WILLSON ROADWILLSON ROAD
CITY OF SALEM, MASSACHUSETTS
n ; BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970 .
TEL. 978-741-1800
STANLEY J. USOVICZ, JR. FAX 978-745-0343
MAYOR W WW.SALEM.COM
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
CERTIFICATE OF FITNESS
CERTIFICATE # 694-05
DATE ISSUED: 11/15/05
Property Located at: 1 Wilson Road UNIT # House
Owner/Agent: Dr. Hans Vonwiess
Address: 1071-lighland Avenue
City/Town: Salem, MA Zip Code: 01970 24 Hour Phone: 978-744-2782
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
JOANN�, MPH, RS, CHO
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
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
q.
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 I W� UNIT q
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
OWNER/LESSER)q ( NGiiS In l)_w0ANAGER/AGENT
No P.O. Box No P.O. Box
CITyaklh�L_ USS-\91C)CITY.
RESIDENCE PHON
BUSINESS
SINESS PHONE (24 HRS.) ql&-(yq
TOTAL I lY�
NUMBER OF ROOMS: _
ROOM USE 1.L1jifc /�2.Nm ZeCirm leo)rco"(h
5 bed�rt fl.
THERE IS A TWENTY-FIVE (S25.00) DOLLAR FEE, PAYABLE BY CHECK OR MONEY
ORDER TO THE CITY OF SAEM HEALT DEPAR MENT THIS FEE IS PAYABLE AT THE
TIME OF INSPECTION.
ff
APPLICANTSSIGNATUR �d U1� _DATE_.I_I 1��
INSPECTORS USE ONLY
DATE OF INITIAL INSPECTION // -') 0 a DATE OF REINSPECTION
DATE OF ISSUANCE OF CERTIFICATE 0 DATE FEE PAID:
TYPE OF UNIT: DWELLING., BOTHER CHECK N `ol 7e CHECK DATE
NOTES:
F
CODE ENFORCEMENT INSPECTOR 9/28/98