HomeMy WebLinkAbout89 A White Rock Road Registration ApplicationbH e - 24-11;
2025 Rental Registration Application,o
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TOWN OF YARN,IOUTH
Health Departmena
I I,16 ROTITE 28, SOUTH YARMOI]TH
MASSACH USETTS 02664
Telephone (5O8) 398-2231, ext. 1240
Fax (508) 760-3172
E-nrail: mdalel (a yarmouth.ma.us
t*y,rn
Important Notice IPLEASE READ CAREFULLY):
If you do not receive your rental certificate within 30 days of sending in your application, please contact our
ffice immediately! Please be aware that untilyou receive a rental certificate from the Health Department, your
roperty is being rented without a valid certificate, which may result in fines and other penalties.
ubmitting the registration application does not complete the process or guarantee the automatic issuance of
rental certificate. Your application will undergo a *review process, which includes verification of assessors'
ecords, septic system, the number of bedrooms and previous inspections.
+An inspection may be required as part of this process.
Please note that occupancy limits are in place based on septic capacity and the number of
bedrooms. These measures are in place to protect our drinking water and aquifers. As
Yarmouth prepares for a future transition to a town sewer system, these steps are crucial
for preserving our water resources. Previous occupancy determinations may be subiect to
adiustment based on the criteria mentioned above.
Io
Smoke Detectors and Carbon Monoxide Detectors are Required!
Monoxide Detectors and verified that they are less than 10 years old: P/errse lnrtirri
Contact the Building Department regarding questions on type and location prior to purcha
Smoke-det€ctor'locationrmouth.ma.us/Document Center /yiew / 1 122 I /
Owners: I have ensured the batteries are changed, have tested ALL Smoke Detectors bon
. A ncrrrefundable application fee of $8O per unit/rental is required.
. Rental Certificates expire on December 37.t,2025.
. To register online and pay via credit card, visit the Town of Yarmouth Health Department
website: https://www.yarmouth.ma.us/ 12 7/Health If you prefer to pay by check, you may begin
your application online. After completing the initial steps, make your check payable to the Town of
Yarmouth, and be sure to include your BHR number [which will be provided during the online
application processJ and your rental address. Make a note in the notes section that you will be
sending a check. Mail the check to the address above.
. If NOT registering online, please make checks payable to: Town ofYarmouth and mail
completed application (on reverse side,) & payment to: Town of Yarmouth Health Department.
See Reverse Side )
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Please Print Clearly
Rental Property Information
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81 (D Lrh,i<Qo-t< Q-r
F.,4.uir(rrt-
Rental Propefty Add ress
Weekly/Short Term (less than 31 days) _
Rental Period
Year-Rou nd/Long Term
Trash Removal by
Tenant_
Paid Pick UD:
Owner Housef, Duplex_ Condo_ Apartment_ Room_
r'd^rL,a\ (c,btn
Rental of:
Property Owner Full Name
f,ut^ fll.
(required) Entire Mailing Address:
B f c^:t^r.\e Rr.(<- G{
)a^,' to-+ k Qc-'\ / ,MA oe 6 + s-
(rcqrrired ) Primary Phone Number
6 tz gte- ,1 ?s
Alternate Phone Number:
5 44A ?ett 5
568 8(5 llrl
( r'equiled) E-mail Address
r-)Kotts6"q' I n,",-,1 . t o,-,
Representative's E-nrail AddressOwner's Representative/Rental
Agent/ VRBO, Del Mar, Vacasa, We
Need a Vacation, Other
Representative's Primary Phone
Number:
I hereby acknowledge that I have reviewed and am fully familiar with the Town of Yarmouth's Chapter 108
Rental Housing Bylaw, Chapter 104 Anti-Noise Bylaw, the Town of Yarmouth Short'Term Rental Bylaw (where
applicable), and the Massachusetts State Sanitary Code, Chapter ll (Minimum Standards ofFitness for Human
HabitationJ, These documents are available for reference on the'lown's website and may also be obtained upon
request from the Yarmouth Health Department.
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 fines & fees.
DilteSi /)
17/26 024
UrU I I 2024