HomeMy WebLinkAboutRegistration Form - - - / .
�� ��� �'�� �r��� ��� �
INSPECTION OF ALL IT ARE R� IRE�
UN S QU .
�
�� � Please call to schedule 508-398-2231, ext. 1240 � ��W�� 9 hi y_a-.��
� '
G;� � 2017 RENTAL/LEASE REGISTRATION JAN 19 20
17 �
� �� TOWN OF YARMOUTH — B OARD OF HEAL H�,.�.�,;a,_, ,,�^,
��� I 1146 ROUTE 28 S TH Y ��``=�=�'�—�! ��
, OU ARMOUTH 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.
-- RE�I�AL/LEASE Registrations E�F�RE on 1?ECEMBER 3� of each �ear. 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 $70 per unit. �
�2- �S'�i!9 N.�1�'-� '�-' �4 ' ��. ��;r�v� .�'.� o� 2� �
, ,,-
Rental Property Address %t
���
Tenant(s} Name(s) (If Annual Rental)� --�G�ny�P e#
�--,.... �Z--�L_---�_`.._��.� �- --._�.
Rental Agent (if any) Email or Phone#
� �
� Owner Nam�Req,, ired Inf�l Email or Phone# (Required)
�„i � o �(z�=t-. � p v�" �J I ,t..) ���r✓ :1'�/Mi o��- ��� ✓,78' Sj,$"��?
Mailing Address. City/Town State ZIP
�t,� �(Z f,,�. y,c1.2 rr� 6uT� /�i�- �'� G' 7�
Rental Period: Annu , Seasonal (Winter-Summer), 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 Mono�de Detectors? �L�'�'
�10tcE ALARM5
� '� Signature
',r�x
-` �� (Required)
���������:**��*�**�*��������"����**�����*�����**��**�*��**�****�*�
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. 1S` Offense $50.00 / 2°d Offense $100.00 / 3rd Offense
(and eac� add`itional�-$200.00. This applies to any T`Oi�V�ER";�`AGEN'T''O� `T�NAI�T"
� �������������������������������������������������������������������������
Trash Removal by: Owner t� Tenant Disposal w/Sticker at Landf'ill
Paid Pickup Name of Company � ��
I '� I 1
� a�
..!�"
���n��E[ll�!��ee���E�l'�1����E��«������1�ttet�r�Il11[��
ZLOV GL.�V�w`y�`'OW,IpiA�2J�
� �48��� .
�uear�nowltag
/���� � � l�Ro2���J
££ I.Q9ZA 1tJtCI-�H�fl2tltl��►
�
� to9Zo fi99Z0 `dY�i `u}nout���u�nos
� �,u�Q.(apn� .
Q,da gZ a�nog 9fii i
a8easod Sfl
pasas�d ,LN�Y�I.L2I�d�Q H.L'IF1�H H,LIlOL�T2id�
�
- ---------�-_< ---
___ , _____ _
, _.T
_.__ _ __ _-
— - -
: _ . � _ ____ ,,
�
N�
� ...-��
�