HomeMy WebLinkAbout62 Pine Grove Road paper applicationh t oyg-)).)l
Application tor 2O24 Rental Registration
TOWN OF YARMOUTH
Health Department
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664,
Telephone (SO8) 398-2231 , ext. 1Z4O
Fax (508) 760-3422
E-mail: epolite@yarmouth. ma. us
httDs://varmouthma. porta l.oDenqov.com/
T The nOW Yof rma utoh es itXCed o nn uonce ath stTEam ned ohen ne ostratin CESSroregp
ake mit Uore friser nde h na Ieve before S m ittsvplv to etsatrteduoncasleffortlescreateacrucovantdnocVEntenvntahyouratiStnoefelypvreg
S thts U edrad s temS OU ha thnge ower topsv a e ith thUSY ho theut ntirepng roCCSS N ootnsrougp vuon!'nu h m nv tc t art docunt n-avI thyompo
o u o da hot so nda muc mh e Th mortyp roved a rmtfop S edSI edn mto kea o Iu repp st at onsYsnneSMCCaoothdnceffintepe
arbonDetectplYC
p rrchasrnq
Smoke Detectors and Carbon Monoxide Detectors are Requiredl
Owners: I have ensured the batteries are changed, have tested ALL Smoke
l\,4onoxide Detectors and verified that they are Iess than 10 years old.
Contact lhe Building Deparlment regarding questions on lype and location prior tohllosvarmoulh.ma.us/nlCenter/VieM1 1221lSmoke-dele oalocalion
A non-refundabte apptication fee of $80 pef UniUfental is required.
Rental Certificates expire on December 31.1. 2024.
lf NOT registering online, please make checks payable to: Town of Yarmouth and mail completed application &payment to: Town of Yarmouth Health Department.
hcation and feeed, upon receipt of your aThe Health Depaftment willcaltto schedule an inspection if requir,
Rental Propefi lnformation
All fields are re uired! lncom lete forms without a valid hone # or email cannot be rocessed
Nm
less than 31 da
a rtmen t
r
ate Phone Nor|mary Alte uired)E-mail dress8'a1t 1)o /llLLI
e tLd(.
r u o e
5 ahn5Z- qD+
I .,,l.t L,4L
&iq/)
Rental P rty Ad d
mova by
perty Owner atlin
Du ex
Address
Rental Period
Short Tnnual
entalras
Owner
ame
OU RoomCondo
rpss
I
Owner's RAgent/Ageepresentatrve/Rehtal
cY
Ll kn Primary Phone No lrequinJOleJma**66 ress: I
rtment in writing when I am no longer renting the property, or I may be
,u,u ll'3 g'0J3
fo I Bylaw (if
which are
VE TE a a m a now o TMa ahYaUrmoSthThortrmentaReicablneathedappl
H aUM Hn ba otatin a of a a lab e on Uo Sb eit
Fu(
su bj
Sign
hermo
ect to Ith Depamust noti
'aO ,r-L
re unde tars dn th eaHfy
ft fues
L,
Revised: 1 023
A)>t_)
/6i-Yi'a\iqs
There,
,,,/
Tenant
I \
/)
4
(