HomeMy WebLinkAbout22 Merrymount Road paper application8#<.2t va7 f\z
LTH DEP'I
TOWN OF YARMOUTH
Health Department
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHU
Telephone (508) 398-2231 , exl. '1240
Fax (508) 760-3472
E-mail : epolite@yarmouth.ma.us TEB 0 ) 20!.4
HEI,
The Town of Yarmouth is excited to announce that we've streamlined the online registration process to
ake it more user-friendly than ever before! Simply visit https://varmouthma. portal.ooenqov.com/ to get
tarted. There, you can effortlessly create your account and conveniently pay the registration fee
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 rmponant documents, the
bility to upload photos, and much more! This improved platform is designed to make your registration
xperience smooth and efficient.
Rental Property lnformation
All fields are re uired! lncom lete forms withoul a valid hone # or email cannot be rocessed
Trash Re
owner_/_
lbv:
Tenant
Rental of:
House Du lex Condo A artmen Room
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 leis than 1O years old: P/ease initial ly'l
Contact the Building Department regarding questions on type and location prior to purchasing.
hllos://www.varmoulh ma. us/OocumenlCenlerA/iew/1 1 22 1 /Smoke'deleclor-location
A non-refundable application fee of $80 pef Uniufental is required.
Rental Certificates expire on December 31"t, 2024.
lf NOT registering online, please make checks payable to: Town of YanrDuth and rnail completed applic€tion &
payment to: Town of Yarmouth Health Department.
The Health Depaiment will callto schedule an inspection if raquired, upon receipt of your application and fee.
Rental Property Address
3i lYi(rru0ioLtn/ (tfri
Rental Period:
Seasonal \ Short Term (less than 3'l days)An nual
Property Owner Name
Kn 't?1(.t/ ft(n/ff,hra o/92u4
4 7'6 3V7 oo gt
nmary one orequ Alternate Phone Noq7r r7q5 ob95-
(required)E-mail Address
pary7n/4rrOc1n,td r / corl
enepresen
ncy
SAgenUAge Primary Phone No (required)E-mail Address
Furthermore. I understand I must notify the Health Department in writing when I am no longer renting the property, or I may besubject to fines and €es
Sign
arYarmouth Short Term
for Human Habitation)
I Bylaw
which a
tar e
taRen aI bCAle dan het S atet San ta Co e c ah(pp )ry pter
al ofI re ava a eb oon Iu beS te shttp rm utho ma
Minimum Standa rds of Fitness423/RentalHousino-Prooram
'tu
Datefunu/,r fu?rilo**
Revised: 10/2312023
+
@ Application tor 2024 Rental Retlstration
*
Mailing Address:i8 CyVrlss /anr,