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HomeMy WebLinkAboutApp# 18-E084 1 .r• oF.ygQ
r: = TOWN OF YARMOUTH
1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
Telephone(508)398-2231 Ext. 1292-Fax(508) 398-0836
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMaittEIVE
• APPLICATION FOR AUG 2 0 2018
CERTIFICATE OF EXEMPTION
YARMOUT
Application is hereby made for the issuance of a Certificate of Exemption under Sections 6 a dQL6flalVagf$ry V9fAY
Acts of 1973, as amended, for the proposed work as described below and on plans, drawingsr', opho-togra
accompanying this application.
Type or print legibly: �-,�
f
Address of proposed work: .R.5-C Porn 1 r" � n Map/Lot#
Owner(s): (U(-P -- C-.rok 1l )1 r(Ser Phone#: 717-7n 1- 7 (
All applications must be submitted by owner or accompanied by letter from owner/ approving submittal of application.
Mailing address: 167 / Lane_ li444- T A 71`73 Year built:
Email: c1704-'3 5-3 (, rorty- ,nek Preferred notification method: Phone Email
Agent/Contractor: Phone#:
Mailing Address:
Email: Preferred notification method: Phone Email
Description of Proposed Work(Additional pages may be attached if necessary):
n 11 7,42A Pt nc or Shed . APPROVE,
Ana 20 ZQ13OC2
�r&u ousl1 cieco.1ed dor w la- 6kratni). St.td was no-t- : ,slulle�. )(" ( allg j(}
c71fID,f ttV�S tfffff G YV
Signed(Owner or agent): Date: 6 70 '1 d
> Owner/contractor/agent is aware that a permit may be required from the Building DepanYnent(Check other departments,also.)
> This certificate is good for one year from approval date or upon date of expiration of Building Permit whichever date shall be later.
For Committee use only:
Date: 2 -11) Approved _Approved with changes _Denied
Amount ao Reason for denial: R1=CE11/1"L D
Cash/CK#: (o357 AUG 2
Rcvd by: Si/ i 2018
TOWN CLERK
SnUTlI :;` H, MA
Date Signed: Signed: „..4L.4.,5: APPLICATION#1 O [ 0 0-4
V5.2017
•
O Front Elevation © Left Elevation PINE HARBOR
OOD PRODUCTS
SCALE I/71':I-Q' SCALE I/4•=r-0•• PINDIARBOR 1-800160.5NODM
259 Quote Anne Road
AIwYICA,MA 02645
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PROJECT:
} 4'-0' 1 i--8,-0' i 8' x 14' Quvett Cape
CLIENT:
Bruce Burger
ADDRESS:
85 Pompano Road
© Rear Elevation © Right Elevation Varmouthport MA 02675
SCALE 1/4'=I'-0' Seel E 1/4.=r-0'
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PHONE:
717-940-7947
{ n E-MAIL:
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ial' PMAnwod (ri '-� ADDRESS OF PROPOSED WORK:
C) C �q 85 Pompano Road
• � , '� Iy N �.�/l Vormouthpor[.MA 02675
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_, { REVISION DATE:
8/16/18
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