HomeMy WebLinkAbout188 Diane Ave 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 l"ll.rJ I
E-mail: epolite@yarmouth. ma. usw
'ifF fn" Town of Yarmouth is excited to announce that we've streamlined the online registration process tomakeitmoreUSer-friendlythaneverbeforeISimplyvisit@toget
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
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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 Detectols/Carbon
Monoxide Detectors and verified that they are leis than 10 years old: P,ease rnnraLll
Contact the Building Depadmenl regarding questions on type and location prior to purchasing-
httos://www.varmouth ma. us/DocumentCenlerA,/ieW1 1 221 /Smoke'detectoFlocation
A non-refundable application fee of $80 per UniUrgntal is required.
Rental Certificates expire on December 31s', 2024.
lf NOT registering online, please make checks payable to: Town of YanrDuth and rnail completed application &
payment to: Town of Yarmouth Health Department.
ftment willcaltto schedule an inspection if required, upon receipt of yourapplication and feeThe Health Depa
Rental Property lnformation
All fields are re(uired! lncom lete forms without a valid )hone # or email cannot be rocessed
ou"Y DU
Rental of:
ex Condo Room
orl,
Rental Period:
AnnualX Seasonal Short Term (less than 31 days)
-
Rental Property Address
\"r.tBB DrNl's
Trash Removal by:
owner- tenantY
52.08 \^/. krn,-los\r t( Crrcrnp\r- Qoad
Mailing AddressProperty Owner Name
CLPr Er-x LLC
Alternate Phone No (required)E-mail Address
C HRr s? rNrl.trcs Q G F't4J
(required)Primary Phone No
779'c.1v,79+5
Primary Phone NoOwner's Representative/Rental
AgenUAgency
d I must notify the Health Department in writing when I am no longer renting the property, or I may be
2\oDate:
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anitary c
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and I arr mil tar
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Sign
04 Anti-Mise Byla\r, Town ofng B,/aw,
ode, Cha nimum Standards of FitnessState S sino-Prooramrmouth.3/RentalHoite. httos
Furthermore lunde
subject nes an
Yarmouth Short Term Rental Bylaw (if applicable) and the
for Human Habrtation) allof whrch are available on ourwe
Revised: 10/2312023
l,
(required)E-mail Address: