HomeMy WebLinkAbout156 Long Pond Drive paper applicationApplication tor 2O24 Rental Registration
TOWN OF YARMOUTH
Health Department
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664
Telephone (508) 398-2231 , ext.'1240 REGEIVEDFax (508) 7 60-3472
E-mail: epotite@yarmouth.ma.us l;rN J 4 2024
The Town of Yarmouth is excited to announce that we've streamtined the ontine r."n[,Hl;'fl1":5"'. ,"
make it more user-friendly than ever before! Simply visit https://varmouthma. porta l.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 documenls, 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 10 years old: P/ease initialt64-
Contact the Euilding Department regarding questions on type and location pfior to purchasd6.'
hllosl/www varmoulh ma us/DoclrmentCenter^./iew 1 1 22 1 /Smoke-detecloclocalon
A non-refundable apptication fee of $80 pef UniUfgntal is required
Rental Certificates expire on December 31"', 2024.
lf NoT registering online, please make checks payable tor Town of Yarmouth and mail completed application &
payment to: Town of Yarmouth Health Department.
The Health Depaiment will call to schedule an in spection if requircd, uport receipt of yourapplication aDd fee
l5b Lond Portd D '"'
Rental Property Address
al r/'seasonal- Short Term (less than 31 days)Annu
Rental Period
Trash Removal by:
owner / Tenant
Rental of:
House :lDuplex- Condo Apartment RoomProperty Owner Name
l(v 3ll{-tt4" o
Mailing Address
,L I " "".1-5 /4,1 a
( requrred)Pnmary Phone No
2/t'/
Alternate Phone No (required)E mall Address
act^)LLrlt/ ),C.Owner's RAgenVAgeepresentative/Rental
ncy Primary Phone No
506-1
(required)E-mail Address
{
5|fi::[il"i:J.T"'Srstand I must notifv the Health Department in writing when I am no tonger renting the property, or I may be
Date JOL -t .t7
apterRental Bvlaw
allofwhlch a
VE an h s
Sign
and lam the Town armouth ntal Housrn haYarmouth Short Term (if applicable) and the State Sanita ryC ode, Chapter l(N4inimu
s/423lRefor Human Habitation)re available on our website. httos:/.varmou .ma.u
c-t
Fitness
roqram
SC By
m S na ad Srd o
nta oH Su no P
All fields are re uired! lncom lete forms without a valid hone # or email cannot be rocessed
(//
J
Revised: 10/2312023
Rental Property lnformation
)-