HomeMy WebLinkAbout178 Seaview paper rental applicationPlease call to schedule 50E-398-2231, ext. 1240
MON-FRI. 8:30 AM-4:30 PM
Annual Rcgistration is an Owner Rcsponsibility
2023 RENTAL/LEASE REGISTRATION
TOWN OF YARMOUTH - BOARD OF HEALIH
1146 ROUTE 28, SOUTII YARMOUTI{ MA 02664
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H EALTH OEPI
ATTENTION LANDLORDS of Houses, Apartnents, Duplexes, Condomimums, Room tn
occupied dwellings) and Short Term Rcntals. Excluding [IoteVMotel, lnn, Lodging House or Bed and Breakfast
operations. (CIIAPTER 108 - OCCUPANCY OF BLJILDINGS BYLAW).
Note: Compliance with Zoning regulations is nol inforre{ nor intcnded.
RENTAL/LEASf, Registratioor EXPIRE on DECEMBER 31 of cach year. fEE IS $80 PER RENTAIJ
LEASE UMT. Comptete tbis form and rrtrrtr to the lleslth Olnce. Checla pEytble to: "TOWN OF
YARMOUTH'. For edditlonal I'ORMS AND/OR QUESTIONS, contact the EEALTH OFFICE AT
50&398-2231, x1240
Owner Neme @equlrtd Info)
Michael & Rene6 Anderson
Email and Phone #
Michael: mdauO91961@gmail.com (503)218-9139
Malling Addrcss
2 Upstone Drive
City/Iown
Nashua
Stcte
NH
ZIP
03053-3045
Rentll AgeDt (if eny) Email and Phone #
Rental Period: Anr:ual - Seasonal - Short Tcrm-
Rental of: House_Duplex-Condo-Apartment-Room-
-Smoke Detectors and Carbon Monordde Detectors Required-
Owners: I have ensured the batteries are changed, end heve tested ALL Smoke
Detectors/Carbon Monoxlde Detectors?
Smoke,/ CO detectors older than l0 years must be replaced.
Call fire department r€garding qucstions on new type and location prior to puthasing. 508-398-2212
PENAIITIES - Late registration of more than 30 DAYS after receipt or violations of any part of Chapter 108,
rroy be subject to non-crimioal citations issued as follows. Each day's violation deemed a separate offense.
l* Offense $100.00 / 2d Offense $1(X),00 (and each additional) $200.00. This applies to any OWNER or
Rcprcsentative.
Trash Removal by: Owner_ Tenant_ Disposal dsticker at Landfill
(Oucc a weel minimum)
Paid Pickup_ Name of Company Nauset Disposal
Note: Pleese remove trrsh & retycle binr from ruad after pick up day,
$80.00 Annual fee: Owner mry tlso register online https ://yarmouth.ma.us
(follow online services icon, then Pennits & L
Signature
(Requlre)
:
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Rentrl Pmperty Address
178 Seaview Avenue
Rer.l0ll7/12