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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 19 2017 �
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TOWN OF YARMOUTH BOARD OF HEAL H ��:�-;.�,,-��� �,,�->>T a
1146 ROUTE 28, SOUTH YARMOUTH MA 02664 � ��4� -
Register on line and SAVE $10 per unit @www.yarmouth.ma.us (Online Services)
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�"'( 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.
R��T���.ILEASE Registrations EXPIRE on DECEMBER 31 of each year. FEE IS
$80 PER RENTAL/LEASE LTNIT._ Complete this form and return to the Health
Office. Checks payable to: "T�WN 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.
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Rental Property Addre
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Tenant(s) Name(s) (If Annual ntal) Email or Phone #
Rental Agent (if any) Email or Phone #
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`*-� Owner Name Required Inf ) Email or Phone# (Required)
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Mailing Address CitylT wn State ZIP
Rental Period: Annual �.Seasonal (Winter-Summer), Weekly
Rental of: House Duplex Apartmentf�Condominium Room
--Smoke Detectors and Carbon Monoxide Detectors Required—
Operable smoke and carbon monoxide detectors are required at each habitabie 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?
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�OItE ALARMS "
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.: _ Signatur � �
� /1(1N HLY (Required)
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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. lst Offense $50.00 / 2nd Offense $100.00 ! 3rd Offense
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��, (and each additional) $200.00. This applies to any "OWNER", "AGENT" OR "TENANT"
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Trash Removal by: Owner� Tenant Disposal w/Sticker at Landfill .�
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