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id
4.74. y Application for 2024 Rental Registration
3
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TOWN OF YARMOUTH
Health Department
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETT _
Telephone (508) 398-2231, ext. 1240 iu, ,, ' ==
Fax (508) 760-3472 APR 2 2 2024
E-mail: epolite@yarmouth.ma.us
c,t4 HEALTH DEPT.
The Town of Yarmouth is excited to announce that we've streamlined the online registration process to
make it more user-friendly than ever before! Simply visit https://varmouthma.Dortal.opengov.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 Detect Carbon
Monoxide Detectors and verified that they are less than 10 years old: Please initial
Contact the Building Department regarding questions on type and location prior to purchas
https://www.varmouth.ma.us/DocumentCenterNiew/11221/Smoke-detector-location
• Anon-refundable application fee of$80 per unit/rental is required.
• Rental Certificates expire on December 315t, 2024.
• If NOT registering online, please make checks payable to: Town of Yarmouth and mail completed application&
payment to: Town of Yarmouth Health Department.
• The Health Department will call to schedule an inspection if required, upon receipt of yourapplication and fee.
Rental Property Information
All fields are required!Incomplete forms without a valid phone#or email cannot be processed.
Rental Property Address:
Rental Period:
qd>� gh-iikelise,44,:r7ual /Seasonal Short Term (less than 31 days)
Trash Remov I by: Rental of:
Owner V Tenant House" Duplex Condo Apartment Room
p — p —
Property Owner Name: JQ� Mailing Address: lam` f
el
4)676
requ e rlma Plion No. / /
q � ►Y ernate Phone No.--- 10/7 � (required -mail Addre s:
Z?6-0206
wnerRe resentative/Rental yy -2J4,3
rimary Phone No bYPIleak/OSV4(required)E-mail Addr s
Agent/Agency
I have read and lam familiar with the Town of Yarmouth Chapter 108 Rental Housing Bylaw, Chapter 104 Anti-Noise Bylaw, Town of
Yarmouth Short Term Rental Bylaw(if applicable)and the MA. State Sanitary Code, Chapter II (Minimum Standards of Fitness
for Human Habitation)all of which are available on our website.https:llwww.varmouth.ma.us/423/RentalHousina-Program
Furthermore, I understand I must notify the Health Department in writing when I am no longer renting the property, or I may be
subject to fin and fees.
Sign: it(� dli Date:
Revised: 10/2 3
RENTAL-66 BREEZY POINT RD
NUSSBICKEL DALE E
107 REILLY ROAD
LAGRANGEVILLE, NY 12540
N.
q9A)
F= g. Application for 2024 Rental Registration
TOWN OF YARMOUTH
Health Department
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664
Telephone (508) 398-2231, ext. 1240
Fax (508) 760-3472
E-mail: epolite@yarmouth.ma.us Pk' r 2 2024
" ,5 HEALTH DEPT.
The Town of Yarmouth is excited to announce that we've streamlined the o ' process to
make it more user-friendly than ever before! Simply visit https://varmouthma.portal.opengov.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 10 years old: Please initia
Contact the Building Department regarding questions on type and location prior to purch si,'g.
https://www.varmouth.ma.us/DocumentCenterNiew/11221/Smoke-detector-location
• A non-refundable application fee of$80 per unit/rental is required.
• Rental Certificates expire on December 31st, 2024.
• If NOT registering online, please make checks payable to: Town of Yarmouth and mail completed application &
payment to: Town of Yarmouth Health Department.
• The Health Department will call to schedule an inspection if required, upon receipt of yourapplication and fee.
Rental Property Information
All fields are required!Incomplete forms without a valid phone #or email cannot be processed.
Rental P
ropertyAddres : v Rental Period:
Ix_
q9 I 0 Annual Seasonal Short Term (less than
l / _ t a 31 days)
Trash Remov y VRental of:
Owner ✓ Tenant
House_Duplex_Condo_Apartment Room_
Pro erty Owner Na e: Mailing Address:
�ni I o'I 4inpi
1, ��/ X %M
re aired Prima one No. 1( rY rnat Phone No. (required)E- it Address:
t)54/ta
O er's epresentative/Rental rims Phone No (required)E-mail Addis:
Agent/Agency
I have read and I am familiar with the Town of Yarmouth Chapter 108 Rental Housing Bylaw, Chapter 104 Anti-Noise Bylaw, Town of
Yarmouth Short Term Rental Bylaw(if applicable)and the MA. State Sanitary Code, Chapter II (Minimum Standards of Fitness
for Human Habitation)all of which are available on our website.https://www.varmouth.ma.us/423/RentalHousinq-Program
Furthermor I understand I must notify the Health Department in writing when I am no longer renting the property, or I may be
subject to es and ices.
Sign: '� � a-�� Date: c)—/c7111.2)-(/'
Revised:10/23/2023
RENTAL 92 B BREEZY POINT ROAD
NUSSBICKEL DALE E
107 REILLY ROAD
LAGRANGEVILLE, NY 12540