WINTER ISLAND ROADCITY OF SALEM, MASSACHUSETTS
m 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 # 131-07
DATE ISSUED: 3/22/2007
Property Located at: 3 Winter Island Road UNIT # House
Owner/Agent: Peter & Diane 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
Lgle--
J ANNE SCOTT, MPH, RS, CHOVAO
HEALTH AGENT CODE ENFORCEMENT INSPECTOR
/I
APPLICATION FOR CERTIFICATE OF FITNESS
13 l -d?
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT UNIT #G vS R
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
W—E ._ESSER//?� C Ijbia , MANAGER
/AGENT ox No P.O. Box
ADDRESS ADDRESS
CITYRa)�m
CITY tjA
RESIDENCE PHONE g T44- 3 i U BUSINESS PHONE (24 HRS.)
BUSINESS PHONE ' g 145- 3,) q
TOTAL NUMBER OF ROOMS:__ 51
ROOM USE: 1 ___ 2. 3 4
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/�--DATEZv --
INSPECTGRS u E ONLY
DATE OF INITIAL INSPECTION3-` - O _2 7 DATE OF REINSPECTION
---
DATE OF ISSUANCE OF CERTIFICATE3_-�'' Z DATE FEE PAID:. Z 6
TYPE OF UNIT: DWELLING1/OTHER
NOTES:-- /�l
CODE ENFORCEMENT INSPECTOR
CHECK if Q (v 76 CHECK DATE
9/2£1/98
CITY OF SALEM, MASSACHUSETTS
yp
..�f
BOARD 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
13 l -d?
IN ACCORDANCE WITH STATE SANITARY CODE, CHAPTER II, 105 CMR 410.000
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION".
PROPERTY LOCATED AT UNIT #G vS R
IS THIS UNIT DESIGNATED AS RIGHT LEFT FRONT BACK PLEASE CIRCLE ONE
W—E ._ESSER//?� C Ijbia , MANAGER
/AGENT ox No P.O. Box
ADDRESS ADDRESS
CITYRa)�m
CITY tjA
RESIDENCE PHONE g T44- 3 i U BUSINESS PHONE (24 HRS.)
BUSINESS PHONE ' g 145- 3,) q
TOTAL NUMBER OF ROOMS:__ 51
ROOM USE: 1 ___ 2. 3 4
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/�--DATEZv --
INSPECTGRS u E ONLY
DATE OF INITIAL INSPECTION3-` - O _2 7 DATE OF REINSPECTION
---
DATE OF ISSUANCE OF CERTIFICATE3_-�'' Z DATE FEE PAID:. Z 6
TYPE OF UNIT: DWELLING1/OTHER
NOTES:-- /�l
CODE ENFORCEMENT INSPECTOR
CHECK if Q (v 76 CHECK DATE
9/2£1/98