HomeMy WebLinkAbout2026 Rental Application_84 UnitsRENTAL REGISTRATION APPLICATION 2026
TOWN OFYARMOUTH HEALTH DEPARTMENT
1146 ROUTE 28, SOUTI{ YARMOUTH, MA 02664
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D RENEWAL
tr NEW APPLICATION
Pubtic tlealtlr
PLEASE REGI TER YOUR RENTAL PROPERTY NO LATER THAN APRIL 1, 2026
IMPORTANT RENTAL CERTIFICATE NOTICE
IF YOU DO NOT RECEME YOUR RENTAL CERTIFICATE WTHIN 30 DAYS OF APPLYING, CONTACTTHE HEALTH DEPARTMENT
IMMEDIATELY UNTIL YOU RECEIVE THE CERTIFICATE, YOUR PROPERTY IS 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:e VERIFICATION OF ASSESSOR RECORDSo SEPTIC SYSTEM CHECK. NUMBER OF LEGAL BEDROOMS. VIEW OF PREVIOUS INSPECTIONS
OCCUPANCY LIMITS
DETERMINED BY
o SEPTIC SYSTEM CAPACmY
. NUMBER OF LEGAL BEDROOMS
WHY THIS MATTERSj THESE MEASURES PRO|EC| DRINKING WATER AND AQUIFERS, ESPECIALLY AS THE TOWN
rI} NS'flONS TOA FUTURE SEWER SYSIEM.
SMOKE AND CARBON MONOXIDE DETECTORS
AS PART OF YOUR COMPLTANCE RESPONSIBILITIES, PLEASE ENSURE THE FOLLOwlNG:. ALLSMOKE DErECTORS & CARBON MONOXIDE DErECTORS HAVE FRESH BATTERIESo ALL UNIIS HAVE BEEN TESTED AND ARE lN PROPERWORKING CONDITION
. ALL UNISARE LESS THAN 10 YEARS OLD
OWNER CERTIFICATION BEQI'IBEP
ICERTIFYTHAT I HAVE COMPLETED THE ABOVE REQUIREMENTS
Smoke Detector Loaatlgn Requrrements - Yarmouth-ltA - copy avaitabte at Buitding Department
FEES (PER UNIT)
SHORT-TERM / WEEKLY RENTALS
RENTAL$ OF 31 DAYS OR T655
IVSPEENONS 8EQ U I RED Y E ARLY
$180 ANNUALLY
LONG.TERM / YEAR.ROUND RENTALS // $Bo ANNUATLY
A NON-REFUNDABLE APPLICATION FEE OF $80 PER UNIT/RENTAL IS REQUIRED
AN ADD]TIONAL FEE OF $1OO PER UN]VRENTAL IS REQUIRED FOR SHORT-TERM RENTALS PER BUII..DING CODE
RENTAL CERTIFICATES EXPIRE ON DECEMBER 31ST OF EACH YEAR
MAIL OR DROP OFF CHECKTO THE YARMOUTH HEALTH DEPARTMENT: 1146 ROUIE 28, SOUTH YARMOUTH, MA 02664
TO REGISTER ONLINE AND PAYVIA CREDIT CARD, VISTTTHE TOWN OF YARMOUTH HEALTH DEPARTMENT WEBSI'TE:
httpsil/s& ryJarmeqth.ma,us/1 2TlHeallh
owNER tN|T|ALS _
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DUPLEVMULTI.FAMILY RENTALS. REFUSE DISPOSAL RESPONSIBILITY
ln accordance with 105 CMR 410.560, and excopt es providsd in 105 CMR 410.560(Cl (tor BULK itoms) , the ownor of any residence
containingtIrc or more drrclunguniE, a rooming hou3€, homoloss sheltor, or manufactured housing communtty, shall bs
r6pon3iblo for and pay for the finat coll,oction and ultim.te disposal of rgfu3€.
I, THE OWNER, CERTIFY THAT MY RENTAL PROPERry, WHICH CONTAINS TWO OR MORE DWELLING UNITS, IS IN COMPLIANCE
wTH MA STATE SANTTARY COOE 105 CMR 410.550 (C) AND 105 CMR 410.560 (4)(E).
OWNER INITIALS
RENTAL IIIFORMAflON
INCOMPLETE FORMS WTTHOUTAVALID PHONE # OR EMAILWlLL NOT BE PROCESSED
RENTAL PROPERTY ADDRESSZ)> *o.r-r=- AV 5.sr -t ^
L(o"..r^.r."t^ ) \W!+ OLLeLa\
PROPERry OWNER NAME
Jcx^."^ {r-( fl't1t,^le b ij-n1-fnLuJ &i"-q t*.,^t^
PROPERry OWNER MAILING ADDRESS? a'>- Ao-r^-1<- .r:-6,1--fl-t q e,-"-"r,t i,S& \nAA OLQa\
PROPERryOWNER PHONE #
REQUTRED fuV +t O.- t-tSK<ALTERNATIVE PHONE #
IF APPLICA,BLE
PROPERry OWNER EMAIL ADDRESS
REQUIRED
OWNER'S REPRESENTATIVE/RENTAL AGENT
tFAppLtcABLE 6O_n&..- l_L\a<+
sDr< - a+q"- Br(oL{[c-u\ sb< "lua^ qsKs [c.rn^*,t1
REPRESENTATIVE PHONE #
REQUIRED
3cnAzz-6,fft-e-x h{ta - Ur, i ^J Co-rv\REPRESENTATIVE EI'4AIL ADDRESS
REQUIRED
$g,rn-rrr"r*R-RouND trsHoRr-rERM/*EEKLy
RENTAL PERIOD:
PAID PICK-UP TRASH COMPANY NAME
(owruen DTENANT
trHousE trDUpLEX trcoNDo (eennruerr onoon
NUMBER oF uNrrs FoR RENT: 3t1
RENTAL OF:
I hereby acknowtedge that I have thoroughty reviewed and am futlyfamitiar with the fotLowing reguLations:
Town ofYarmouth Chapter 108 - Rsntal Housing Byl€w, Town of Yarmouth Chapter 104-Anti-Noise Bytaw, Town of Yarmouth
Short-Term Rontal Bylaw (if appticabte), Massachusetts State Sanitary Code, Chaptar ll - Minimum Standards ot Fitness for Human
Habitation
These documents are avaitabte for reference on the officiat Town of Yarmouth website and may aLso be obtained upon request from the
Yarmouth Heatth Department. Furthermore, I understand that I am required to notifythe Heatth Department in writingwhen I cease
renting the property. Faiture to do so may resutt in the imposition of fines and/or fees.
QUESTIONS: Phone #: 508-398-2231 Ex. 1240, EmaiL rniecterberger@yarmoulh.ma_us
APPLICANT SIGNATURE DATE 4>rlztt
TRASH REMOVAL BY:
ACKNOWLEDGMENT STATEMENT
Unit Unit Type
L23 Studio
125 Studio
75?Studio
161 1. BR
233 Studio
243 Stud io
253 Stud io
101 1.8 R
702 1-BR
103 Studio
104 Studio
105 Studio
106 Studio
707 Studio
108 Studio
109 Studio
110 Studio
111 Studio
L72 Studio
113 Stud io
tL4 5tud io
115 Stud io
116
Studio
118 1-B R
t20
L22 Studio
L27 Studio
L29
Studio
132
133 Studio
t34 Studio
135 Studio
136
737 Studio
138 Studio
139
140 Studio
r4l Studio
r42
143 studio
1-44 Stud io
1-BR
148 1. BR
149 Studio
1.8 R
L77
Studio
Studio
131
Studio
Studio
Studio
Studio
L47
150 Studio
151
L54
156 Studio
207 St ud io
202 1-BR
203 Studio
204 Studio
206 Studio
208 Studio
209 Studio
7L0 Studio
277 Studio
2t2 Stud io
2t3 Studio
214 Studio
215 Studio
2t6 Studio
277 1-BR
278 Studio
220 1- BR
222 Studio
224 Studio
226 Studio
227 1-BR
Stu d io
237 Studio
235 Studio
Studio
239 1-BR
240 Stud io
24L Studio
245 Stud io
246 Studio
249 1-B R
252
255 Studio
257 Studio
259 1-BR
264 1-BR
Studio
Studio
228
Studio