HomeMy WebLinkAboutRegistration Form r� __
�, Y� ,
�� � � �
� � �
� ��. �
� �° �� Q M
��_ � �_ ._� � t'�, = o
.w.'4
`�,e, y �� r� a �
�..`"° � � �'���: m � Q
� c �
..� .,_T `S � t .�� J � �
Y
�" '� �
..� . � � ,.,_� � � �� :6
\y � ry` C �
� � � � p �
�� � 4.� � � �MU
. �. � �
� , , � � �;,� �
� � �.� �,� ��, � �
�. +' , � M�1 :
'� � � . , .
�a�``. , � ' � .� i•
n -.� m� , q ,� �
c� _i � k � ��
t y � . �
� t � .. � ,� �. �
�� - � :� � � � �
� •� � � �
s,� -� �
�s ' � � ���
�� » �__ ____ �
/�-- g�'v��--,���I
��INSPECTION OF ALL UNITS ARE REQUIRED.
`# ��� ��a�i� Please call to schedule 508-398-2231, ext. 1240
2017 RENTAL/LEASE REGISTRATIO E i��} � W ��' �
TOWN OF YARMOUTH - BOARD OF HE T�N 19 2017
1146 ROUTE 28, SOUTH YARMOUTH MA 02664 ,r�3 , , ,��.^
.
Register on line and SAVE $10 per unit @www.yarmouth.ma.us (O • f-� - �`� '; ` �-:`. �
�, 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�NTAI.fLEASE Registrat�ans EXPIRE on DECEMBER 31 �f each year. FEE IS
$80 PER RENTAL/LEASE IJNIT. 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. , d� ` � �
� ' � � �.�
Rental Propert Ad re � , �
� � � , ��1 d�� �'"b � .�I'� �! ���
Tenant(s) Name(s) (If Annual Ren 1) Email or�hone#
�
, , �
Rental A t if any) mail or Phone#
d1 $ 6 �g'.3
� Owner N e ( uire Info) - , Email or Phone# (Required)
� � �' G e
Mailing Address City/Town State ZIP
Rental Period: Annual � , Seasonal (Winter-Summer), Weekly
Rental of: House �Duplex Apartment Condominium Room
--Smoke Detectors and Carbon Monoacide 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?
SM�ICE ALARMS � �
� '�� Signature �
.
�ION H Y (Required)
�����x��������*��****������`�='"���������**����*�*��***��*���**�=���*�
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 / 3`d Offense
_ _ _ _ � : - « -,� « » « „
(and eac�addltional) $200.00. Trus applies to any OWNER , AGENT OR TENANT
ti,, �:��������x��x��������������x����x���������:�:������:����x��x��x��:x�����x��x��������x�:�:x�
Trash Removal by: Owner Tenant Disposal w/Sticker at Landfill
, aid Pickup Name of Company
_________tAaT' IIPT'P_..._. __._.__._ _._._.. tP!]�`�'1PYP._ _.. ._.. _..._..... __._,�__tP?7'�PTP_... ..._.__. __.�ae__...___._.tP9Y r1PYP-,_.._____.
_ _ _ -_._.. ____
�
�if�����r����rtt'��'�����'�t�''�1'���11'�'!�'
t��'-S�L��`���
��tr��� #��
�3��S A� ;�
� 6 6 01.0�ti�f�3Xi�.l.C1�# ;' �.
--.
�'
i�Z° �99Z0 F�Y�I`ulnout.z��u�nos
»anQ.Sayn�
aIdd gZ a�no2I 9�i i
a�as�a sn
paSlsid L.=:�a;�:�:'s.��:�_�==:��w3 =�� W.i.� �l���f���1l��f�f��tl�f.1����������'��I".�110InI2IV�
•.
- ,
, i
�
F
. . ,�:,�; .
� ' s ,
, . �
" � � . 4
• ��
. � �
_. *
a �1
.Y,-_..a--�.c.r-.,-.,.- '��...-- __...�"�.,___.�.