HomeMy WebLinkAbout67 South Street paper applicationApplication for 2024 Rental Registration
TOWN OF YARMOUTH
Health Department
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664
Telephone (508) 398-2231 , ext. '1240
Fax (508) 760-3472
E-mail : epolite@yarmouth.ma.usw7F fne Town of Yarmouth is excited to announce that we've streamlined the online registration process to
make it more user-friendly than ever before! 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 lhe entire process. Not only
can you securely comrnunicate with our team, but you'll also garn access tc your impcrtant dccuments, the
ability to upload photos, and much morel 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 bafteries are changed, have tested ALL Smoke Detectg;s/Carbon
Monoxide Detectors and verifled that they are less than 10 years old: P/ease initial-f!
Contact the Building Oeparlment regarding questions on type and localion prior to purchasing.
httos://www.varmouth ma us/DocumentCenler^/ieW1 1221lSmoke-detector-location
A non-refundable apptication fee of $80 pef uniUfental is required.
Rental Certificates expire on December 31"', 2024.
lf NOT registering online, please make checks payable to: Town of Yannouh and rnail conpleted application &
payment to: Town of Yarmouth Health Department.
The Health Depadment willcallto schedule an inspection if required, upon receipt of your application and fee.
Rental Property lnformation
All fields are re uired! lncom lete forms without a valid hone # or email cannot be rocessed
House /ou
Rental of:
ex Condo Room
Rental Property Addrg;s:A7 S.-fa >/
9o jo,t"- o,ta
Rental Period:
Annual Seasonal Short Term (less than 3'1 days)
Trash Removal by;
Owner Tenant
Property Owner Name:
ae<nn e (arstOl Mailino Address:C)'C..th sC Jo 74r.n,.'/a
(required)Primary Phone No
fbt- 373'7)y1
Alternate Phone No
196- Bq-926 t-(required)E-mail Address:
)oadd ece\ O ?onrott. a P
Owner's ReDresentative/Rental
AoenVAoenbv-'r./"*(t
Primary Phone No (required)E-mail Address
I have read and larr familiar with the To,!n ofYanrpuh Chapter 108 Rental Flouslng Bylaw. Cttapter 104 Arti-l'kise Bylary. ToW1 of
Yarmouth Short Term Renlal Bylaw (if applicable) and the MA. Slale Sanrtary Code. Chapter ll (l\.4inimum Standards of Fitness
foIHumanHabltation)allofwhiChareaVailableonourwebSite,
the Health Department in writing when I am no longer renting the property, or I may be
Dare: t;/2ey',^s
Furth
subje
Sign
Revl 14t2312423