HomeMy WebLinkAboutApp# 18-E081 0
TOWN OF YARMOUTH IP' Ro
;h. x 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 i
r Itx
Telephone (508)398-2231 Ext. 1292—Fax (508)398-0836 f AUG aro r
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITS K!^''r`Sf# 9i1lAAPr'
APPLICATION FOR
CERTIFICATE OF EXEMPTION
Application is hereby made for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of
Acts of 1973, as amended, for the proposed work as described below and on plans, drawings, or photographs
accompanying this application.
Type or print legibly: 11
Address of proposed work: T 7'J Wn i4.e. eacrk "R(), ytc>r'r►lesil4 c2orf , M4 Map/Lot#
Owner(s): KthyN� /i.SU I II v Phone#: 17�( -a(x-6)6 5
All applications ust be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: 2'7 Ur 14/k;-4 c Rock Rd YArmav rem 0;6. 7 S Year built: (4
Email: Preferred notification method: Phone Email
Agent/Contractor: T�LJc l�c��ri n Phone#: 50$r 3C a-So)3 •
Mailing Address: 3-' 9 x�)G�hro%�, s t A l 4 a.,.,.5 NV% 0)6O
Email: Preferred notification method: N, Phone Email
Description of Proposed Work(Additional pages may be attached if necessary):
C-\"C^--14`5- e C¢l0-s pc evw.( hcJ°ie f,-ccvh �.ea.c1 (1.rcky ;coy,-�
9 V'S C')5-G. +ter) ,, RECEIVED
AUG 13 2018
TOWN CLERK
SOUTH YARMOUTH, MIA'.
Signed (Owner or agent): Date: 1 1.Q�
Ifir
> Owner/contractor/agent is aware thataprmit may be required from the Building Department.(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: Sl--/p� Approved Approved with changes Denied
Amount JO Reason for denial:
K#: C
Rcvd by: AI/
Date Signed: g//3 my�j/5- Signed:i)� ✓ %' o
/ APPLICATION#� Cl �. j� 8
V5.2017
238-C3
8^ 658 r D n 1 Gray SW Cl7ouds
fib _ O8 '
ID-55Z