HomeMy WebLinkAbout12 Hidden Acres Ave paper applicationApplication for 2O24 Rental Registration
TOWN OF YARMOUTH
Health Department
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS02564
The 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 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 secureiy commuriicate wiffi our team, bu1 you'll also gain access to yourimpodant ciocuments, the
ability to upload photos, and much more! This improved platform is designed to make your registration
experience smooth and efficient.
Dtl 16 'ti'tJ
Telephone (508) 398-2231 , ext. 1240
Fax (508) 760-3472
E-mail: epolite@ya rmouth.ma. us t
H E,qLTH DEPT
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 initia0lt l
Contact the Building Department regarding questions on type and localion prior 1o purchasfrfg
UmentCenler^/ie 1 1221lSmokedetector-locationhtlos://www varmouth .ma us/Doc
A non-refundable apptication feeof $80 pef Uniufental is required
Rental Certificates expire on December 31't, 2024.
lf NOT registering online, please make checks payable tor Town of Yarmorith and mail completed application &
payment to: Town of Yarmouth Health Department.
The Health Depaftment will call to schedLle an inspectiol if required, upon receipt of you r application andfee
Rental Property lnformation
All fields are re uired! lncom lete forms without a valid hone # or ema cannot be rocessed
Rental Property Address
rl }hdlelr ecres flue tD. Ular-o,r*r
Rental Period:
An!ual_1 Seasonal_ Short Term (less than 31 days)
Trash Removal by:
Owner Tenant /
Rental of:
House Duplex Condo Apartment Room
Property Owner Name
3"rg lDe*qale -r3 GUq R-J f"oshar" UT o5orG(requrred)PrtmaryPhone No
cD)- q3q-3lqb
Alternate Phone No I (reqLired)E-mail Address:
loCt^le.sted€-6rnr^ - c6 rnOwner's Representative/Rental
Agent/Agency Primary Phone No ( req u ired ) E--rna il Address
Furthermole, I understand I must notify the Health Department in writing when I am no longer renting the property, or I may besubject to fines and bes
OJS
apte
I Bylaw (if
which are
Sign
I have read and lam fumiliar with the Town ofYarrnouth Ch ter 104 Anti-Noise Bylaw, Town ofr 108 Rental Hous ng Bylaw, Chap
ode, Chapter llYarmouth Short Term Renta applicable) and the State Sanita ryc l\,4inimum Standards of Fitness
423/RentalHousinq-Prooramfor Human Habitation) all of available on our websile httDs://www.varmouth.ma.u
Date lA -, O -a
Revised: 1 0/2
lMailing Address