So' 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#424-05
DATE ISSUED: 7/8/05
Property Located at: 3 Columbus Square UNIT#3
Owner/Agent: Peter Haywood
Address: 4 Columbus Square
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-745-3797
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 If'
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
s
CITY OF SALEM, MAsSAcHusETT'S
y, BOARD OF HEALTH
♦ 120 WASHINGTO14 STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
-1
FAX 978-74-745PH, 43RS
STANLEY U50VICZ, JR.
- JOANNE SCOTT, MPH, RS, CHO -
MAYOR HEALTH AGENT
APPLICATION FORCERTI E FICAT OF FITNESS
I SS
IN ACCORDANCE WITH STATE SANITARY CODE-, CHAPTER tI, 105 CMR 410-000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT at GU aJ LG-S UNIT# 3
IS THIS UNIT DESIGNATED AS RIGH'T/ LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER } [ I� ANAGER/AGENT
No P.O. Box �`C No P.O. Box
ADDRESS 1 LU _ADDRESS }
CITY_ �! ems_— _..—_CITY
RESIDENCE PHONE-'fig 7j4-:3
rg%
� -BUSINESS PHONE (24 HRS)dj� rI 4S 3- Z
BUSINESS PHONE
TOTAL NUMBER OF ROOMS:
ROOM USE: t�-�+(�,/�yti�.
THERE IS A TWENTY-FIVE ($25-00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY
ORDER TO THE CITY OF JA 'MHEALTH DEPARTMENT THIS FEE IS PAYABLE AT THE
TIME. OF INSPECTION.APPLICANTS SIGNATURE L�J7J/?7 DATE_
INSPECT ORs; US-- NAY
^ at�.o
DAl E OF INITIAL INSPECTION -... -_-DAT E OF REINSPECTION_. --- . --_--_--
I
DATE OF ISSUANCE OF CERTIFICATE: '��' �a DATE FEE PAID-
TYPE OF UNIT DWEt_LIN - OTHER CHECK d- CHECK DATE a'"
NOTES
CODE ENFORCEMENT INSPECTOR 9/28/98