HomeMy WebLinkAbout122 South Shore Drive paper Rental applicationI'e{19 ?l-lNepa r$f (yqaQrnql
**INSPECTION OFALL UNITSARE RE IRE lrkrt
Please call to schedule 508-398-2231, ext. 1240
MON-FRl, 8:30 AM-,1:30 PM
Annual Registration is an Owner Responsibility
2023 RENIAL/LEASE RBGISTRATION
TOWN OF YARMOUTH _ BOARD OF HEALTH
1146 ROUTE 28, SOUTH YARMOUTH MA 02664
5NOK[ ALARA5
.Q;.ffi--H ,t'l
ON LANDLORDS of Houses, Apartments, Duplexes, Condominiums, Room Rentals. (in owner
occupied dwellings) and Short Term Rentals. Excluding Hotel/Motel. Inn. Lodging House or Bed and Breakfast
operations. (CHAPTER 108 OCCUPANCY OF BUILDINGS BYLAW).
Note: Compliance with Zoning regulations is not inferred, nor intended.
RENTAL/LEASE Registrations EXPIRE on DECEMBER 31 of each year. FEE IS $80 PER RENTAL/
LEASE UNIT. Complete this form and return to the Health OIIice. Checks payable to: "TOWN OF
YARMOUTH". For additional FORMS AND/OR QUESTIONS, contact the HEALTH OFFICE AT
508-398-2231, x1240
i ZZ Sc;uTH S HoRr DF.
Rental Property Address:rACt< cn,,,.r -i-d Al ld Jen ru Ta, r (D eo.lvtcncr vET- .{o8-fi|-ctsDb,
Owner Name (Required Info)
D3 GeeeltLAN
Email and Phone #
DclR vABtvrou+rMrr-Ary\oz61{
Mailing Address City/Town State ZIP
Rental Agent (if any)Email and Phone #
Rental Period: Annual_ Seasonal_ ShortTerm{
Rental of: House X Duplex_Condo_Apartment Room_
--Smoke Detectors and Carbon Monoxide Detectors Required_
owners: I have ensured the batteries are changed, and have tested ALL Smoke
Detectors/Carbon Monoxide Detectors?
Smoke/ CO detectors older than l0 years must be replaced
Call fire departrnent regarding questions on new type and location prior to purchasing. 50&39g-22 I2
PENALTIES - Late registration of more than 30 DAYS after receipt or violations of any part of Chapter I 0g,may be subject to non-criminal citations issued as follows. Each day's violation deemei a separate offense.
lst Offense $100.00 / 2na Offense $r00.00 (and each additional) $200.00. This applies ro any OWNER orRepresentative.
Trash Removal by: Owner
(Once a week minimum)Disposal ilSticker at Landf,rll XTenant
Paid Pickup_ Name of Company
Note: Please remove trash & recycle bins from road after pick up day.
$80.00 Annual fee: Owner may also register(follow online services icon, then permiti A li line: https://yarmouth.ma.us
SignatureRe\.10/17122
(Req
c ses).
x_
J