HomeMy WebLinkAboutRegistration Form u_�� � -�g'�7 t�� ���
INSPECTION OF ALL UNITS ARE�E U _D.
Please call to schedule 508-398-2231, ext. 1240 u� {�� �
P��� �� � JAN 2 5 2017
�' 2017 RENTAL/LEASE REGISTRATION ' �
�
�
� �� TOWN OF YARMOUTH — BOARD OF HEALT�--- -u'-�� ' �`� r_ �
1146 ROUTE 28, SOUTH YARMOUTH MA 02664
Register on line and SAVE $10 per unit C�www.yarmouth.ma.us (Online Services)
� 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
BUILDINGS BYLAV�. Note: Compliance with Zoning regulations is not inferred, nor
intended.
- RENTAL/LEASE Registrations E�£PIRE on DEeEIV�B��t 31 0€-caek-�ea�.-F�E=--�S
$80 PER RENTAL/LEASE LTNIT. Complete this form and return to the Health
Office. Checks payable to: "TOWN OF YARMOUTH". For additional FORMS
AND/OR QUESTIONS, contact the HEALTH OFFICE AT 508-398-2231, x1240,
MON—FRI,8:30 AM-4:30 PM. —OR- REGISTER ON LINE for $70 per unit.
�',5' ��vy�,� /r�. �, /�-`�t-�z��
Rental Property Address
Tenant(s) Name(s) (If Annual Rental) Email or Phone#
Rental Agent (if any) Email or Phone#
�Gt�i�� �'��PJz�'.� :Sf1� rT%���5�10
� Owner Name (Required Info) Email or Phone # (Required)
I� S� v�,�a�� �J= `lr���v� � l� �-�'7,3
Mailing Address _. _ City/Town State ZIP __ ��_
Rental Period: Annual ✓ , Seasonal (VVinter-Summer), Weekly
Rental of: House Duplex Apartment Condominium Room
--Smoke Detectors and Carbon Mono�cide 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?
sr,acE au�s
� ,� � _ _
Signature � "
� iu���Y (Require
���*��*�����*�***�*��������"*��*��*�����*����**��****�*��**�***�*
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 additional) $�.�0. This applies to any "OWIV�R';"AGENT'' Ol� i`1'El�A�1T"
� �����������������������:���:����x��������������������������������������������
Trash Removal by: Owner Tenant � Disposal w/Sticker at Landfill
Paid Pickup Name of Company
` __.tnn.-�ArA____ -t�^t'�PrP_____ _ .___tP�r�1t�T'p- -�--- � . . +�•,r hn+-� .....__.
� _
l.
ti"
�t1'tl�.�'t!1ltst��i.�4E�.�t�[�'ll���t1�i�1�E���.��t�.f��
LZ£E-£L�Q�+It `�ouue��sa/�
P2i ��S tr�
2�1�t'u€�saa�
€s ���a-� ��.�n��.�
�
to9Zo �99Z0 �'Y�I`�I�nouz���u;�ta�
l�anQ,Sa�in�
Q�dd gZ a�nog 9�i T
a8e�sod SR
plsas=a ,LN�Y�i.L2I�'d�Q H.L'I��H H,LIlOY�I2i�'�
�
� --— __ — -___ �-- --- _—_—_-- - ..: -- -—-
_ ;
��