HomeMy WebLinkAbout785 Route 28 #7 paper applicationo
Application tor 2024 Renta! Registration
TOWN OF YARMOUTH
Health Department
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664
Telephone (508) 398-2231 , ext. 124O
Fax (508) 760-3472 L ^-: n
E-mail: epol ite@yarmouth. ma.uswT 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 httos://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 lhe Building Depanment regarding questions on type and location prior to purchasing.
httos://www varmouth.ma us/DocumentCenterly'iewl 1221lSmoke-detecloclocalion
A non-refundable application fee of $80 per uniUrental is required.
Rental Certificates expire on December 31"r, 2024.
lf NOT registering online, please make checks payable to: Town of YanrDutr and rnail completed application &
payment to: Town of Yarmouth Health Department.
The Health Depafiment willcallto schedule an inspection if required, upon receipt of your applicalion and fee.
Rental Property lnformation
All fields are re uired! lncom lete forms without a valid
Rental Property Address A6 (r+ Z8 ,..nu.i + .7
s ovtrt Ya'r-rv. odH^, F4A oZ-G G\
one # or email cannot be rocessed
nua Seasonal Short Term less than 31 S
Trash Removal by
Owner Ten"nt J
Renlal of:
Housev Duplex Condo Apartment Room
Property Owner Name:
Robc<+O 1,t6[4. \r.rn rcrf
Mailing Address: Gn V.r i lto\^: A \/<- \-)ri+ A
l\..1orn n\: , r+A O-LO o\
(required)Primary Phone No.
tJft-e6o-G17--L
Alternate Phone No.
60'6 - gLY- rl t 3Lt
(required)E-mail Address
d o *t +<-<\ rs< o,@ 1$^\ \ . c-bvv'
Owner's Representatave/Rental
AgenUAgency
lonlc,a \raqathct-s.:
Primary Phone No
a6- 3Gn - 3q3Q
(required)E-mail Address
P.r$ci a@ Srdrb ck- ca|ecd 'c*n
ermote, I understand I must notiry the Health Department in writing when I am no longer renting the property, or I may be
cl lo fines and €cc
\-\ Dare: r\ tzo/L3
m
Chapter
the N4A.lBylaw
which a
I have read and larafamiliar with the Town of YanrcLrth 108 Rental Housi 104 Anti-lkise Bylaw, Torrvn oIng Bylaw
ode, ChaYarmouth Short Term Renta (if applicable) and State Sanitary C pter lvlinimum Standards of Fitness
for Human Habitation) all of re available on our website
Furth
subje
Sign:
Revrsed: 10/23/2023
Rental Period: