HomeMy WebLinkAbout654 Willow Street paper application\
Application for 2024 Rental Registration
TOWN OF YARMOUTH
Health Department
1145 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664
Telephone (5O8) 398-2231 , ext. 1240
Fax (508) 760-3472
E-mail: epolite@yarmouth. ma. us
httos://varmouthma. Dortal.oDenoov.com/
effo
The OWT ofn aYrmo ISuth xe tocited na no nUce ath VEwe stre ma edn h oen n s ra no rocessregp
kea mit reo seru f ndte ath even bI oefre S m itsvp toIy getrtedtaTerehuoncalertcateuoaIucconnacdnonVCentvatheofeenvvlypveg
effic
S h S U r edad S m ou have he r ong en a irh us roh hpgsyv Uo he nt re SroceS N oot npowessugp vnmcoumncatorumbutooSaYSCEStoUTomondcomuntSnvgvp
b o u o da h Soto na md chu mo e Th S m oved rmatfoitvp edS ned mto kep uor stra otinppsvreg
le n SMo aothnd nexpe
ctors and Carbon Monoxide Detectors are Required!
the batteries are changed, have tested ALL Smoke Detectors/Carbon
Monoxide Detectors and verified that they are less than 10 trttlial G
purchasfng.
years old: P/ease
Contact the Euilding Department regarding questions on type and iocation prjor to
rmouth.ma us/DocumentC nler/VieW1 1221lSmoke-d eclor localion
Smoke Dete
Owners: I have ensured
A non-refundabteapplicarion fee of $80 pef UniUfgntal ,s required
Rental Certilicates expire on December 31s', 2024.
lf NOT registering online, please make checks payable to: Town of Yarmouth and mail completed application &
payment to: Town of Yarmouth Health Department.
urapplication atid feetofThe Health Depaftment will calt to schedule an inspection if required, upon rece
Rental Property lnformation
Rental Prooertv Address:
65{ {^J,'llo,,J 5t 5./a.r".,'i-A Annual Seasonal Short Term (less than 3'l days)
Rental Period
ldo
Room5rt mentouse Du lex Condo A
Trash Removal by
Owner Tenant
Rental of
Property Owner Name
ho.,g BoosohdoS+d,I lot: St, S,
Mailing Address
65 ACrflca TA
5oB-366-6aa7
mary ne oreq u r Alternate Phone N-
'{ tz"aaFBT 16
(required)E-mail Address:ji;;h A i ; B.;J3Lr'ao ar't aa) -qfio-tl - Co ilPrimary Phone No
{in (required)E-mail Address
P/n
5,1ff!3ltiffi?lr'ir$rstand I must notifv the Health Department in writing when I am no longer renting the properry, or r may be
I Bylaw (
whrch ar
h a s
a
ter 1
t\.4 in
Ho
ave re an a ri'l m tat armou 108 nta ous nYarmouth Short Term Re;ta if applicable) and the A. State Sanita rycode, Chafor Human Habitation) allof e available on our website pte
ap
r ll
IS a T 0mnlStaUndaSrdFofsneS
Date a3ltt1Sign
A fields are re uiredl lncom lete forms without a valid hone # or email cannot be rocessed
ffiobtl
Revr 023
owner's ReoresentafiVeTREEi5T-Aoent/Aoencv. tr/A