HomeMy WebLinkAboutRental Application 2026RENTAL REGISTRATION APPUCANON 2026
TOWN OF YARMOUTH HEALTH DEPAFITHENT
1 146 BOUTE 24, Sotml YAFllOlrrH, MA 02664
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D RENEII'AL
D I{CW APPUCANOfl
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PLEASE REGISTER YOUR RET{TAL PROPERTY NO LATER THAN APBIL 1 , 2026
;1,1P6InJ[IIIT RENTAL CERNHCATE NONCE
IF YOU DO NOT RECETVE YOUR RENIAL CERNFICAIE WTTHIN 30 OA'IIS OF APPLYING, CONTACT THE HEALTH DEPARTMENT
IMMEDI,ATELY. UNTIL YOU RECETVE THE CERTIFICATE, YOUR PROPERry lS CONSIDERED NOT CERNFED FOR RENTAI- WHICH MAY
RESI'LT IN FINES AND PINALTIES.
APPUCANON PROCESS
SI,'BM]TNNG IHE APRICATION DOES I{OT AI'TOMANCAT.LY ESUE A RENTAL C-EBNHCAIE A REVIEW PROCESS FOLLOVVS, WHICH
INCLUDE&
. VERIFEAflON OFASSESSOR RECORDSo SEPIIG SISIEM CHECKo NUMBER OF LEGAL BEDROOMS
. VIEW OF PREVrcUS NSPECTIONS
OCCUPANCY LIMTTS
DETERMINED BYo SEPIIC S\6TEM CAPACITY. NUMBER OF LEGAL BEDROOMS
WHY THIS MATTER* IHESE MEASURES PROTECT DRINKING WATER AND AQUIFERS, ESPECIAIaY AS THE TOWN
TBI.NSTTIoNSTO A FUruRE SE}VFR SYSTEM.
SHOXE AND CARBON MONOXDE DETECTORS
AS PART OF YOUR COMPUANCE RESPONSIULMES, PLEASE ENSURE THE FOLLOWNG:
o AtI SMOXE DEIECTO$ & CARBON MoNOxlD€ DEIECIORS HAVE FRESH BATTERIES
r Al.I UNftS FtAvE BEEN IESIED AND ARE lN PROPER WORKIiIG CONDTflON
. Al-L UNITS ARE LfSS THAN 1 O YEARS OLD
OWNER CERTIFICATION REQUIBED
I CERTIFY IHAT I HAVE COHPT.ETED THE ABOVE REQUIREMENTS
OWNER IN]TIALS
Sryroke Deteclor Loqatlon-BeqqiremeDfs-Jarmouth. MA - coptr available at BdldirE Deparffi
FEES (PER UNTT)
SHORT-TERM / WEEKLY RENTAIS
RENIALS OF 31 DAI(S OF I.€SS
/NSPECI/ONS R€QU I R E D Y E A R LY
$180 ANNUALLY
LONG.TERM / YEAR-ROUND RENTALS $80 ANNUALLY
A NON-REFUNDABLE APPLICATION FEE OF $80 PER UNIT/RENTAL IS REQUIRED
AI{ AIXXNONAL FEE OF $1OO PER UMTRENTAL IS REQI.ERED FOR SHORT-IER!,! BEI{rA!S PER BT'ILDIT{G CODE
RENTAL CEKIIFICATES D(PIRE ON DECEMBER 31ST OF EACH YEAR
HAIL OR DROP OFF CHECX To IHE YARIIOi TH HEALIII DEPARtllEtf: 1l/t6 ROT IE 28, SOUIH vARHOUTH, !,tA 02664rO REGISIER O UI{E ATiID PAY vlA CNEDTT CTRD, VlSlT IHE IOWN OF YARMOUTH HEALTH DEPARIMEM WE&SITE:
hlps4wuorcJamou \l1,ma.us I 1 271 Heatth
A./;l
DUPI.EX/MULN-FAMILY REI{IALS - REFT,SE DISPOSAL RESPIONSIBIUTY
ln accordance with I 05 CMR 41 0560, and excspt as provto €d in 'l 05 CHR /fI 0560(Cl (for aUfX items) , the ow'rer of any residence
containing two or mors dEllirE units, a rooming housc, homete.s slElt€r, or manutactrod housiry comrnunlty, 3haU bo
rcsponsibL lor and pay forffis final colloctkrn ard rdtimats disposst ot rrfuso.
I, THE OWNER, CERTIFY IHAT,TIY RENTAL PROPERTY, WHICH CONTAINS TWO OR MORE DWELUNG UNITq IS IN COT.IPIIANCE
wTH MA SrArE SANTTARY CODE lOs CMR 410.560 (C) AND 105 CMR 41O.s60 (4XE).
RENTAL INFORMATIOI{
INCOMPLETE FORMS WIIHOUT A VAUD PHONE# OR EMAIL WLL NOT 8E PROCESSED
b Pou+rs l-t,r t ;1115t tja rn uq.h.: m* u)t '13
RENTAL PROPERTY ADDRESS
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PROPERTY OWNER NAME
)di Pie+ro
|tl t\aalt n u a",t- , (\ t) rctst, fiA o>t'l G
PROPFRTY OWNER MA[NG ADDRESS
PROPERTY OWNER PHONE #,
REQU|RED TTtl_ C,,t y-gUO AIERNAITVE Pt{oNE # b-/t)
tF AppLtCABLE b t1- ,1 trr1 -/ 1ct ,7 X
p y/.5 o6,1c.huo t)!'-
PROPERTY OWNER EMAIL ADDRESS
REQUIRED
tF APPLToABLE ! u6l',,.a- l't,'lo t^t , &r t-,',1 d;laaa- I czcv, yl^-/t,fn c.
OWNER'S REPRESENTATryE/RENTAL AGENI
REPRESENTAIIVE PHONE #
REQUTRED ft t_,71f -ct9t5
f n k 6 qe Ji st on.LoL<a^ cl -b.t-o *
REPRESEMTATWE EMAIL ADDRESS
REQUIRED
4 sxorr-renmrwrexrv
RENTAL PERIOD:
tr LONG-TERM/YEAR-ROUND
TRASH REMOVAL BYJ{ r;i uu iri-tF
PAID PICX-UP TRASH COMPANY i.IAME:
OOVVNER trTENANT
ft al b c.-o, t (-ot1
HOUSE O Dt'PtD( tr@NDO O APAfiIHENT O ROOM
NUMBER oF UNIS FOR RENT: bnf
RENTAL OFr il
ACKNOWLEDGMENT STATEMENT
I hereby acknodedEe that I hav€ thoroughly revirywd and am tuLty familiar with the fotlowing regutstioos:
Towt of Ysrmouth Chapt6' 1o)8 - Rsmst Hollirl8 Bytff, Town of Yamoutt Chapter lott - Attd-taoi38 Br8rv, Town ol Yrnrorirl
Short-Tsm Rsntat Byl,aw (if appticabte), f.tasechusstE Stst Sanitary Code, Cftapto.ll - Midmun St dads ol Fitness for Human
|.,EHtation
These documents are availabte for reference on the officiat Town of Yarmouth \./ebsite and may atso be obtained upon request from the
Yarmouth Heatth Department- Fur$ermore, I understand that I am required to notify the Heatth Departnent in wridng when I cease
renting the property. Faiture to do so may resutt in the imposition oI fines and/or fees'
oI,ESTIONS: Phone #: 508-398.2231 Ex. 1240' EmaiL rniederberger@yarmouth'ma.US
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OWNER INMALS
APPLICANT SIGNAruRE axeAuLL-a5 a