HomeMy WebLinkAbout148 Berry Avenue paper applicationApplication tor 2024 Rental Registration
TOWN OF YARMOUTH
Health Department
RECEIENOUTE 28, SOUTH YARTYIOUTH, MASSACHUSETTS 02664
Telephone (508) 398-2131, ext. '124O
JAN 2 q 202{ Fax (508} 76,0-3,,72s-mail: epolite@yarmouth.ma.us
HEALTH DEPT.
The Town of Yarmouth is excited to announce that w.ive strea, rlined the online registration procees to
m..ke it ,nore user-trienoly than ever before! Simply visit https://varmouthma.portal.oDenoov.com/ to gst
started. There. you can effortlessly create your account and conveniently pay the registration fee.
L'sing this upgraded system. you'll have the power to engage with us throughoul 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!
Ov.'ne:s I have ensured the batteries are changed. have tested ALL Smoke Detectqrs/Carbon
Mono).ide 3etectors and verified that they are leis than 1O years old: P/ease i,,ttial /6.1r'
^ontacl lh€ Eurldrng Oei-a,lmenl eqa,drng qJe;rr:n5 -n'ypeand ocatlc,n p,rort\ pLlicha3rng
hll)s wl1 ^ !d,mo,rh md uj Oocun_entce rter V ev,, 1221 3n oxe delecto',o(al,un
A non-refundable appricatrsi feeoi $80 pef UniU:'ental is requi'ed.
R ).r'al C.rrtificales expire on Decenrb ,r 3lsr 2024.
lf NOT registering online, )lgase ma' e checks palaulg lo: Tuwn cf Yarmlurh and mail corrrlieted anplication &
paymonl to: o.rn o: i'ar.nouth Heal,h Oepartment.
,heHealtn Depadmont willcJllto scheduli en n.pechon it re,1uir"d. upo receiptolyourat plication and tae.
All fields ara uirs,l! lncom
Rental Property lnformation
et! foms without a valid hot,e # or emai, can;tot be /i-essed
t46r^{l{,rqaMn
Rental Pro y Addres Rental Period:
Annual Seasonal Short Term (less than 31 days)
Trash Rerioval by; /
Owner Tenant
Rental of:
Housey(uuplex- Condo- Apartment- Rooir-
Mairins Address: gdg C,h+fry 6fr2- t-ShrewsLcrur,/ n A Ltt,SLlf
ProDerlv Owner Name:Rbliorl- Crdtl1iJr.
' ?nv in? .Y- /rt)v, rnz- (-n^,
ireq'uireri )E-mait nddresq ,,-10l*ro*crulcrorn*t/a.'' 4tffr.l .ro+u-
(requirdd )Primary Phone No(whtrt 3bb4
Allernaleerlone No.
Gdr)Ex ?24(
lrequired;E-4ait Acld.ress:
rqtlrLls(?mtdcttVc
r7. hln l.s ./'b.l.vl
'kffi*/{Zll"rPOwner's Repre se n tative/R e n talAgenuAsency Lt Z- bfel n+,(,RA Reai Fsh,k--, )
I must notify the Health Uepartment in writing when I am no longer rentinE the ploperty, or I may be
anl
DateSiEnQ-LxA-{
slr; r-
Co"cle.
fr
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ro a.an i;dble)and tne Cnapler i/inimum Standards of FitnessappLSrate S.nitary
l.rble on our website. I
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ilation )-Thfor Hu nan Habfu-n3q
h T R n E aaOU5oe r:'l eh v()
zz lz-oz1
eatatd
Fr rthermore. I undarstand
subject to fines and fue6.
Revrsed 10 23 2023
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