HomeMy WebLinkAbout300 Buck Island Road 21B 2023 Paper appicationL ext/lffiO slr=
**INSP ECTION OFALL UNITS ARE RE UIRED!**
I'lcasc call to schcdulc 50ta-.39ti-'2 23 I . ext. 124{}
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.\nnual Rcgistralion ir an ()nnt,r Responsibilitr
2023 RENTAL/LEASE REGISTRATION
TOWN OF YARMOUTH _ BOARD OF HEALTH
I 146 ROUTE 28, SOUTH YARMOWHMA 026il
JlIxL ALARAS..Q, !*vt t r'
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AITENTION LANDLORDS of Houses, Apartrnents, fluplexes, Condominiums, Room Rentals. (in owner
occupied dwellings) and Short Term Rentals. Excluding HoteyMotel, Inn, Lodging House or Bed and Breakfast
operations. (CHAPTER 108 - OCCUPANCY OF BLIILDINGS BYLAW).
Note: Compliance with Zoning regulations is not inferred, nor intended.
RENTAL/LEASE Reglstrrtlons EXPIRE on DECEMBER 3l ofeach yerr. FEE IS $E0 PER RENTAL/
LEASE UNIT. Complete this form rnd rcturn to the Heelth Olfrce. Checks peyable to: "TOWN OF
YARJVIOUTH". For eddltional FORMS AND/OR QUESTIONS, contrct the HEALTH OFFICE AT
50&39E-2231, x1240
D {*n P1/+.
Rental Property Address(^Ic,r;o Llac V-,e-g;Dt- 11s-- 3*32
Owner Name (Requlred Info)Email and Phone #
e
Mailing Address
ft Cn<q D
ZIP
Rental Agent (if rny) ./ Email
Rental Period: Annual 4lseasonal- Sho4ferm:
Rentalof:House_Duplex_Condot-,/Apartment Room_
-Smoke Detectors and Carbon Monoxide Detectors Requl
Owners: I have ensurrd the batteries are changed, end hsve tested AL
Detectors/Carbon Monoride Detectorc?
Smoke/ CO detectors older than l0 years must be replaced.
Call fire department regarding questions on new type and location prior to purchasing. 508-398-2212
PENAL'IIES - Late registration of more than 30 DAYS after receipt or violations ofany part of Chapter 108,
rlay be subject to non-criminal citations issued as follows. Each day's violation deemed a separate offense.
lr Offense $100.fi) / 2"4 Offense $1fi).00 (and each additional) $2(X).00. This applies to any OWNER or
Representative.
Trash Removal by: Owner _
(Oncc a weck minimum)
Paid Pickup_ Name of Company
Disposal dSticker at Landfill _
Note: Plerse remove trrsh & recycle bins from road efter plck up day,
$80.00 Annual fee: Owner may also register online: https://yarmouth.ma.us
(follow online services icon, then Permits & Lic
Signature
(Require)
Tenant
/6
avs)
HEALTI O trH l.
REv 10/17/?2
State