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HomeMy WebLinkAboutRegistration Form_ _ /G���/1�t��d � �k�k ��INSPECTION OF ALL UNITS ARE REQU�ED! Please call to schedule 508-398-2231, ext. 1240 � ���,� � � � JA�1 3 0 2017 �� 2017 RENTAL/LEASE REGISTRATION � ��� TOWN OF YARMOUTH - BOARD OF HEALTI-��-- 1146 ROUTE 28, SOUTH YARMOUTH MA 02664 Register on line and SAVE $10 per unit @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 , BLTILDINGS BYLAV�. Note: Compliance with Zoning regulations is not inferred, nor intended. . --- R�AITALJLEASE Registrations EXPIRE on DECEMBER 31 of each year. FEE IS $SO PER RENTAL/LEASE U1vIT. 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 $70 per unit. �33� ���v, ,�-,�e:n�'� Rental Property Address Yl 0..� Tenant(s) Name(s) (If Annual ental) Email or Phone# Rental Agent (if any) Email or Phone # G��-�� �.�- `_1 �1_ ��s-3'?S$ Owner Name (Required Info) Email or Phone # (Required) � aS ���,n�+n�.., �.�n-�. �,/�.,�-, . rn� o� i� I Mailing Address__ _ City/Town State ZIP Rental Period: Annual '✓ , Seasonal (Winter-Summer), Weekly Rental of: House ✓1Duplex 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 Monoxide Detectors? S�ICE ALARM5 � '� Signature '���s��-2. �_ ���{{�Y (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. ls` Offense $50.00 / 2"d Offense $100.00 / 3rd Offense (and each additional) $200.00. This applies to any"OWNER", "AGENT" OR"TENANT" �, :x�����x����������:x�:x��:������������:���:x�:����:������������:��x��x�x�*��x����������� Trash Removal by: Owner Tenant � Disposal w/Sticker at Landfill Paid Pickup Name of Company � 4nnr�1P1'P___________________ tear ere-------------------tear ere------- � � � ���II������'l�t���Nl���I:��e!eE�ree��ll j!Il�l�!l�tii�E�hle�E Z6£I.-66i.Z0 b�i`��aM tr��au�n�u�('SZ �.�� f�MF�swe��� �l�6tT�ll�i�3� . 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