HomeMy WebLinkAbout85 Merchant Ave paper applicationApplication tor 2024 Rental Registrati o
TOWN OF YARMOUTH
Health Department
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664
Telephone (5o8) 398-2231 , ext. 1240 RECEIVEDFax (s08) 760-3472
E-mail: epolite@yarmouth.ma.us tf,N t_r 8 2024
r-https://varmouthma. oortal.oDenoov.com/
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Smoke Detectors and Carbon Monoxide Detectors are Required!
Owners: I have ensured the batteries are changed, have tested ALL Smoke Dete
l\ilonoxide Detectors and verified that they are less than 1O years old: p/ease
Contaci the Building Department regarding questions on type and location prior to
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pulcnasrng
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ctors/Carbon
A non-refundable application fee of $80 pef Uniufgntal is required
Rental Certificates expire on December 31"', 2024.
lf NOT registering online, please make checks payable to: Town of Yarmouth and mail completed application &
payment to: Town of Yarmouth Health Department.
rapplication and feeuired, Ltpon receiplofThe Health Departtnent will calllo scltedule a it1spection if t.
Rental Property lnformation
All fields are re uired! lncom lete forms without a valid hone # or email cannot be rocessed
Rental of:
Du lex Concio A anment Room
Rental Period:
Se let?t (
n ual Seasonal SShort Term less than 31 daet
Rental Property Address
Trash Removal by
Owner Tenant
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Property Owner Name
e Po, E',
I\ilailing Address
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9 t s43, -Lz? yAIternate Phone No
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S:E mail Addres
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(requir
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resen enerSAgent/Ag ency Primary Phone No
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(requi red)E-mall Address*L'^<
5,16!3[llii:r"!',ifr"rstand I must noljfv the Health Department in writing when r am no tonger renting the propeny, or r may be
Date:
I Bylaw
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Sign
ave re and lam m tar wt own armouth ter '1 nta I OUSIYarmouth Short Term Ren (if applicable) and the A. Stale S ode, Chapte nimum Standa rds of Fitnessfor Human Habitation) ail of le on our website. httDs:re availab rmouth 3lRentalHo sinq-P ram
Revised: 1 0/2