HomeMy WebLinkAbout1 HIghland St 2026 Application9to
PLEASE REGISTER YOUR RENTAL PROPERTY NO LATER THAN APRIL 1, 2026
hrblicHealthtr RENEWAL
O NEw APPLICATIoN
IMPORTANT RENTAL CERTIFICATE NOTICE
IF YOU DO NOT RECEIVE YOUR RENTAL CERTIFICATE WITHIN 30 DAYS OF APPLYING, CONTACT THE HEALTH DEPARTMENT
IMMEDIATELY UNTILYOU RECEIVE THE CERTIFICAIE, YOUR PROPERry lS CONSIDERED NOT CERTIFIED FOR RENTAL, WHICH MAY
RESULT IN FINES AND PENALTIES.
APPLICATION PROCESS
SUBMITTING THE APPLICATION DOES NOT AUTOMATICALLY ISSUE A RENTAL CERTIFICATE. A REVIEW PROCESS FOLLOWS, WHICH
INCLUDES:
r VERIFICATION OF ASSESSOR RECORDS
o SEPTIC SYSTEM CHECK
. NUMBER OF LEGAL BEDROOMS
. VIEW OF PREVIOUS INSPECTIONS
(t
OCCUPANCY LIMITS
DETERMINED BYr SEPTIC SYSTEM CAPACIry
o - NUMBER OF LEGAL BEDROOMS
WHY fHB MAITERS: rHESE MEASURES PRO|ECT DRINKING WATER AND AQUIFERS, ESPECIALLY AS THE TOWN
rE4NS'r/ONS TOA FUTURE SEWER SYSTEM.
b
SMOKE AND CAREON MONOXIOE DETECTORS
AS PART OF YOUR COMPLIANCE RESPONSIBILITIES, PLEASE ENSURE THE FOLLOWNG:o ALL SMOKE DETECTORS & CARBON MONOXIOE DEIECTORS HAVE FRESH BATTERIESo ALL UNTTS HAVE BEEN TESTED AND ARE lN PROPER WoRKING CoNDITION
. ALL UNITS ARE LESS THAN 1OYEARSOLD
Smoke Detector Location Requirements - Yarmouth. MA- copy avaitable at Buitding Department
OWNER INITIALS
owNER CERTIFICATTON REQI'I8ED
I CERTIFYTHAT I HAVE COMPLETED THE ABOVE REQUIREMENTS
FEES PER
$180 ANNUALLYSHORT-TERM / WEEKLY RENTALS
RENTALS OF 31 DAYS OR TESS
/NSPECr/ONS BEQABEDJEABIT
LONG-IERM / YEAR-ROUND RENTALS $80 ANNUALLY
AT TA
RENTALSNIAL
HEALIH
PAY YAR HEALI
ma.s/1
LIAPPc No EEF OF 0$8 PE UR ITN R NE L RE U DREaANADDITIFEEONALOF00$1 IS REQUIREO PER NGBUILDIREPEXEIRNoDECEMRBE13oFEACHRYEALMAIDORPROCHECKTOIHEYARMOUTHDEPARTMENT1146ROUIESOUTH28,MARTO 02664ONEGISTERELINANDVIAEDCRITTHETOWNOFoMUTHHPADEERTMNTWESBITELttparmouthUZ7Htheal
RENTAL REGISTRATION APPLICATION 2026
TOWN OFYARMOUTH HEALTH DEPARTMENT
1146 ROUTE 28, SOUTH YARMOUTH, MA 026
N,L,
SHORT-IERM
NON-REFUNDABLE ISPERUN]T/RENTAL FOR CODECERTIFICATES
OFF
YARMOUI}l,CARD,VISIT
DUPLEVMULTI.FAMILY RENTALS - REFUSE DISPOSAL RESPONSIBILITY
ln accordance with 105 CMR 410.560, and except as provided in 105 CMR 410,580(C) (tor BULK hems) , the owner of any residence
containingtwo or more dwelling units, a rooming houss, homelsss sholter, or manufactured hollsing community, shatt be
responsible for and payforthe final cotlection and uttimate disposa[ of refuse.
I, THE OWNER, CERTIFY THAT MY RENTAL PROPERTY, WHICH CONTAINS TWO OR MORE DWELLING UNITS, IS IN COMPLIANCE
wtTH MA STAIE SANTTARY CODE 105 CMR 410.560 (C) AND 105 CMR 410.560 (4XE).
RENTAL INFORMATION
INCOMPLETE FORMSWTHOUT AVALID PHONE # OR EMAILWLL NOT BE PROCESSED
ADDRESS"lt'qit'^a S+ . Weol_ \q-rro,,,t RENTAL PROPERTY
I
a_ n!ton iv1
PROP NER
OWNER MAILING ADDRESS15 Se*lr-s ?r*A Saazrd-,& /rta-d)-51o 3PROPERTY
ALTERNATIVE PHONE #
IF APPLICABLE
PROPEBTY OWNER PHONE #
REeU'BED So\_ .lrt_ ?I+V
PROPERTY OWNER EMAIL ADDRESS
REQUTRED ko-{t^\<x,^nr D 4I O \rv.or\,c-,-r
owrueR's RepnEseurnrrvElnrrurer aoENt
tft?ft1c4BtE-
!,
REPRESENTATIVE PHONE *
t*49!8Ep^
REPRESENTATIVE EMAIL ADDRESS
REQUIRED
q/*r-rr*r*.r*.,RENTAL PERIOD:
tr LONG-TERM/YEAR-ROUNDG*bIf bct ,ffiTRASH REMOVAL BY
PAID PICK-UP TRASH COMPANY NAME:
)ts.t-ER DTENANT
*(u,,tr DUPLEX trCONDO DAPARTMENT DROOM
ACKNOWLEDGMENT STATEMENT
re availabte for reference on the otficiat rown ofYarmouth website and may atso be obtained upon requestfrom theDepartment' Furthermore, I understand that I am required to notify the Heatttr oepartment in writing when I ceaserentingthe property. Faiture to do so may resutt in the imposition offines and/or fees.
Habitation
These documents a
Yarmouth Heatth
Town
(i
herI ac nkowte atth I have oroth revtebydgeewed na adm ttyughamltiar theth Iottowi tatiu S:onfuttyregng
T ol utharmo ach 108 Rental oH iuspter ownT of utharmoBylaw,ng Cha 1I 04pte of rmo hutBytaw,rtSho ermT Rentat I ti ac (eb sacMasBytaw Statehusettsapp Sa)c f II Mi unlmnitaryCode,mhapte Standards Fitof forness Huma n
QUESTIoNS: Phone #: 508-398-2231 Ex. 1240, Emait: rniederbergerrdyarmouth.ma,us
IAPPLICANT SIGNATURE
DATE >oLb
OWNER INMALS
RENTAL OF:
NUMBER OF UNITS FOR RENT:
-Anti-Noise