HomeMy WebLinkAbout105 Hemeon Drive paper applicationApplication for 2024 Rental Registration
TOWN OF YARMOUTH
Health Department
1146 RoUTE 28, SoUTH YARMOUTH, MASSACHUSETTS CRSUEIvED
Telephone (508) 398-2231, ext. 1240
Fax (5o8) 760-3472 tAl! ! 1 2024
E-mail: epol ite@yarmouth.ma. us
HEALTH I]EPI
The Town of Yarm outh IS eXcited to an noU n ce that WE VC stI am n ed the on ne Ieg strat on procesS
ake t more u SCt frrend IY th n ver befo I Simp v S it https://varmouthma. portal.openqov.com/to get
arted There voU an effort eSS v cr ate yo ur account an d conVEntent ly pav th reg Strat on fe
sing this upgraded system, you'll have the power to engage with us throughout the entire process. Not only
n you securely communicate with our team, but you'll also gain access to your important documents, the
bility to upload photos, and much more! This improved platform is designed to make your registrationperience smooth and efficient
Smoke Detectors and Carbon Monoxide Detectors are Required!
Owners: I have ensured the batteries are changed, have tested ALL Smoke Detectortcarbon
Monoxide Detectors and verified that they are leis than 1O years old: P/ease initiat Ak-
Conlact the Building Department regarding questions on type and tocatron pflor to purchasid
httos //www.varmout .ma us/DocumenlCentet N iew I 1 1 221 -detectorlocalion
A non-refundabteapplication feeof $80 pef Uniufgnta! is required
Rental Certificates expire on December 31"r, 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 De aiment will call to schedule at) itl ion if rcquited, Ltport rece lof ut application and fee
Rental Property Address:
lc, 5 ll e-rnt 61,--.Seasonal_ Short Term (less than 3.1 days)Ann ua I
Rental Period
Trash Removal by:
owner '/ r"n"nt tlou."lupt"x_ Condo_ Apartment Room
Rental of:
Property Owner Name:
i\ur,. porf l? "'l lt I ru s I
lvlalling Address
v,J '). rljL, n4 bj
(required)Primary Phone I[o.
5c t z,i8 t;,r)
Alternate Phone No I requ red)E ma Address
Primary Phone No
5 r j '/0t'/J-1 /
(requ red)E mail Address
Furthermo!e, I under-stand I must notify the Health Department in writing when I am no longer renting the property, or I may besubject to fines and €es
Dale
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Sign
own o armouth Cha ous 104 Anti own
(if applicable) and the A. State Sanita ryCode, Chapter Minimum Standa of Fitness
re available on ourwebsrte hftps:/423/RentalHousino-Prooram/www.varmouth.ma.u
Yarmouth Shorl Term Rental Bylaw
for H uman Habitalionl all of which a
I have read and am m
epresen
ncyAgenUAgenerS
Kt rt-lf l( 6)qvr- t L,I
Rental Propefi lnformation
All fields are re uired! lncom lete forms without a valid hone # or email cannot be rocessed
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Revised: 10/23/2023
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