HomeMy WebLinkAbout2026 Rental ApplicationRENTAL REGISTRATION APPLICATION 2026
TOWN OFYARMOUTH HEALTH DEPARTMENT
1 .I 46 ROUTE 28, SOUTTI YARHOUTH, MA 02664
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h$licEealthE] RENEWAI
E] NRTV APPTICATION
PLEASE REGTSTER YOUR RENTAL PROPERW NO LATER THAN APRIL 1, 2026
IHPORTANT RENTAL CERTIFICATE NOTICE
IF YOU DO NOT RECEIVE YOUR RENTAL CERTIFICATE WITHIN 30 DAYS OF APPLYING, CONTACT THE HEALTH DEPARTMENT
IMMEDIATELY UNTIL YOU RECEIVE THE CERTIFICATE, YOUR PROPERry IS CONSIDERED NOI 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:
o VERIFICATION OF ASSESSOR RECORDS
o SEPTIC SYSTEM CHECK
. NUMBER OF LEGAL BEDROOMS
. VIEW OF PREVIOUS INSPECTIONS
DETERMINED BY. SEPTIC SYSTEM CAPACITY. NUMBER OF LEGAL BEDROOMS
WHY THIS NATTERS THESE ME4SURES PROTECT DRINKING WATER AND AQUIFERS, ESPECIALLY AS THE TOWN
IRANS'T'ONS TOA FUTURE SEWER SYSTEM.
SMOKE AND CARBON MONOXIDE DETECTORS
Smoke Detector Location Reouirements - Yarmouth. MA - copy avaitab(e at Buitding Department
s43OWNER INITIALS
OWNER CERTIFICATION REOUIRED
ICEBTIFYTHAT I HAVE COMPLETED THE ABOVE REQUIREMENTS
PER UNFEES
$180 ANNUALLYSHORT.TERM / WEEKLY RENTALS
RENTALS OF 31 DAYS OR LESS
INSP ECII OL S.BEQABEDJEABLY
$80 ANNUALLY
LONG-TERM / YEAR-ROUND RENTALS
mouth.ma.us/l2zHeatth
OCCUPANCY LIMITS
AS PART OF YOUR COMPLIANCE RESPONSIBILITIES, PLEASE ENSURE THE FOLLOWNG:
o ALL SMOKE DEIECTORS & CARBON MONOXIDE DEIECTORS HAVE FRESH MTTERIES
r ALL UNITS HAVE BEEN TESTEDAND ARE lN PROPER WORKING coNDlTlON
o ALL UNITS ARE LESS THAN l0YEARSOLD
A NON-REFUNDABLE APPLICATION FEE OF $80 PER UNIT/RENTAL IS REQUIRED
AN ADDMONAL FEE Of ilOO PER UN]VRENTAL IS REQUIRED FOR SHORT.TERM RENTALS PER BUII.OING 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, HA 02664
TO REGISTER ONLINE AND PAY VIA CREDIT CARD, VISlTTHE TOWN OF YARMOUTH HEALTH DEPARTMENT WEBSITE:
DUPLEVMULTFFAMILY RENTALS - REFUSE DISPOSAL RESPONSIBIUTY
tn accordance with 105 CMR 410.560, and oxcopt as provided in 105 CMR41O.56O(C) (for BfrU( items) , the orvn€r of any residence
containing trvo or moro dvyatling uniB, a rooming hous€, hometcs shcltsr, or manuHul€d horBing community, shatt b€
rBponsiblo for and pey for the finat colLction and ultimato disposat of reluse.
I, THE OWNER, CERTIFY THAT MY RENTAL PROPERTY, WHICH CONTAINS TWO OR MORE DWELLING UNITS, IS IN COMPLIANCE
wTH MA STATE SANTTARY CODE 10s CMR 410.560 (C) AND 10s CMR 410.560 (4)(E).
OWNER INITIALS 5b
RENTAL INFORMATION
INCOMPLETE FORMS wlTHOUTAVALID PHONE # OR EMAIL WILL NOT BE PROCESSED
RENTAL PROPERTY ADDRESS" " i9-4 S;i Sea A,re hn;t 4 ilns+Var^oatf, mft 02a73
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SSIPROPERTY OWNE AILING AD
PROPE OWNER NAM
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ALTERNATIVE PHONE #
IF APPLICABLE
PROPERTY OWNER PHONE *REauYt3-s/S -al /€
REautREYfu' lev /0ao ot cema
PROPERTY OWNER EMAIL ADDRESS
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VE/RENTAL AGENTOWNER'S REPRESE
IF APPLICA
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REPRESENTATIVE PHON #
REQUIRED
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REPRESENTATIVE EMAIL ADDRESS
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6orr-r..r*r.*r,RENTAL PERIOD:
D LONG-TERM/YEAR-ROUND
TRASH REMOVAL BY
PAID PICK-UP TRASH COMPANY NAME:
udwNen tr TENANT
trHousE trDUpLEx gdotoo DApARTMENT trRooM
NUMBER OF UNITS FOR RENT: I
ACKNOWLEDGMENT STATEMENT
These documents are avaitabte for reference on the officiat rown ofYarmouth website and may atso be obtained upon requestfrom theYarmouth Heatth Department. Furthermore, I understand that I am required to notitv ttre Heantr oep"rt*"it in *ritlng *hen I ceaserentingthe property. Faiture to do so may resutt in the imposition ortines anotoitees.
Habitation
Yarmouth Anti-N Town Ya
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OUESTIONS: Phone #: 508-398-2231 Ex. 1240, Emait: rniederberger(Oyarmouth.ma.us
APPLICANT SIGNATURE b DATE 0
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RENTAL OF:
hereby fottowingTowno8Bytaw,
for