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**INSPECTION OF ALLOS A REODi D!**
Please call to schedule 508-398-2231, ext. 1240
Annual Registration is an Owner Responsibility
2022 RENTAL/LEASE REGISTRATION
TOWN OF YARMOUTH — BOARD OF HEALTH
1146 ROUTE 28, SOUTH YARMOUTH MA 02664
ATTENTION LANDLORDS of Houses, Apartments, Duplexes, Condominiums and
Room 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 /L.FACF. Reoictratinstc FYPIP' ,n nvrEMRF,A 21 of po':i3 year. FTE 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.
59 1UJDOt ON SO U t O Th PU
Rental Property Address
Tenant(s) Name(s) (Required if Annual Rental) Email or Phone #
Rental Agent (if any) Email or Phone #
Owner Name (Required Info) Email & Phone # (Required)
Mailing Address City/Town State ZIP
Rental Period: Annual , Seasonal New Owner
Rental of: House Duplex 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
attached garages. Owners: Have you ensured the batteries are changed, a d have tested AL ou
Smoke Detectors/Carbon Monoxide Detectors? —�
711OKt ALARMS v
� VE Signature -�--�
VAtsl
_4TEST
MNTNLY (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. lst Offense $100.00 / 2nd Offense $100.00 (and each
additional) $200.00. This applies to any "OWNER" or OWNER representative
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Trash Removal by: Owner Tenant_ Disposal w/Sticker at Landfill
(Once a week minimum)
Paid Pickup Name of Company
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Self-Receipt for 2022 Rental Lease Registration for Your Records
$80 (Eighty Dollars) per Unit
Note: Please remove recycle bins from road after pick up day.
Rental Address Amount Paid Check #
Rev.09/15/21
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