HomeMy WebLinkAbout79 Massachusetts Ave paper application@ epplication for 2024 Rental Registratioh-
TOWN OF YARMOUTH
Health Department
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664
Telephone (508) 398-2231 , ext. 1240 ,, , .l
Fax (508) 760-3472
E-mail: epolite@yarmouth. ma. us
skflF fne Town of Yarmouth is excited to announce that we've streamlined the online registrataon process to
make it more user-friendly than ever beforel Simply visit https://varmouthma. portal.openqov.com/ to get
started. There, you can effortlessly create your account and conveniently pay the registration fee.
Using this upgraded system, you'll have the power to engage with us throughout the entire process. Not only
can you securely communicate with our team, but you'll also gain access to your importafit docurnents, the
ability to upload photos, and much more! This improved platform is designed to make your registration
experience smooth and efficient.
Smoke Detectors and Carbon Monoxide Detectors are Required!
Owners: I have ensured the batteries are changed, have tested ALL Smoke Detectqrs/Carbon
Monoxide Deteclors and verified that they are bls than 10 years old: P/ease initiat 8.Q IContact the Building Department regarding questions on type and localron prior to purchasrng
httos://www varmoulh.ma us/DocumenlCenter^y'ieW1 1221lSmoke'detector-location
A non-refundable application feeof $80 pef UniUfental is required.
Rental Certificates expire on December 31s', 2024.
lf NOT registering online, please make checks payable to; Town ofYannoufr and rnail conpleted application &
payment to: Town of Yarmouth Health Department.
The Health Department will callto schedule an inspaction if required, upon receipt of your application and fee.
Rental Propefi lnformation
All tields are re uiredl lncom lete forms without a valid hone # or email cannot be rocessed
14 ,ltudasarx*"*o )*r-
Rental Period:
Seasonal /rnonr"r^(less than 31 days)Ann ual
Trash Removal by:
OwnetJa Tenant
Rental of:
Duplex Condo Apartment RoomHouse
Property Owner Name
Ar,sl;n llvsan S +hYnt e4 Gw^az 51. )tVttdora- l,t* ozta
(required)PrinAry Phone No
Lt'l, b4*, atto
Alternate Phone No
6n, ?9, Lz36
J (required)E-mail Address
Aushn+ll eYed"on
O\,^/ner's ReDresentative/Rental
AgenVAgenby
nla-
Primary Phone No (required)E-mail Address
ar with the To,m of Yanrputh CtEpter 108 Rentd FlousirE R/aw, Chapte|Io4 Anti-Mise R/a^, Tc'\,!rr of
ntal Bylaw (if applicable) andthe MA State Sanrtary Code. Chapter ll (l\4rnrmum Standards of Frtness
of which are available on our website. https://www.Varmouth.ma.usi423lRentalHousinq-Prooram
the Health Department in writing when I am no longer renting the property, or I may be
Date
I have read and lart famili
Yarmouth Sho( Term Re
for Human Habitation) all
subject to fi s and bes.
Sign
Furthermore. I understand I must
ne+
Revlsedr 1 o23
Rental Property Address:
N4ailing Address: