HomeMy WebLinkAbout541 Buck Island Road paper applicationApplication lor 2024 Rental Registration
TOWN OF YARMOUTH
Health Department
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664
Telephone (508) 398-2231 , ext. 1240
Fax (508) 760-3472
E-mail: epolite@ya rmouth. ma. us
*rn" ro*n 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.ooenqov.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 efflcient.
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 initiat
Contact the Building Department regarding questions on type and location prior to purchasing.
a us/DocumenlCenter^/tew/ 1 122 1 /Smoke-delecloclocalionhttos://www varmouih m
A non-refundabte apptication feeof $80 pef UniUfental is required '' " l?
Rental Certificates expire on December 31sr, 2024.
lf NOT registering online, please make checks payable to: Town of Yarmouth and mail completed application &
payment to: Town of Yarmouth Health Department.
The Health Departtnent will calllo scheclule an it6pection if required,on receiplof your application and fee
Rental Propefi lnformation
All fields are re uiredl lncom lete forms without a valid hone # or email cannot be essed
Rental Property Addr )ss
,+{/ e,.A -G/"^) 1,1-Annual rz€easonal Short Term (less than 31 days)Trash Removal by: '
Owner_ fenant y'
Rental of:
House t/Duplex- Condo Apartment Room
Property Owner Name
0.hntqtKL k^,ilMailing Address/r
( req ui red)Pii mai[P
5v9 8g? - bt86
hone No Alternate Phone No (requ ired)E-maY Add ress
e4 pn"o@a-o/,can
(Jwner's ReDresentative/RentaT
Agent/Agenby Primary Phone No (required)E-mail Address
derstand I musl nolify the Health Department in writing when I am no longer renting the property, or I may bend bes
Date ,r/*l"rz
Chapter
the tvlARental Bvlawallofwhich a ite
Furthermore. lun
subject to fines
Sign
I have read and lam farnrl,ar wtth the Town ofYarmouth 108 RentelIouai
Yarmouth Short Term (lf applicable) and State Sanitary ChttDs://www.vfor Human Habitation)re available on our webs
Rev sed 1 023
11 -_
Rental Period.
R' NTAt
JANNINI EDWARD J TRS
15 KIMBERLY DRIVE
NORTH EASTON, MA 02356