HomeMy WebLinkAbout2026 ApplicationRENTAL REGISTRATION APPLICATION 2026
TOWN OFYARMOUTH HEALTH DEPARTMENT
1 146 ROUTE 28, SOUTH yARMOUTH, MA 02664 ^31\iLt[N'
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PLEASE REGISTER YOUR RENTAL PROPERTY NO LATER THAN APRIL 1 ,2026
IMPO RTANT RENTAL CERTIFICATE NOTICE
IF YOU DO NOT RECEIVE YOUR RENTAL CERTIFICATE WITHIN 30 DAYS OF APPLYING, CONTACT THE HEALTH DEPARTMENIIMMEDIATELY UNIIL YOU RECEIVE IHE CERTIFICATE, YOUR PROPERTY IS CONSIDERED NOT CERTIFIED FOR RENTAL, WHICH MAY
RESULT IN FINES AND PENALTIES.
AS PART OF YOUR COMPLIANCE RESPONSIBILITIES, PLEASE ENSURE THE FOLLOWING:
ALL SMOKE DETECTORS & CARBON MONOXIDE DETECTORS HAVE FRESH BATTERIES
ALL UNITS HAVE BEEN TESTED AND ARE IN PROPER WORKING CONDITION
ALL UNITSARE LESSTHAN lOYEARS OLD
OWNER CERIIFICATION REQTTEEA
I CERTIFY THAT I HAVE COMPLETED THE ABOVE REQUIREI.4ENTS
OWNER INITIALS R
- c0py avaitabte at Buitding Department
FEES (PER UNtr)
A NON-REFUNDABLE APPLICATION FEE OF $80 PER UNIT/RENTAL IS REQUIREDAN ADDITIONAL FEE OF $1OO PER UNIT/RENTAL IS REQUIRED FORSHORT-TERM RENTALS PER BUILDING CODE
RENTAL CERTIFICATES EXPIRE ON DECEMBER 31SI OF EACH YEARMAILoR DRoP oFF cHEcKToTHE YARMOUTH HEALTH DEPARTMENT:1 146 BOUTE 28, SOUTH YARMOUTH, MA 02664TO REGISTER ONLINE AND PAY VIA CREDIT CARO, VISIT THE TOWN OF YAR14OUTH HEALIH DEPARTMENT WEBSITE:
APPLICATION PROCESS
ICATION DOES NOT AUTOMATICALLY ISSUE A RENTAL CERTIFICATE, A REVIEW PROCESS FOLLOWS. WHICH
INCTUDES
SUB14ITTING THE APPL
OCCUPANCY LIMITS
DETERMINED BY;r SEPTIC SYSTEM CAPACtTyo NUMBER OF LEGAL BEDRooMS
WHY THIS MATTERS: THESE MEASURES PROIECT DRNKING WATER AND AQUIFERS, ESPECIALLY ASTHE TOWN
TRANSITIONS TO A FUflJRE SEWER SYSTEM.
oSM EK DAN BBCA No M o oNx ED DET RSECTO
SHORT-TERM / WEEKLY RENTALS
EENTA(S OF37 DAYS OB TESS
IN.SPECIi ONS REQUIRED YEAR!Y
$1BO ANNUATLY
LONG-TERM / YEAR.ROUND RENTALS $80 ANNUALLY
9
. VERIFICATION OF ASSESSOR RECORDS. SEPTIC SYSTEM CHECK. NUMBER OF LEGAL BEDROOMS. VIEW OF PREVTOUS tNSpECTtONS
DUPLEX/MULTI-FAMILY RENTALS - REFUSE DISPOSAL RESPONSIBILIW
ln accordance with 105 CMR 410.560, and except as provided in 105 CMR 410.560(C) (ror BULK items) , the owner of any residence
containing two or mor€ dwelting units, a rooming house, hometess shelter, or manufactured housing community, shatt be
responsibte for and pay tor the tinaI cotlection and uttimale disposat of refuse.
I, THE OWNER, CERTIFY THAT MY RENTAL PROPERTY, WHICH CONTAINS TWO OR MORE DWELLING UNITS, IS IN COMPLIANCE
wlTH MA STATE SANITARY CODE 10s CMR 410.560 (C) AND 10s CMR 410.s60 (4)(E).
owNER rNrrALs 3 O
RENTAL INFORMATION
INCOIqPLETE FORMS WITHOUT A VALID PHONE # OR EI4AIL WILL NOT BE PROCESSED
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RENIAL PROPERTY ADDRESS
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PROPERTY OWNER NAME
bbitLarc CsO I0ar1nt5
PROPERTY OWNER MAILING ADDRESS
DiHon€ALL
5o8-)3-t-57y4
PROPERTY OWNER P ONE #
REQUlRED
ALTE NATIVE PHONE #
IF APPLICABLE
rq.lph dirnonte@ /ah oo . Co rn
PROPERTY OWNER EMAIL ADDRESS
REQUIRED
R,al pnbi honte,, [.4a er
OWN ER'S REPRESENIATIVE/RENTAL AGENT
IF APPLICAELE
50i-ab1-5'774
REPRESENTAI]VE PHO NE #
REQUIRED
flLONG-TERM/YEAR-ROUND trSHORT.TERM/WEEKLY
TRASH REMOVAL BYI
PAID PICK.UP TRASH COMPANY NAME
trOWNER tsTENANT
RENTAL OF:
dHousE DDUPLEX trcoNDo TAPARTMENT trRooM
REPRESENTATIVE EMAIL ADDRESS
faiphdirYbnte oo'cofi
QUESTIONS: Phone #: 508-398-2231 Ex. 1 240, Emait: rniederbergeL@yffmOulb.m?.us
ACKNOWLEDGMENT STATEMENT
I hereby acknowtedge that I have thoroughly reviewed and am fulty famiUar with the fotlowing regulationsl
Town olYarmouth Chapter 108 - Rentat Housing Bytaw, Town otYarmouth Chapler 104 -Anti-Noise Bytaw, Town ofYarmouth
Shon-Term Rentat Bytaw (if applicabte), Massachusetts State Sanitary Code, Chapter ll - Minimum Standards of Fitness for Human
Habitation
These documents are avaitable for reference on the officiatTown of Yarmouth website and may atso be obtained upon request trom the
Yarmouth Heatth Department. Furthermore, I understand that I am required to notify the Heatth Department in writing when I cease
renting the property. Faiture to do so may result in the imposition of fines and/or fees.
APPI ICANT SIGNATI JRF DAT F
REQUIRED
RENTAL PERIOD:
NUMBER OF UNITS FOR RENT: T
I