HomeMy WebLinkAbout18-E087 • q� V
TOWN OF YARMOUTH
RECEIVED
1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836 AUG 2 3 2018
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE YHKIVIUUjH
OLD KING'S HIGHWAY
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: nd ,/ ,p (� 1
Address of proposed work: oire Urn/1A K . 1`R.rnuc9h 1,(t Map/Lot# ?9//3•e oZ
Owner(s): 1 r hfj,((IrGA l-w\n( cu- Phone#: 114-C1gc{-W1o5
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: P.O.('o,c 'AA Ptr> k)Skcc My1 O&(0-1,1 Year built '7mn-triR
Email: G3\ oic-p o.vick liCtlinn.C,OWN 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):
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WOO id (tka. h-o pvb a 3aP4 Rasp - in `l-?u nuddlc, J rru-[ C,„„,1- Lerce•
1 m atten Q - 0 334 pots. be cant.- a- 2S P- I +o low C./ r CU-c c( 6
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Signed(Owner or agent): �� Date: S-23-2018
> Owner/contractor/agent Is aware that a permit 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: ke -%c v/Approved _Approved with changes _Denied
Amount SO Reason for denial: —'
I< CAS1-4 RECEIVED APPROVED
Rcvd by: 61/ 41‘.11-0 2 4 2018 AUG 2 4. 2018
YARMOUTH
SOU H YARL GUIH, MA
OLD KING'S HIGHWAY
Date Signed: 7I<,1/4d(8.--* G Signed: j 6
APPLICATION#: /BSG pQf7
V52017
na5v,36. Can , OLD AUGKING2'S 3 2018HIGHWAY
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302.72'
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a LOT 6
` I 41.328 SF
`'\_ 0.95 AC.±
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FOUNDATION PLOT PLAN DCE #16-273
PREPARED EXCLUSIVELY FOR THE PURPOSE OF OBTAINING A BUILDING PERMIT, NOT FOR ANY OTHER USE
LOCATION : #94 OLD ITYANNIS ROAD YARMOUTHPORT,MA
SCALE : 1” = 40' DATE : 8-21-18 PREPARED FOR:
REFERENCE : MAP 94 PARCEL 13.62 DUBLIN CONSTRUCTION
DB 29059 PG 87
I HEREBY CERTIFY THAT THE STRUCTURE RECEIVED �4p�,�NOFMAssgcy'.
SHOWN ON THIS PLAN IS LOCATED ON THE
GROUND AS SHOWN HEREON. AUG 24 2018 m
�o DANIEL A.
Itoff 50e-382-4541 : u OJALA N
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MA 02675 DATE REG. LAND SURVEYOR
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