HomeMy WebLinkAbout785 Route 28 #9 paper applicationApplication lor 2024 Rental Registration
TOWN OF YARMOUTH
Health Department
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664
Telephone (508) 398-2231, ext. 1 240
Fax (508) 7 60-3472
E-mail: epolite@yarmouth. ma. us Iw
'iliF fne Town of Yarmouth is excited to announce that we've streamlined the online registratron 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 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 more! This improved platform is designed to make your registration
experience smooth and efficient,
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Smoke Detectors and Carbon Monoxide Detectors are Required!
Owners: I have ensured the batteries are changed, have tested ALL Smoke Detectors/Carbon
Monoxide Detectors and verified that they are less than 10 years old: P/ease initial
Contact ihe Building Deparlment regarding questions on type and location prior to purchasing.
httos://www varmouth ma us/DocumentCenlerA/iew/1 1221lSmoke-detectoclocation
A non-refundableapplication fee of $80 pef UniUfental is required.
Rental Certificates expire on December 31st, 2024.
lf NOT registering online, please make checks payable to: Town of Yannoutr and rnail completed application &
payment to: Town of Yarmouth Health Department.
Tha Health Depaftment willcallto schedule an inspection if required, upon receipt of your application and fee.
Rental Property lnformation
All fields are uired! lncom ete forms without a valid hone # or email cannot be rocessed
Rentat Property Address: 135 fr+ z'g \rnit q
5oorr,r\ yo-rtu'o.Jth , MA ozbA\
Rental Period:
Annr"lJs.""onal Short Term (less than 31 days)
-Trash Removal bv:,/
Owner Tenant \,
Rental of:
Duplex Condo Apartment RoomJHouse
Mailing Address: Grl \,{,l\O,! \\re- ur,^ t iL
Wcihhi5 t W oLG6\
Property Owner Name:
Raosf+e Malc/" :Si->rqc\'
(requared)Pramary Phone No.Alternate Phone No.
6of - 8>Y - rl ( 3t-/r
(required)E-mail AddressOwner's Representative/RentalAgenUAgency
Po"ffiorar Vaqalvrm.s
Prirnary Phone No
qoa -3b\ . SqzG
tify the Health Department in writing when I am no longer renting the property, or I may be
F{arsirE q/iaw,
tary Code, Cha
Cpaer
the NIA.
N
MIpter
lHo tn .P fa
Sign
I have read and lan }amiliar with the Town of YanrDutrr lOFReniel
Yarmouth Short Term icable)and State Sani
for Human Habitation)
Rental Bylaw (if appl
allof which are avai lable on our website
rstand I must no
Date. \\ f3O / L
To^,n of
Fitness
Furthermore, I unde
subject to fines and
104 Ant'-l\kise Byla,
inimum Standards of
Revisedl 10/23/2023
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([equired)E-mail Address:
ffft;r4n o, o @ gw.a r \.cor"e