HomeMy WebLinkAbout40 Braddock Rd Application 2026**:l
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N NEW APPTJCAIr)N
hrblic Heaftn
PLEASE REGISTER YOUR RENTAL PROPERTY NO LATER THAN APRIL 1, 2026
IMPORTANT RENTAL CERITIFICATE NOTICE
IFYOU DO NOT RECEIVE YOUR RENTAL CERTIFICATE WTHIN 30 DAYS OF APPLYING, CONTACTTHE HEALTH DEPARTMEMT
IMMEDIATELY UNTIL YOU RECEIVE THE CERTIFICATE, YOUR PROPERTY IS CONSIDERED NOT CERTIFIEO FOR RENTAL, WHICH MAY
RESULT IN FINES AND PENALTIES.
APPLICATION PROCESS
SUBMITTING THE APPLICAIION DOES NOT AUTOMATICALLY ISSUE A RENTAL CERTIFICATE. A REVIEW PROCESS FOLLCNiVS, WHICH
INCLUDES:o VERIFICATION OF ASSESSOR RECORDSo SEPTIC SYSTEM CHECK
. NUMBER OF LEGAL BEDROOMS
o VIEW OF PREVIOUS INSPECTIONS
OCCUPANCY LIMITS
AS PART OF YOUR COMPLIANCE RESPONSIBILITIES, PLEASE ENSURE THE FOLLOWING:
. ALL SMOKE DEIECTORS & CARBON MONOXIDE DETECTORS HAVE FRESH BATTERIES. ALL UNITS HAVE BEEN TESIED AND ARE lN PROPER WORKING CONDTflON
. ALL UNITS ARE LESS THAN 1OYEARSOLD
- copy avaitabte at Burtding Department
SMOKE AND CARBON MONOXIDE DETECTORS
OWNER INITIALS
OWNER CERNHCANON REQ1JIBED
ICERTIFYTHAT I HAVE COMP E ABOVE REQUIREMENTS
FEES (PER UNIT)
$180 ANNUALLYS
REN
/NSP
RM EEKLY RE
LSOF 31 DAYS OR
ETIONS REQUIRED ARLY
LONG-T ND RENTALS $80 ANNUALLY
A NON-REFUNDABLE APPLICATION FEE OF $80 PER UNIT/RENTAL IS REQUIRED
AN ADDMONAL FEE OF tlOO PER UNIT/RENTAL IS REQUTRED FOR SHOFIT.IERM RENTALS PER BUILDING CODE
RENTAL CERNFICATES EXPIRE ON DECEMBER 31ST OF EACH YEAR
MAILOR DROP OFF CHECK TO Il{E YARMOUTH HEALTH DEPARIHENT:1146 ROUTE 28, SOUTH YARMOUTH, MA 02664
TO REGISIER ONLINEAND PAY VIA CREDIT CARD, VISITTHE TOWN OFYARMOUTH HEALTH DEPARTMENT WEBSITE:
hnpsi//wwwyarmoUth.ma.us/'127lHeatth
RENTAL REGISTRATION APPLICATION 2026
TOWN OFYARMOUTH HEALTH DEPARTMENT
1146 ROUTE 28, SOUTH YARMOUIH, MA 02654
DETERMINED BY
o SEPIIC SYSTEM CAPACIIY. NUMBER OF LEGAL BEDROOMS
WHY THIS MATTERS: fHESE MEIASURES PROTECT DRINKING WATER AND AQUIFERS, ESPECIALLY AS THE TOWN
TRANSffIONS TO A FUTURE SEWER SYSTEM.
DUPLEVMULTI.FAMILY RENTALS. REFUSE DISPOSAL RESPONSIBILITY
ln accordance with 105 CMR 410.560, and oxcepl as provided in 105 CMR 410.560(C) (for BULK items) , the owner of any r€sidence
containingtwo or moro dw€Uing units, a rcoming houso, homol6ss 3holtor, or manutactu.sd housing community, shsll bo
Espon3lble for and pay tor the tlnal cotlection and uttlmate dlsposat of rstuss.
I, THE OWNER, CERTIFY THAT MY RENTAL PROPERTY, WHICH C1
W]TH MA SIAIE SANTTARY CODE 105 CMR
ONT.TWO OR MORE DWELLING UNITS, IS IN COMPLIANCE
) aND 105 CMR 410.s60 (4)(E)
OWNER INITIALS
560
QUESIIQI{S: Phone #: 508-398-2231 Ex. 1240, Emait: rniederberger@yarmouth.ma.us
RENTAL INFORMATION
INCOMPLETE FORMSWTHOUT AVALID PHONE # OR EMAILWILL NOT BE PROCESSED
RENTAL PROPERTY ADDRESS- " - Vo TiZa*.* ':t-PROPERTY OWNER NAME4n/tet-Aaueelle'
PRoPERTY owNER MAr''*offij/, c K/- M'/// ury k/,f a cz z
PROPERTY OWNER PHONE #
? 7r.eas.6/7DREQUIRED
ALTERNATIVE PHONE #
IF APPLICABLE
Adoacel+e-€/ Q/tolnal/ ' co"r-
PROPERry OWNER EMAIL ADDRESS
REQUIRED
OWNER'S REPRESENTATIVE/RENIAL AGENT
REPRESENTATIVE PHONE #
REQUIRED
1(rro*.-rr*r*r.*.,
RENTAL PERIOD:
tr LONG-TERMTYEAR-ROUND
TRASH REMOVAL BY
PAID PICK-UP TRASH COMPANY NAME:*""*/?e/tLo
R T]TENANT
Mrorra o orraEx trcoNDo tr APARTMENT trRooM
NUMBER OF UNttS FOR RENT: I
RENTAL OF:
ACKNOWLEOGMENT STATEMENT
I hereby acknowtedge that I have thoroughty reviewed and am tutty tamitiar with the rottowing regulations:
Town of Yarmouth Chapt8r 1 08 - Rental Housing BytEw, Town of Yarmouth ChsptEr 1 04 - Anti-Noiso Bfaw, Town ot Yamouth
Shon-Tem Rontat Bylaw (if appticable), Massachusctts Statr Sanitary Codc, Chaptcr ll -Minimum Standards of Fitn€ss torHuman
Hobitation
These documents are availabtefor reference on the officialTown ol Yarmouth website and may atso be obtained upon requestfrom the
Yarmouth Health Department. Furthermore, I understand that lam required to notifythe Heatth Department in writingwhen lcease
renting the property. Faiture to do so may result in the imposition offines and/or fees.
DATE ,.t/tz /*tt
REPRESENTATIVE EMAIL ADDRESS
REQUIRED
APPLICANT SIGNATURE