HomeMy WebLinkAbout0111 GEORGE STREET - Health 111 George Street -
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Town of Barnstable
Q, Regulatory Services Department
Public Health Division
BAAMMIZ
MAss. ,� Thomas A.McKean,CHO
200 Main Street,Hyannis,MA 02601
Hyannis,MA 02601 Office: 508-862-4644
nuary 09, 2014 email: Bamstable.Rental.4egistration@town.bamstable.ma.us Fax: 508-790-6304
Property location:
SMITH, RICHARD G &SHIRLEY�00
Map Parcel: 319-052
P O BOX 18 111 GEORGE STREET
Barnstable, MA 02630 ID �� •
Barnstable
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RE: 2 14 e t k' Y
qbapt ntal s S
it is tune: newyour re a ration for the ariista al regist s ire each ar on
December 1st T e i ion f is$9 0 p t, plus$ ach a dit' on th s o grty
with the sa ecks sh ble to: Tov �o a table. P lete an s page of
this appli t' r forth. Please prin a opriate c(pectidis xt to ar4pr a catio ne er
represent ' e or unit inf ti t s not corre e sure t efe ce the t number a r tal untwou are
registering swell tenant inf omplet tion forms)alo i ere ,red
amount to ublic a ivision, 200 ii eet, H i A 601.
Shou ore applic s they a a i I e at tow . r t ma.us. o f
Depart nu. ulatory D Then, within the Reg ry Depart yo will fi t
Health ision and i tions. Yo p o as many as you need, nd return t the Heal
Division with the appr ri a 2014 fees ed. A$ late fee will be assessed t ho a rene anuary
31, 2014. •
Failure to comply with this ordinance will result in the issuance of a non-cr ' I citation in mount of
$100. Each day of non-compliance is considered a separate offense.
Should you have any questions, please contact the Health Division at 508-862-4644. We appreciate your attention
to this matter.
Thank you.
Map Parcel: 319-052, 111 GEORGE STREET, Barnstable
Total number of rental units you own at this property:
Do you have Zoning/Building Division approval for an accessory apartment?
Property Owner
Name: SMITH, RICHARD G&SHIRLEY L Co-owner:
Mailing address: P O BOX 18, Barnstable, MA 02630
Daytime phone: Home phone: (508)362-9212 Cell phone:
Email:
Owner's Representative (if Applicable)
Last name: First name:
Mailing address:
Daytime phone: Cell phone : Email:
Complete unit information on reverse side.
I certify that the information provided above is true:
Applicant's signature: Date:
Map Parcel: 319-052, 111 GEORGE STREET, Barnstable
Please complete unit registration. Print the appropriate corrections next to any incorrect information and sign at the bottom.
Unit number: Building number: Address:
Check one: Single family dwelling unit: x❑ Apartment building/Condo: ❑ Accessory apartment: ❑ Duplex: ❑
Number of bedrooms: 3 Private drinking well? Yes No Dwelling constructed prior to 1979? Yes No
Will there be any children under the age of six who will begq°ccupying the rental unit? Yes No
Occupant name: Y+y i 1616
Daytime phone: Cell phone : ;email: .
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I certify that the information provided above is true:
Applicant's signature: Date: