HomeMy WebLinkAbout181 Thacher Shore Road paper application9€N\> Qrnffic Lt((/
Application for 2024 Rental Registration
TOWN OF YARMOUTH
Health Department
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02654
Telephone (508) 398-2231 , ext. 1240
Fax (508) 760-3472
E-mail: epolite@ya rmouth. ma. us
The Town of Yarmouth is excited to announce that we've streamlined the online registration process to
ake it more user-friendly than ever beforel Simply visit https://varm outhma. porta l.openqov. com/ to get
rted. There, you can effortlessly create your account and conveniently pay the registration fee
sing this upgraded system, you'll have the power to engage with us throughout the entire process. Not only
n you securely communicate with our team, but you'll also gain acc€ss to your important documents, the
bility to upload photos, and much more! This improved platform is designed to make your registration
xperience smooth and efficient.
Smoke Detectors and Carbon Monoxide Detectors are Requiredl
Owners: I have ensured the batteries are changed, have tested ALL Smoke Detectors/Carbon
Monoxide Detectors and verified that they are less than 10 years old: p/ease initial (Yl l\ L
Conlact the Building Deparlmenl regarding questions on type and location prior to purchasing.
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A non-refundable apptication fee of $80 pef UniUfgntal is required
Rental Certificates expire on December 31"t, 2024.
lf NOT registering online, please make checks payable to: Town of Yarmouth and mail completed application &
payment to: Town of Yarmouth Health Department.
rcalion and feerequired, upou receipt of your aThe Health Deparlment willcallto schedule an inspection if
Rental Property Address:
l gl16ac?vtt Sho,n Soao(nnual SSeasonaly'st o.t T"rrn Iess than 31 daTrash Removal by:
Owner V Tenant
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Property Owner Name
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Mailing Address:l$l-(6actwa Shao Rd, Y, Po,fO2-G 5
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requr nmary one o Alternate PhoneJ\o
fo€' 22-t- ozotz (required)E-mail Address
Kat'ev)d ()crr\q sa(enepresen
ncyAgent/Ageners Primary Phone No (required)E-mail Address
5,Yf;::['if fi?J.gfr"rsland I must notifv the Health Department in wdting when I am no tonger renting the property, or I may be
apte pI Bylaw
which a
e a rsesSC
ave read an aTn mil own o arm t1 lHous n ter 104 lawYarmouth Short Term Fenta (if applicable) and the ode, Chapter l\rinimum Standa rds of Fitnessfor Human Habitation) allof re available on our website vaf outh ,ma.us Housinq -P423lRental ram
Sign \<Date ll- 3- 23
uiredl lncom lete forms without a valid hone # or email cannot be ocessed
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Revlsed 10/23/2023
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Rental Property lnformation
All fields are re
Rental Period: