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**INSpECTIoN oFALL uNITS ARE REOUIRED!** 5 0.Y -tco-
Please call to schedule 508-398-2231, "*t. l2i6-** 1fr|k
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Annual Registration is an ()rvner Rcsponsihilitv
2023 RENTAL/LEASE REGISTRATION
TOWN OF YARMOUTH-BOARD OF HEALTH
. -$ ll46RourE28,sourHyARMourHMA 02664le7"\\
Xf C\i7 ATTENTION LANDLORDS of Houses, Apartments, Duplexes, Condominiums, Room Rentals. (in owner
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- 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 Reglstrations EXPIRE on DECEMBER 3l ofeech year. FEE IS $80 PER RENTAL/
LEASE UNIT. Corplete thls form and return to thc Herlth Office- Checks peyeble to: ITOWN OF'
YARMOUTH". For additional FORMS AND/OR QUESTIONS, contsct the HEALTH OFFICE AT
508-398-2231, x 1240
Rental nuV
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owner Name (Required Info) , r pi"it iffi J,l4t4 'Tht,-Llzd0ta]^ W 1)ya".Jo-" fl '<zsro b
Mailing Address City/Town State
Email and Phone
Seasonal- Short Term-(oocupancy less than 3 I days)
lex Condo Apartment Room
-Smoke Detectors rnd Carbon Monorlde Detectors Requlred-
Owners: I have ensured the batterles are changed, and have tested ALL Smoke
Detectors/Carbon Monoxide Detectors?
Smoke/ CO detectors older than l0 years must be replaced.
Tenant
Rental aoo ,
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Call fire department regarding questions on new type and localion prior to purchasing. 508-398-2212
Trash Removal by: Owner _
(Once a week minimum)
Paid Pickup_ Name of Company
Disposal ilSticker at Landfill _
Note: Please remove tresh & 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 & Li
Signature
(Require)
PENALTIES - Late registration of more than 30 DAYS after receipt or violations ofany part ofChapter 108,
nray be subject to non-criminal citations issued as follows. Each day's violation deemed a separate offense.
l* Offense $1fi).00 / 2na Offense $100.00 (and each additional) $200.00. This applies to any OWNER or
Representative.
Rev l0/l?22
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ZIP
Rental Agent (if any)
Rental Period:\