HomeMy WebLinkAbout2026 Rental ApplicationF.Ft a.ta a trFAaIF.FII atFaAr a r FrFra aA rr?a /rrrrrErr rAL nEl,tDt ttA I tvN ArrltvAt lv!\ zuzo
TOWN OFYARMOUTH HEALTH DEPARTMENT
.I1'16 ROUIE 28, SOUTH YARMOUTH, MA 02664
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:] NEWAPPLICATION
PLEASE REGISTER YOUR RENTAL PROPERTY NO LATER THAN APRIL 1 , 2026
IMPORTANT RENTAL CERTIFICATE NOTICE
IF YOU DO NOT RECEIVE YOUR RENTAL CERTIFICATE WITHIN 30 DAYS OF APPLYING, CONTACTTHE HEALTH DEPARTMENT
IMMEDIATELY UNTILYOU RECEIVE THE CERTIFICAIE, YOUR PROPERTY IS CONSIDERED NOT CERTIFIEO FOR RENTAL, WHICH MAY
RESULT IN FINES AND PENALTIES.
SUBI'IITTING THE APPLICATION DOES NOTAUTOMATICALLY ISSUE A RENTAL CERTIFICATE. A REVIEW PROCESS FOLLOVVS, WHICH
INCLUDES:. VERIFICATION OF ASSESSOR RECORDS. SEPTIC SYSTEM CHECK. NUMBER OF LEGAL BEDROOMS
. ViEW OF PREVIOiJS iNSPECT|ONS
DETERMINED BY
. SEPTIC SYSTEM CAPACITY
O NUMBER OF LEGAL BEDROOMS
WHY THIS MATTERS: THESE MEASURES PROTECT DRINKING WATER AND AQUIFERS, ESPECIALLY AS THE |OWN
I&ANSINONS TOA FUTURE SEWER SYSTEM.
APPLICATION PROCESS
OCCUPANCY LIMITS
SMOKE AND CARBON MONOXIDE DETECTORS
AS PART OF YOUR COMPLIANCE RESPONSISILITIES, PLEASE ENSURE THE FOLLOWING:. ALL SMOKE DETECTORS & CARBON MONOXIDE DETECTORS HAVE FRESH BATTERIES. ALL UNITS HAVE BEEN TESTEDAND ARE IN PROPER WOBKING CONDITION
. ALL UNITS ARE LESSTHAN lOYEARSOLD
NU/NFR (:FPTIFiT:ATIrr^l PFNI
'IPFNICEBTIFYTHAT I HAVE COMP
OWNER INITIALS
,nrorffiF9urREMENTS
Smoke Detector Location Requirements - Yarmouth. MA - copy availabte at Buitding De
FEES (PER UNIT)
SHORT.IERM i WEEKLY RENIALS
RENTALS OF 31 DATS OR LESS
LONG-TERM / YEAR.ROUND RENTALS $80 ANNUALLY
A NON.REFUNDABLE APPLICATION FEE OF $80 PER UNIT/RENTAL IS REQUIRED
AN ADDTTIONAL FEE OF $1OO PER UNIT/RENTAL IS REQUIRED FOR SHORT-TERM RENIALS PER BUILDING CODE
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MAIL OR DROP OFF CHECK TOTHE YARMOUTH HEALTH DEPARTMENT: 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664
TO REGISTER ONLINE ANO PAY VIA CREDIT CARO, VISIT THE TOWN OF YARMOLIIH HEALTH DEPARTMENT WEBSITE:
r//wu^lv.ya rmoutLrna.usll2TlH 9a tth
DUPLEx/MULTI.FAMILY RENTALS. REFUSE DISPOSAL RESPONSIBILITY
ln accordance with 105 CMR 410,560, and except as provid6d in 105 CMR 410.560(C) (for BULK items) , the ownsr of any residence
containing two or more dlvolling units, a rooming houss, homeloss sh6ltar, or manufactursd housing community, shall b6
responsiblo lor and payfor the final colloclion rnd ultimatg disposal of refus6.
I, THE OWNER, CERTIFY THAT MY RENTAL PROPERry WHICH CONIAINS TWO OR MORE DWELLING UNITS, IS IN COMPLIANCE
wTH MA STATE SANTTARY CODE 10s CMR 410.560 (C) AND 105 CMR 410.s60 (4)(E).
OWNER INITIALS
INCOMPTETE FORMS WI'[HOUT AVALIO PHONE # OB MAIL WLL NOT BE PROCESSED
RENTAL INFORMANON
aS.2 rWL 9o"+l^rtRENTAL PROPERTY ADDRESS
PRoPERTY.*NERMATLTNGADDRESS w ao/ land E4 s"t b'*1 a n- o t -) c
PROPERTY OWNEB PHONE # , ;, \
REQUTRFD "f ts te lbb )Ql (4.tL )
ALTERNATIVE PHONE #
IF APPLICABLE
OWNER'S REPRESENTATIVE/RENTAL AGENT
IF APPLICABLE Nlt
REPRESENTATME PHONE #
REQUIRED ,Vh
REPRESENT, AT!\-4E EMA!L,4DDRESS
REQUIRED Nlt
,i6r-roRr-rEnMruvEexlv lfr"A/ - W;?.4RENTAL PERIOD:
tr LONG-TERI'4/YEAR.ROUN D
pHouse DDUeLEx trcoNDo tr AeARTMENT lRooM
RENTAL OF:
NUMBER OF UNITS FOR RENT:
TnvTEnt r vvYttEn t\ttt'tE'
PROPERTY OWNER EMAIL ADDRESS
REQUIRED
TRASH REMOVAL BY
&'<1..1U_u\_
gY*d,,/^hP@ /a hoo'reM
r ER ! TENANT
PAID PICK-UP TRASH COMPANY NAME:&
ACKNOWLEDGMENT STATEMENT
I hereby acknowtedge that I have thoroughty reviewed and am fuily famitiar with the foltowing regutations:Town of Yarmoulh Chapter 1OB - Rentat Housing Byt8w, Town of ysrmouth Chaptsr 104 _Anti-Noise Bytaw, Town of yarmouthShort-T6rm Rental Bylaw (if applicabte), Massachu setts Ststa Sanitary Code, Chapter ll _ Minimum Stsndards of Fitness for HumanHabitation
These documents are avail.able for referen
Yarmouth Heal.th Department. Furtherm
renting the prope
OUESTIONS: phone #: 508-398-22 31 Ex.1240,Emait: rniederberger@yarmouth_ma.us
ce on the officiat Town of yarmouth website and may atso be obtained upon request from theoreJ understand that I am required to notify the Heaith Departmentin writing when I ceasefiy. F€ilure to do so may resul.t in the imposition offines and/o,t"e.. "
APPLICANT SIGNATURE oorr3* /0-> PL
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