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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 � JAN 3 0 2017
� l�3 TOWN OF YARMOUTH — BOARD OF HEALTI�I -� �
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1146 ROUTE 28, SOUT'H YARMOUTH MA 02664 -- � - T;,
Register on line and SAVE $10 per unit @www.yarmouth.ma.us (Online Services)
� AT1'ENTION 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 EXPIR� on BECEIdIBER 31 of each year. FEE IS
$80 PER RENTAL/LEASE U1vIT. Complete this form and return to the Health
Office. Checks payable to: "TOWN OF YARMOUTH". For additional FORMS
AND/0R 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.
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Rental Pro erty Address
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Tenant(s) Name(s If Annual Rental) Email or Phone#
Rental Agent (if any) Email or Phone #
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� Owner Name (Required In o) mail or Phone# (Required)
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Mailing ddress_�� _City/Town-------- -----State_,__ _____, __ ZIP___ _�— _---- -`--,�
Rental Period: Annual�, Seasonal (Winter-Summer), Weekly
Rental of: House Duplex Apartment Condominium Room
--Smoke Detectors and Carbon Mono�tide 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 Monoacide Detectors?
�olcE ALARMS
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Signature 6
" rir��Y (Required)
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PENALTIES — Late registration of more than 30 DAYS after receipt or violations of any
part of Chapter 108, rraay be subject to non-criminal citations issued as follows. Each day's
violation deemed a separate offense. lst Offense $50.00 / 2"d Offense $100.00 / 3`d Offense
�: (anci eacbadditional)-$�UU:�. fihis applies to any``�7WNER", "ACiEI�'I"' OR "TENANT"
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Trash Removal by: Owner Tenant Disposal w/Sticker at Landfill
Paid Fickup Name of Company
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