HomeMy WebLinkAboutRental Application2OZS Rental Registration Application
TOWN OF YAR]VIOUTH
Herlth Department
I I46 ROTITE 2E, SOI]TH YARMOUTH
MASSACHUSETTS 02664
Telephone (508) 398-2231, ext. 1240
Fax (508) 160-3472
E-mail: md aley@r Yarmou th. ma.u s
Important Notice (PLEASE READ CAREFULLY):
Ifyou do not receive your rental certificate within 30 days ofsending in yorrr appliration. pleasc 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
I rental certificate. Your application will undergo a *review process, which includes verification of assessors'
[ecords, septic system, the number ofbedrooms 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.
Ia
Smoke Detectors and Carbon Monoxide Detectors are Required!
Owners: I have ensured the batteries are changed, have tested ALL Smoke DetectorylCarbon
Monoxide Detectors and verified that they are less than l0years old: Please initiol /-rJ
Contactthe BuildinS Department regard ing questions on type and location priorto purchasing
httns: /lw$a,r,vrrmo uth.ma.us /D ocumentcertp/View/ LL22flSEohe.deledorilola tio tr
A ncrrrefundable application fee of $80 per unit/rental is required.
Rental Certificates expire on December 37\\,2025.
To register online and pay via credit card, visit the Town of Yarmouth Health Department
website: https://www.y armouth.ma.us/ 127 /Health lt 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 fwhich witl 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 of Yarmouth and mail
completed application (on reverse sideJ & payment to: Town of Yarmouth Health Department.
See Reverse Side )
Please Print Clearly
Rental Property lnformatioD
@ N
e1"^"'
Rental Property Address
eekly/Short Term (less than 31 days) _
fver"clh
Rental Period
ear-Round/LonB Term)l Uto"oBi- P
Trash Removal by:Rental oi
HouseTNbuptex- Condo- Apartment Room-,/wner- Tenan
required) Entire Mailing Address:
Jg Sl"ue,/ (r,f,r KD
Ce*lel,l llg.AA
roperty Owner Full Name
5 [16 1Vv,',e \
5o& 9 6o o?6&
Alternate Phone Number:
1o&36o7Qt
(rerl uired) E-mail Address:
lct
Owner's Representative/RentalAgent/ VRBO, Del Mar, Vacasa, We
Need a Vacation, Other_
Representative's Primary Phone
Number:Representative's E-mail Address
I hereby acknowledge that I have reviewed and am fully familiar with the Town ofYarmouth'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 ll (Minimum Standards of Fitness for Human
Habitation). These documents are available for reference on the Town'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.
Date
-4
Si g/.or.)C
Revised 7r/26/2024
(r'equirect) Primary Phone Number: