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��INSPECTION OF ALL UNITS ARE REQUIRED!��
Please call to schedule 508-398-2231, ext. 1240 ����
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��`�_� 2017 RENTAL/LEASE REGISTRATION � FEB 01 2017 :�
TOWN OF YARMOUTH — BOARD OF HEALTI� e_ - ..- . __
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1146 ROUTE 28, SOUTH YARMOLTTH MA 02664 - �
Register on line and SAVE $10 per unit @www.yarmouth.ma.us (Online Services)
L„�'ATTENTION LANDLORDS of Houses, Apartments, Duplexes, Condominiums and
Room Rentals (in owner occupied dwellings). Excluding Hotel/Motel, Inn, Lodging
House or Bed and Breakfast operations. (CHAPTER 108 — OCCUPANCY OF
BLTILDINGS BYLAV�. Note: Compliance with Zoning regulations is not inferred, nor
intended.
ItENT�LEI.EAS� Registrations EXPIRE on DECEMBER 31 of each year. FEE IS
$80 PER RENTAL/LEASE U1vIT. Complete this form and return to the Health
Office. Checks payabie to: "TOWN OF YARMOUTH". For additional FORMS
AND/OR QUESTIONS, contact the HEALT�I OFFICE AT 508-398-2231, x1240,
MON—FRI,8:30 AM-4:30 PM. —OR- REGISTER ON LINE for $70 per unit.
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Rental Property Address ao7 . 3Z�� SZ�,��(
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Tenant(s) Name(s) (If Annual Rental) Email or Phone #
Rental Agent (if any)��n���� ��� t-�1��n� E So 1 or�Sne�
,�, Owner Name (Required Info) ��n �L;ne 2 Email or Phone# (Required)
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_ Mailing Address City/Town C�Q t�"7 State ZIP
Rental Period: Annual , Seasonal ✓ (Winter ummer , Weekly ✓
Rental of: House ✓ Duplex Apartment Condominium Room
--Smoke Detectors and Carbon Monoxide Detectors Required—
Operable smoke and carbon monoxide detectors are required at each habitable level and in basements with
any appliances using fossil fuels (oil, gas, kerosene), including coal or wood stoves and enclosed or
attached garages. Owners: Have you ensured the batteries are changed, and have tested ALL your
Smoke Detectors/Carbon Monoxide Detectors?
�otcE ALARMS
� '� Signature ��Lc�c�� �a��.
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PENALTIES — Late registration of more than 30 DAYS after receipt or violations of any
part of Chapter 108, may be subject to non-criminal citations issued as follows. Each day's
violation deemed a separate offense. ls` Offense $50.00 / 2°d Offense $100.00 / 3rd Offense
_ - - - - -- ---. --- . __ ---_----
�and each aaditional) 200.00. Tlus applies to any "OWNER", "AGENT" OR"TENANT"
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Trash Removal by: Owner ✓ Tenant Disposal w/Sticker at Landfill
Paid Pickup Name of Company
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