8 Holly Lane paper application**INSPECTION OFALL UNITS ARE REo UIRED!**
Please call lo schcdule 508-398-2231, ext. 1240
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,{nnual llegistration is an O*ner Rcsponsibilitl
2023 RENTAL/LEASE REGISTRATION
TOWN OF YARMOUTH _ BOARD OF I{EALTH
1146 ROUTE 28, SOUTH YARMOUTH MA 02664
i,lO(E ALARNS.Quro-lS-n*l
AITENTION 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.
RENTAULEASE Registrations EXPIRE on DECEMBER 31 of each yean FEE IS $80 PER RENTAU
LEASE UNIT. Complete this form and return to the Health Offrce. Checks payable to: "TOWII OF
YARMOUTH". For additional FORMS AND/OR QUESTIONS, contact the IIEALTH OF'FICE AT
508-398-2231' xl240
8 HotcY LA^rE
Rental Property Address
Owner Name (Required Info)
"OD$A B. RO6T'4Y9 TBIJ'T
Email and Phone #
No ehut ,o$ - 49) - 4z+6
Mailing Address
52 hx.Uttwo etrq RDr
City/Town
weLLESaZ?
State
N4
ZIP
o 24$2
Rental Agent (ifany) Email and Phone #
Rental Period: Annual / Seasonal Short Term
Rental of: House'/ 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 old€r than l0 years must be replaced.
Call fire department regarding questions on new type and location prior to purchasing. 508-398-2
}
212
PENALTIES - Late registration of more than 30 DAYS after receipt or violations of any part of Chapter 108,
raay be subject to non-criminal citations issued as follows. Each day's violation deemed a separate offense.l Offense $100.00 / 2nd Offense $100.00 (and each additional) $200.00. This applies to any OWNER or
Representative.
Trash Removal by: Owner
(Once a week minimum)
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 online: https ://yarmouth.ma.us(follow online services icon, then permit s&Lic
Tenant v/' Disposal w/Sticker at Landfill
Signature
(Require)
Re\t.l0ll7D2
enses).
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YARMOUTH HEALTH DEPARTMENT
1145 Route 28
South Yarmouth, MA 02664
ROBERTS SANDRA B TR
52 KENILWORTH RD
WELLESLEY, MAO2482
RENTAL. 8 HOLLY LN
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