HomeMy WebLinkAboutRegistration Form ����5� v����%�� / �
*�INSPE� IO OF �LL UNITS ARE I�EQUIRED!*�
Please call to schedule 508-398-2231, ext. 1240 ��--- - - - ,
i :
�
2017 RENTAL/LEASE REGISTRATION � JAN � 7 2017 N
TOWN OF YARMOUTH - BOARD OF HEAL'I�H � ,� ,_ Y �
1146 ROUTE 28, SOUTH YARMOUTH MA 02664 -�-----------_��-:
Register on line and SAVE $10 per unit @www.yarmouthma.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 IPegistrations EXPIRE vn DECEMBER 31 of each year. FEE IS
$80 PER RENTAL/LEASE UNIT. 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.
�9�5��� �.S1��Q �,� /S� �i�e � S�1 a�e
� � �
Rental Property Address � � „ /���.U�� ����
�,e-�►� / l/
�
,
Tenant(s) Name(s) (If Annual Rental) Email or Phone #
Rental Agent (if any Email or Phone# b%�'f� ;�'�(10��
� o � �I � . , �
�-`' Owner Name equired Info E 1 or Phone# (Required)
�a ��-� /I, �/ ����8' �
Mailing Address CitylTown 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�ICE ALARMS
� '� Signature
• /10N HLY (Required)
**=k***�k�k*�k*�k�k�k�k*�k�k*�k�k****=k�`�k�k*�k�k**�k***�k****�k**�k�k**��k*y9��k*�=�k**�k**�k
/
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 / 2"d Offense $100.00 / 3rd Offense
,�, �and each adcT'itional)�200.00. This applies to any"OWNER';"AGENT"OR "TENANT"
���������:x��������:����������:����:���x����������������������������:��x��x�������
Trash Removal by: Owner Tenant Disposal w/Sticker at Landf'ill
�
Paid Pickup✓Name of Company
---------tear here----------------tear hPrP-------------------tear here-------------------tear here-------
... _ .
a
1{'�i'����l1�'��i��i"��I����i�lll�i�t�re����ey�j
L9£tr-98 tZ0�`��t!W
�a������a�z�
��
� � o�o��r a��cww���r-------____ _
�
to�Zo �99Z0 �IY�i`u�nout.z��u�nos
l�anQ.(apn�
atdd gZ a�nog 9�I I
aSelsod Sfl
p1S=S�d ZN�Y�I,L2I�'d�Q H,L'Id�H H.I,IlOY�i2Id�
.
�
�
__ .__ _ .�. . �
�., � .�.�, - .�-
. .� :- - _� �.,,�,�..�....r..�