HomeMy WebLinkAboutRental Application 2026RENTAL REGISTRATION APPLICATION 2025
TOWN OFYARMOUTH HEALTH DEPARTMENT
1146 ROUTE 28, SOUTH YARMOUTH, MA 0269
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E NEWAPPLICATION
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PLEASE REGISTER YOUR RENTAL PROPERTY NO LATER THAN APRIL 1, 2026
IMPORTANT RENTAL CERTIFICATE NOTICE
IF YOU DO NOT RECEIVE YOUR RENTAL CERTIFICAIE WITHIN 3O DAYS OF APPLYING, CONTACT THE HEALTH DEPARTMENT
IIYMEDIATELY UNTIL YOU RECEIVE THE CERTIFICATE, YOUR PROPERTY IS CONSIDERED NOT CERTIFIED FOR RENTAL, WHICH I4AY
RESULT IN FINES AND PENALTIES.
APPLICATION PROCESS
SUBMITTING THE APPLICATION DOES NOT AUTOMATICALLY ISSUE A RENTAL CERTIFICATE. A REVIEW PROCESS FOLLOWS, WHICH
INCLUDES:
o VERIFICATION OF ASSESSOR RECoRDS
r SEPTIC SYSTEM CHECK
. NUMBER OF LEGAL BEDROOMS
. VIEW OF PREVIOUS INSPECTIONS
OCCUPANCY LIMITS
DETERI'4INED BV
. SEPTIC SYSTEM CAPACIry
I NUMBER OF LEGAL BEDROOMS
WHY fHlS MATTERST rHESE MEASURES PROTECT DRINKING WA|ER AND AQUIFERS, ESPECIALLY AS fHE |OWN
TRANSITIONSTO A FU|URE SEWER SYSTEM.
SMOKE AND CARBON MONOXIDE DETECTORS
AS PART OF YOUR COMPLIANCE RESPONSIBILITIES, PLEASE ENSURE THE FOLLOWING:
. ALL SMOKE DETECTORS & CARBON MONOXIDE DETECTORS HAVE FRESH BATTERIES
. ALL UNnS HAVE BEEN TESTED AND ARE lN PROPER WORKING CONDITION
. ALL UNITSARE LESSTHAN 1O YEARS OLD
OWNER CERTIFICATION REQUIBED
ICERTIFYTHAT I HAVE COMPLETED THE ABOVE REQUIREMENTS/EOWNER INITIALS
Sqlakeletcstoll-asatial| Reoutcments-Jarmauth-l{A - copy avaitabl.e at Buitding Department
PER UNIT)FEES
SHORT.TERM / WEEKLY RENTALS
RENTALS OF3' DAYS OR IESS
I N SP ECT I Q N S BE QU I RE D Yf ARLY
OANLONG.TERN4 / YEAR-ROUND RENTALS
A NON.REFUNDABLE APPLICATION FEE OF $80 PER UNIT/RENTAL IS REQUIRED
AN ADDITIONAL FEE OF ilOO PER UNIT/RENTAL IS REQUIRED FOR SHORT-TERM RENTALS PER EUILDING CODE
RENTAL CERTIFICATES EXPIRE ON DECEMBER 31ST OF EACH YEAR
MAIL OR DROP OFF CHECKTO THE YARMOUTH HEALTH DEPARTMENT: 1146 ROUTE 28, SOUTH YARMOUTH, MA 026G4
TO REGISTER ONLINE AND PAY VIA CREDIT CARD, VISIT IHE TOWN OF YARMOUTH HEALTH DEPARTMENT WEBSITE:
hEps a-uYl2TlHealth
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$180 ANNUALLY
DUPLEVMULTI.FAMILY RENTALS. REFUSE DISPOSAL RESPONSIBILITY
ln accordance with 1OS CMR 410.560, and except as provided in 105 CMR 410.560(C) (tor BULK items) , the owner of any residence
containingtwo or more dwolling qnits, a rooming house, hometoss shettsr, or manufuctured housing community, shatt b€
responsible for and payforthe rinat cottection and uttimate disposat of refuse.
I, THE OWNER, CERTIFY THAT MY RENTAL PROPERIY, WHICH CONTAINS TWO OR MORE OWELLING UNITS, IS IN COMPLIANCE
wfrH MA STATE SANTTARY CODE 105 CMR 410.s60 (C)ANO 10s CMR410.s60 (4)(E).
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' ! RENTAL tNFoRMAnoN
INCOMPLETE FORMS WTHOUT AVALID PHONE # OR EMAILWLL NOT BE PROCESSED
RENrALpRopEj,ryaDo^rtZu*p Sl"e t' A^,,/ # CA
PROPERTY OWNER NAM '4.-)a.m erl e, f'€\ /-L
PR.PERT.*NERMATLTNGADDRESS 37 E'o{ay ,, Ho5/p'e //V D26lf
PROPERry OWNER PHONE #.foY77€Qlo oREQUIRED
PROPERry OWNER EMAIL ADDRESSREeutRED 5,4tr- lRHf/\//.y'*o; f co *r
OWNER'S REPRESENTATIVE/RENTAL AGENT
IF APPLICABLE
REPRESENTATIVE PHONE #
REQUIRED
REPRESENTATIVE EMAIL ADDRESS
REQUIRED
il.oro-ra^"^raoR-RouND osHoRT-rERM/,,EEKLy
RENTAL PERIOD
Uo*".* tr TENANT
/rt, c;e /.-o/L
TRASH REMOVAL BY
PAID PICK-UP TRASH COT4PANY NAI"1E:
RENTAL OF:
trHOUSE tr DUPLEX tr CONDO
NUMBER OF UNIIS FOR RENT:
Joro*rrr*, o *oo,
ACKNOWLEOGMENT STATEMENT
I hereby acknowtedge that I have thoroughty reviewed and am fuLty famitiar with the fotlowing regulations:
Town of Yarmouth Chapt6r 108 - Rental Housing Bytaw, Town ofYarmouth Chaptor 104 -Anti-Noise Bylaw, Town ofYarmouth
Short-Term Rentat Bytaw (if appticabte), Massechusotts Stats Sanitary Code, Chapter ll - Minimum Standards of Fitness for Human
Habitation
These documents are avaitabte for reference on the official Town of Yarmouth website and may atso be obtained upon request from the
yarmouth Health Department. Furthermore, I understand that I am required to notify the Heatth Department in writing when I cease
renting the property. FaiLure to do so may resutt in the imposition of fines and/or fees.
2231 Ex. 1 240, Ema i t: rniedi Lbergel@Er rm oqth. m a- us
APPLICANT SIGNATU
Phone #: 50
DATE o3,/6 d6.
tFAppLtcABLE SoE rl?S- y:4 O
ALTERNATIVE PHONE #
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QUE$TIONS: