HomeMy WebLinkAbout18 Pond Street Rental Application 2026RENTAL REGISTRATION APPLICATION 2026
TOWN OFYARMOUTH HEALTH DEPARTMENT
1146 ROUTE 28, SOUTH YARMOUTH, MA 02664 r-$
?t].c(v'#r 9 vR.rblic HealtJrtr RENEWAL
E NEW APPLICATIoN
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, CONTACITHE HEALTH DEPARTMENT
IMMEDIATELY UNTILYOU RECEIVE THE CERTIFICATE, YOUR PROPERTY IS CONSIDERED NOT CERTIFIED FOR RENTAL, WHICH MAY
RESULT IN FINES AND PENALTIES.
APPLICATION PROCESS
OCCUPANCY LIMITS
DETERMINED BY:
r SEPTIC SYSTEM CAPACIry. NUMBER OF LEGAL BEDROOI'4S
WHYTHIS MAITERS: IHESE MEASURES PROTECT DRINKING WArER AND AQUIFERS, ESPECIALLY AS THE TOWN
rMNS/r/ONS TO A FUTURE SEWER SYSTEM .
SMOKE AND CARBON MONOXIDE DETECTORS
AS PART OF YOUR COMPLIANCE RESPONSIBILITIES, PLEASE ENSURE THE FOLLOWING
. ALI SI''IOKE DETECTORS & CARBON MONOXIDE DETECTORS HAVE FRESH BATTERIESo ALL UNITS HAVE BEEN TESTED AND ARE IN PROPER WORKING CONDITION
. ALL UNITSARE LESS THAN lOYEARSOLD
OVYNER CERT1FICATION REQUIEED
I CERTIFY THAT I HAVE COMPLETED THE ABOVE REQUIREMENTS
Smqke DeteetorlosalionBcqullcnocnts lfamorutb- - copy avaitabte at Buitding Department
FEES (PER UNIT)
SHORT-TERM / WEEKLY RENTALS
RENTALS OF 31 DAYS OR LESS
/NSEECr/ONS FEQ U I REDY E A RA
$180 ANNUALLY
LONG TERN4 / YEAR-ROUND RENTALS $80 ANNUALLY
A NON-REFUNDABLE APPLICATION FEE OF $80 PER UNIT/RENTAL IS REQUIRED
AN ADDITIONAT FEE OF $1OO PER UNIT/RENTAL IS REQUIRED FOR SHORT.TERM RENTALS PER BUILDING CODE
RENTAL CERTIFICATES EXPIRE ON DECEMBER 31ST OF EACH YEAR
MAIL OR DROP OFF CHECK TO THE YARMOUTH HEALTH DEPARTMENT: 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664
To REGISTER ONLINE AND PAY VIA CREDIT CARD, VISIT THE TOWN OF YARI'4OUTH HEALTH DEPARTMENT WEBSITE:
https:1 ryyvw.yarmouth. ma.qsi 'l 2TlElcritth
SUBMITTING THE APPLICATION DOES NOT AUIOMATICALLY ISSUE A RENTAL CERTIFICATE. A REVIEW PROCESS FOLLOWS, WHICH
INCLUDES:r VERIFICATION OF ASSESSOR RECORDSe SEPTIC SYSTEM CHECK
o NUMBER OF LEGAL BEDROOMS
. VIEW OF PREVIOUS INSPECTIONS
owNERtNtflA$ s:I) F
I
DUPLEx,/MULTI.FAMILY RENTALS - REFUSE DISPOSAL RESPONSIBILITY
ln accordance with 105 CMR 410.560, and excepl as provided in 105 CMR 410.560(C) (for BULK items) , the owner of any residence
containingtwo or more dwetting units, a rooming house, homeless shelter, or manufactured housing community, shal[ be
responsible for and payforthe final cotlection and uttimate disposat of retuse.
I, THE OWNER, CERTIFY THAT MY RENTAL PROPERTY, WHICH CONTATNS TWO OR MORE DWELLING UNITS, IS IN COMPLIANCE
wtrH MA STATE SANITARY CODE 105 CMR 410.560 (C) AND 105 CMR 410.560 (4)(E).
OWNER INITIALS -q J)fL
RENTAL INFORMATION
INCOMPLETE FORMS WITHOUT AVALID PHONE # OR EMAILWLL NOT BE PROCESSED
RENTAL PROPERry ADDRESS
faru o SL.Rrnou o
PROPERry OWNER NAME
ru i1 d /7/
PROPERTY OWNER I'4AILING ADDRESS
Ao louo St,so,4rt n rtzr:utL-, /7/E "2/ 64
PROPERTY OWNER PHONE #
REQUIRED {25-3ap - tsi #
ALTERNATIVE PHONE #
IF APPLICABLE
PROPERTY OWNER EMAIL ADDRESS
REQUIRED --
OWNER'S REPRESENTATIVE/RENTAL AGENT
IF APPLICABLE
REPRESENTATIVE PHONE #
REQUIRED
REPRESENTATIVE EMAIL ADDRESS
REQUIRED
RENTAL PERIOD:
dio*o-rr*rrraoR-RouND rsHoRT-TERM/wEEKLy
TRASH REMOVAL BY:
E{.ro*t! OWNER
PAID PICK-UP IRASH COMPANY NAI"IE:
RENTAL OF:
trDUPLEx ncoNDo 6roarrr* o*oo,! HOUSE
I hereby acknowtedge that I have thoroughty reviewed and am futty famitiar with the fottowing regutations:
Town ofYarmouth Chapter 108 - Renta[ Housing By]aw, Town ofYarmouth Chapter 104- Anti-Noise Bylaw, Town ofYarmouth
Short-Term Rental Bytaw (if appticabte), Massachusetts State Sanitary Code, Chapter ll - Minimum Standards of Fitness for Human
Habitation
These documents are available for reference on the officiat Town of Yarmouth website and may atso be obtained upon request from 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 resutt in the imposition of fines and/or lees.
QTJESTIONS: Phone #: 508-398-2231 Ex.1240, Emait: miederberger@yarmouth.ma.us
APPLICANT SIGNATURE ildt/;2 fa-Z?,^DATE /s-/s.2
I
I
I NUMBER oF uNtrs ron Rerur /
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ACKNOWLEDGMENT STATEMENT