HomeMy WebLinkAbout67 Station Ave paper applicationApplication for 2024 Renta! Registration
TOWN OF YARMOUTH
Health Department
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUS
Telephone (5OB) 398-2231 , ext. 124O
Fax (508) 760-3472
E-mail: epolite@yarmouth. ma. us
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.portal.openqov.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 vou 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.
#DEC 1 '1 2023
HEALTH DEPI
Smoke Detectors and Carbon Monoxide Detectors are Required!
Owners: I have ensured the batteries are changed, have tested ALL Smoke Detectors/Qarbon
Monoxide Detectors and verified that they are leis than 10 years old: P/ease initial C-fr-
Conlacl the Building Department regarding queslions on type and localion prior lo purchasing.
hltps //www yarmoulh ma us/DocumenlCenter,ryrev.,/1 1221lSmoke delector localron
A non-refundabteapptication feeof $80 pef UniUfental is required
Rental Certificates expire on December 31"', 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 Depanment will callto schedule an inspection if required, upon receipt of your application and fee.
Rental Property Address
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Rental Period:
- Seasonal Short Term (less than 31 days)Annual
Trash Removal by:
Owner Tenant
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Rental of
Property Owner NameCrlfoUD ,Eese AJre S W" )Tz
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(requrred)Pfl mary Phone No
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Alternate Phone No ( requ ired )E-ma il Address
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Owner's Representatrve/Rental
Agent/Agency
CHE,;t-€ y't/afs Primary Phone No
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I have read and larn familiar with the Town ofYarmoulh Chapter 108 Rental Housing Bylaw Chapter 104 AntFNoise Bylaw Town of
Yarmouth Short Term Rental Bylaw (if apphcable) and the MA. State Sanrtary Code Chapterll (lvlrnlnum Standardsoft ilness
forHUmanHabitation)allofWhichareavailableonourWebsite,
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 {lnes and €es.
d-2L Date: /
Rental Property lnformation
All fields are re uired! lncom lete forms without a valid hone # or email cannot be roce.s.sed
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Revised: 10/23120
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