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2025 Rental Registration Application
TOWN OF YARMOUTH
Health Department
I I46 ROT'TE 28, SOTiTH YARMO('TH
MASSA('H TISETTS 02664
Telephone (50E) 39E-2231. exr. t240
Fax (508) 760-3472
E-mail: mdalet'Avarmouth.nla.us
Ifyou do not receive your rental certificate within 30 days ofsending in your application, please contact our
ffice immediately! Please be aware that until you 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 ofassessors'
cords, septic system, the number ofbedrooms and previous inspections.
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
Yarmout}l 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
adjustment based on the criteria mentioned above.
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Smoke Detectors and Carbon Monoxide Detectors are Required!
Owners: I have ensured the batteries are changed, have tested ALL Smoke Detectors/Cagf0n
Monoxide Detectors and verified that they are less than 10 years old: Please initial €/L
Contac the Suilding Depanment regarding quesrronq on rype and localon p.,or,o pr'".hr.,ntz-
ntCcnrer/V ie!! / 1 1 2 2 I / S moke-d etector-iocationDocume
A rurrefundable application fee of $80 per unit/rental is required.
Rcrrtal Certificates expire on December 3f i. 2025.
To register online and pay via credit card, visit the Town ofYarmouth Health Department
rvebsite: https://www.yarmouth.ma.us/ 127lHealth Ii you prcf'cr to pay by check, you may bcgin
your application online. After completing the in itia I steps, nrake your check payable to the Town of
Yarmouth, and be sure to include your BHR number flvhich will be provided during the online
application process) 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 tor Town of Yarmouth and mail
completed application (on reverse side) & paynrent to: Town of Yarmouth Health Department.
See Reverse Side -----------)
Important Notice (PLEASE READ CAREFULLy):
*An inspection may be required as part of this process.
Please Print Clearly
Rental Pr()Dert!- Infornlation
Ren ta I Property Addresi:
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L"- brzo,r/eekly/Short Term (less than 31 days) _
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House- Duplex- Condo- Anartme;/oom
Trash Removal by Rentalof'
wner_ 'l'enan
e t? trsE//eru
lNa4Property Owner Ful tne ed)D 6h //6y'J,l?74,,t/et
u I]n fC n (t(lIeq 4k)3Tb1.-y
!'oE- 7a5'-/56er-eq u lre one Llnt TTmary -a/3ilAlternate Phonc
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(req uired) E-mail Address:
e//e,o P 3a/. c:t-*-
?b,b 'JZ.
Representative's Primary Phone
Nunrber:
6q)zzs-tffio
Representative's E-mail Address
/outs4rca,ralpl
and anr fully familiar with the Town of yarmouth's Chapter 109
)ise Bylaw, thc'l'owD oiYarmouth Short-'ferm Rental Bylaw [wherenitalv Code, Chapter ll (Minimum Standards ofFitness for HumanHabitationl. These documents are available for reterence oir the Town's website and may also be obtailed uponrequest from the Yarmouth Health Dep.trtmerrt.
Furthermore, I understand I must notify the Health Department in writing when lam no longer renting theproperty, or I may be subject to fines & tees.
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I hereby acknowledge that I have reviewed
Rental Housing tsylaw, Chapter 104 Anti-Nr
applicable), and the Massachusetts State Sa
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HEATIH DEPT
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Revised:11.024
Rental Period:
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mber:
Owne r's Representa tive/Rcnta iAgent/ VRBO, Del Mar, Vacasa, WeNeed a Vacation, Other_