HomeMy WebLinkAboutRental Applications2OZS Rental Registration Application
TOWN OF YARIVIOT] TH
He.lth Departmcnt
I I46 ROT'TE 28, SOLITH YARMOUTH
MASSACHUSETTS 02664
Telephone (508) 398-2231, ext. 1240
Fax (508) 760-3472
E-mail: mdaley@yarmouth.ma.us
lmportant Notice (PLEASE READ CAREFULLY):
lfyou do not receive your rental certificate within 30 days ot sendrng in your applicatior, please contact our
office immediately! Please be aware that until you receive a rental certificate from the Health Department, your
property is being rented without a valid certificate, which may result in fines and other penalties.
Submitting the registration application does not complete the process or guarantee the automatic issuance of
a rental certificate. Your application will undergo a *review process, which includes verification of assessors'
records, 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 ourwater resources. Previous occupancy determinations may be subiect to
adiustment based on the criteria mentioned above,
Ia
Smoke Detectors and Carbon Monoxide Detectors are Requiredl
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 initial _
Contact the Building Department regarding questions on type and location priorto purchasin&
httosr/lwts.v"rnrorth.ma.us/ Do.Lr lne ntce.ts/View / 1 I 22 I / Snxlk€-dcteLtor-lo.atio D
. A rnrrefundable application feeof $8O per unit/rental is required.
. Rental Certificates expire on December 37st,2025.
. To register online and pay via credit card, visit the Town of Yarmouth Health Department
website: https://www.varmouth.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 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 to: Town ofYarmouth and mail
completed application (on reverse sideJ & payment to: Town ofYarmouth Health Department.
See Reverse Side )
PIease Print Clearly
Rental Property Information
Allfields are required! Forms without a volid phone #, oddress, or e-mail address will not be processed.
Rental Property Address
54\ Lte zO
W6* 7<raoutl\,MA o2<+>
Rental Period:
lYer.-RoundTLong Term .r!l-
Weekly/Short Term (less than 31 days) _
Trash Removal by
Owner Te nan
Paid Pick Uo:
House!Duplex Condo- Apartment- Room_
Rental of:
/it r"te Qr*..i;
Property Owner Full Name
LLL
required) Entire Mailing Addres' """'i;;i,,r"iJ,,i z"( x
+11""ni5, ,^" A oa<ol
(r'equired) Primary Phone Number:
98 zzl ti98t-
Alternate Phone Number:(req u i red ) E-mail Address
,r{ lrn(te",Pdt Q3, ^| l,O,"',
Owner's Rep res e ntat- vElRentaf
Apent/ VRBO, Del Mar, Vacasa, We
Need a Vacation, Other_
{
)kl\M)J
Representative's Primary Phone
Number:
laY 8lo {9a<
Representative's E-mail Address
t4'L
at I have reviewed and am fully familiar with the Town of yarntouth's Chapter 108
Rental Housing Bylaw, Chapter 104 Anti-Noise Bylaw, the Town ofYarmouth Short-Term Rental Bylaw (where
applicable), and the Massachusetts State Sanitary Code, Chapter II (Minimum Standards ofFitness for HumanHabitation). These documents are available for reference on the Town's website and may also be obtained uponrequest from the Yarmouth Health Department.
Furthermore, I understand I must notiry the Health Department in writing when I am no longer renting theproperty, or I may be subiect to fines & fees.
7"zfDate
I hereby acknowledge th
Revis 11/26/2024
.tAN 0n 2025
Please Print Clearly I
Rental Property tnformation
JAN 0s ?025
processed.All fields ore required! Fonns without o volid phone #, oddress, or e-ntail oddress will n<.tt be
ProDertv Address:
It-t4' z8/ I u.',r6ieJ o,- >r
LX>.F ).r"o;1t^, MIA'
Rental
37t
0)*>
Rental Period:
ear-Round/Long Term X!_
eekly/Shon Tertn (less than 3l days) _
Trash Removal try
wner Tenant X
Rental of:
Ail r"tr Q.l<dJ
perty Owner Full Name:
LL(
required) Entire Mailing Address: . -l? HilL slleoi l,/ B
tftc^r-.Y5,.,a4 aa<ol
rimary Phone Number
9a8 zzt qgtz-
Alternate l,hone Nunrber:(required) E-mail Address:
a r [. lrvt r'a] Qq** i l, A*t
, Del Mar, Vacasa,
on, Other_
{r.
e s resentet lve entagen
eed
t tsRo e
a c ta
ntative's Primarv Phone
1av 8ic:\ 1<
Represe
Number:Representative's E-mail Addressl
Furthermore, I understand I must notify the Health Departnrent in writing when I am no longer renting theproperty, or I may be subiect to fines & fees.
fahI'ee b cklro edrvl h ha-V rev d il dl1 ma ut 111 rla ht ht Te Io Y Tr11 uo ht s hc r I B0peRnoHunahCer40lrNospellhTe()tl Y I'onlLl Sh ohl1 e1'I-n'l R taI]ts il h rec!'c bil e lta d h as\lp[)::l hc su setts nSa oCd C il rry l\'l I')n)Iltll tas dtl rtis F rl [1H ,inl tlttJIIhf.l l1 tsn i)I ll rh 1'sb dlt .tl'tl ir ire Ir ri u I1!PufrotnlrhYerll]il oreq u Hth ale t)th rttnep
1\/26/2024
x
)
I'
1 tByl t
t ir pt fHabr).tl llnt.
Please Print Clearly
JAt'l 0 s ?0?5
Rerltal Propertv Information
lll lields ore requirecl! Fonns without a volid phone #, address, or e-nn address will not be processed
rty Address:
tL\< zO/3 ;j:^,rbl</o^ 1y
i,xst X{-"n.,(L, ^$at_
Rental Prope
*\
Rental Period:
ear-Round/Lone Term W
eekly/Shon Term (less than 3 t days) _
Trash Removal by
wner_ Tenant House- Dupler)(Condo_ Apartmenr_ Room_
Rental of
lil r"Ce ?iY,I"c'i, tt(
roperty Owner Full Name required) Entire Mailing Address:
l? i'li1l'. Slkooi ,{/ B
\.^.,.YS,...4r+ c)<Ot
Primary Phone N untber
9"8 ZZi Li501-
(required)Alternate lrhone Number
l,an^al krgyr,-a13
(req uired) E-mail Add ress:
Q clnt t
Agent/ VRBO, Del Mar.Need a Vacation, Other
{k1
wne s Representat
acasa, We
enta
'*)-
resentative's Primary Phone
1ai lic i97:
Rep
Number;Representative's E-tnail Address
/4
Furthermore, I understand I must notify the Health Department in writing when I am no longer renting theproperty, or I may be subiect to fines & fees.
DateSi
1e
h t'e ('(llk()e(iby h re ad dtl nlil talI ra t thhv e oT ll io aYrnl L]5h ch r 0I8l)R nt H()u lt ll a hca rte 0 4e n oNp ue a h T aY [tr o h hS o l1 T Rfn1 I]ta ts ,h reclr.l e nd h il\1pp c tih ctt s a s ll.l C clo hc f}Il uIt t'i1p s nta ild rd f ltr nl nJaHi)t.!II 'fh rl Dl l1 l-r.t fa IIc o h (it)tlr i)e b d t1 I)puesfrottmheaYrnltureqHhaehDertlIt.l)pa
t1/26/2024
'1-
ful
Iit
Town
that
{rt
I))rve bsi Isr tl