HomeMy WebLinkAbout37 & 39 Headwaters Drive paper application@ Apptication tor 2024 Rental R"gi=trr1ffi
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@ya rmouth. ma. us
The Town of Yarmouth ls excited to announce that we've streamlined the online registration process lo
make lt 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 the entire process. Not only
can you securely communicate with our team, but you'll also gain access to your important documents, 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 batteries are changed, have tested ALL Smoke Detectors/Carbon
[/onoxide Detectors and verified that they are less than 1O years old: P/ease initial)4 .
Contact the Building Department regarding questions on type and location prior to purchaiing. -
terMieWl 1221 /Smoke-delector localionhtlosJ/!v\ /w.varmouth ma.us/DocumenlC
A non-refundable apptication fee of $80 pef UniUfgntal is required.
Rental Certificates expire on December 3'1"t. 2024.
lf NOT registering online, please make checks payable to: Town of Yarmouth and mail completed application &
payment to: Town of Yarmouth Heallh Department.
The Health Depadmetlt willcallto schedule an inspectiou if required. upon receipt of your application and fee
Rental P roperty lnformation
All fields are re uired! lncom lete forms without a valid hone # or email cannot be roce.s.sed
Rental Property Address:
,l*'lcr ile,.,4r):,ws ts uJ,lan^.tLtl4
Rental Period:
Annual_z Seasonal Short Term (less than 31 days)
Trash Removal byl
Owner_ Tenant__ll House Duplex e/ Condo Apartment Room
Rental of
Property Owner Name:
Gact* J.xa n Orndon
Mairins Address:, Stv I Cl pre<s /-lo tto"., A- H'to.
13o," ) fa- Sori ,r*< trL 39,.3<t(requ?red)Primary Phone No
C)7- CrD- 1)i'7
Alternate Phone No.
5c?'3L,tt - 34i5'
' (requirgdJE-mait Addressi
,) ,. tt ,, ,l r: ,t t .tt'. i D . at tt:t t'l t t
Owner's Representative/Rental
Agent/Agency
/.,/ /)
Primary Phone No (lequired)E-iiail Address
I have read and lam familiar with the Town of Yarmouth Chapter
Yarmouth Short Term Rental Bylaw (rf applicable) and the MA.
for Human Habitation) all of whrch are avarlable on our website
Furthermore, I understand I must notify the Health Department in writing when I am no longer renting the property, or I may be
subject to fines and bes
Sign
108 Rental Housi 04 Antr-Noise Bylaw, Town ofng Bylaw, Ch
ode, ChapteState Sanitary C nimum Standards of Fitnesshttos://www-varmouth.ma 3/Rental Housino-Prooram
Date: /ri,:)Qii.2,A,r*- d [),^tu-
Revised: 10/2312023