HomeMy WebLinkAbout64 Hemeon Drive paper application#
TOWN OF YARMOUTH
Health Department
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664
Telephone (508) 398-2231, e:
Fax (508) z6o-s472xt-
1240 RECETVED
E-mail: epolite@yarmouth.ma.us JAN A 4 ?0?4
The Town of Yarmouth is excited to announce that we've streamtined the ontinsEahlEtl3F$bcess to
make it more user-friendly than ever beforel 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.
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 1O years old: P/ease initial W*Contact the Euilding Department regarding questions on type and locatron prior to purchaSing
httosl/www.varmouth ma.us/DocumenlCenterV ew/1 1221lSmoke detector,locat on
A non-refundable application feeof $80 pef Uniufgntal is required
Rental Certificates expire on December 31'1,2024.
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 Depaftmeti willcallto sclledLtle an inspection if required, upon receipt of yout applicatiou aud fee.
Rental Property lnformation
All fields are rc uired! lncom lete forms without a valid hone # or email cannot be )rocessed
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Rental Property Addless
t* Ae-t'r<-o n l)Z,v<
Rental Period:
Annual-y(Seasonal Short Term (less than 31 days)
Trash Removal by:
o*ne, y' Tenant
Rental of:
HousefDuplex Condo Apartment Room
Property Owner Name.
Z t x t.U
(requrred)Pn mary Phone No
))L }}"i
Alternate Phone No (required)E marl Address
Owner's Representative/RentalAoent/Aoencv-f),.,i,, y' r I l'r;a 111li T
Primary Phone No
5t 5.1tvlt ]J 1 I
(required)E mail Add ress:
lfl u
I have read and lam fum'|ar wrth the fown ofYarmouth Chapter 108 Rental Housrng Bylaw Chapter 104 Anlr-Norse BvEw. Towa oIYarmouth Shorl Term Rental Eylaw (rf applicable) and the MA. State Sanitary Coae,'Chapter il (t'.4rnrmurn Standar'ds of Frtness
for Human Habitation) all of which are available on our website. hftps://wwi.varmouth.ma.us/423/RentalHousino-Proqram
d I must notify the Health Department in writing when I am no longer rentlng the property, or I may be
a^-7fu**Sign Date: ,h/*'rr'
Furthermore, I understan
subject to fines and bes.
Revised: 10/2312023
Application for 2024 Rental Registration
lvlailing Address: