HomeMy WebLinkAboutBLD-93-845 ..6i•Yiiii. Crit/4193
o • TOWN OF YARMOUTH oKFeld ph yii,'
? MATTAEMEES 41 �N
e6ak1°T, Application for a Permit to Build No. C
UPON FINAL APPROVAL V� 1O- Me MAP /a 3 L le- I
FEE MUST ACCOMPANY THIS APPLICATION. DATE /019) 19 93
The undersigned hereby applies for a permit to build /a��9'�q 3
according to the following specifications /
1. Name of property owner XM aro C�.eely&G,• Tel.
N Address /-W &A',.04/ Sr i'vnn v ry4ner /1w S.)$Z
2.Name ofArchitect(if any) Tel.
" a Name of builder L SII Z itekit/C Address 30C, (-rci)CGCPO /144()
4. License No. #*;:rt Tel. 7970-1 VlSR
5. Name of Mason Address
6. License No. Tel.
N7. Construction address 01 Zoti/ vv Sr AH.C/2-your,v,ner iI
FloodDistrict e_ a/O
8. Date of subdivision Approval plain zone a Zone T
9. Private dwelling CV" Estimated Cost DO NOT WRITE IN THIS SPACE
Type of room No.
10. Multi family ❑ N 4 ,4,0,0 59-n{P- e€ltOaF ili-ti , e /
11. Commercial 0 �z -,,,...,04 PE-Pat- vifrArldCavz Kitchen
12. Other 0 w;/renjiff cat-. sic Dining Rm.
0� �O•`'F Living Rm.
13. No. of stories /97 —
14. Foundation — Full 0 Half Crawl 10 Slab'0111-1 ' Li ________35� o , Bed Rm.
/ io D E�� Bath
15. Materials — Wood fr(ement 0 Other 0 Z Deck
16.Type of heat — Oil 0 Gas 0 Electric 0 Other Closed porch
Family Rm.
17. Garage — 1 ❑ Sun room
18. Swimming pool - Size , Garaged/p031,9 /
19. Storage shed = Size Shed
20. Stove — Wood 0 Coal 0 Alterations
21. Size of lot: No.of feet front NoJof feet rear No.of feet deep
' 22. Size of building. No. of feet front i, No. of feet side No.of feet rear
1 23. Distance from nearest building: Front Ft.side Ft. side Rear
24. Distance back from line or street From rear lot line Side line
25. H.I.C.R. No. / i / `rc /
LOT RELEASED BY \ Signature X-ti �o t
PLANNING BOARD Address / /dui•
s Date \ qe,.,T.-x44,1,7- Vhc ea-673-
i
/0-f 95 o
•
BUILDING
PERMIT' APPLICATION SIGN OFF - /
PLICANT: (,9,a•L_ / -AJ4,�,er," C /'BUILDING PERMIT 1/: a-/C/�
DRESS: LJ at/m/1/ Srze r TELE. NO. -' � DATE FILED: /O. e
tptDCSITE LOCATION: 5 7,ti MAP/l: /D-3 LOU:
THE FOLLOWING INFORMATION OUTLINES THE PROCEDURAL STEPS REQUIRED TO OBTAIN A PERMIT TO BUILD,
ALTER, OR ADD TO A STRUCTURE WITHIN..THE TOWN OF YARMOUTH. THE BUILDING DEPARTMENT WILL DETER-
MINE COMPLIANCE TO THE FOLLOWING (A) ZONING REQUIREMENTS (B) HISTORICAL DISTRICTS (C) FLOOD
• PLAINS ZONING. THE BUILDING DEPARTMENT WILL BE RESPONSIBLE FOR ASSISTING THE APPLICANT THOUGH
THE FOLLOWING DEPARTMENTS:
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT: DETERMINES COMPLIANCE OF WATER AVAILABILITY.
ENGINEERING DEPARTMENT: DETERMINES COMPLIANCE FOR PARKING AND DRAINAGE.
CONSERVATION COMMISSION: DETERMINES COMPLIANCE TO WETLANDS ACTS, I.E. : IF LOT(S) BORDER ANY
TYPE OF WETLANDS, STREAMS, PONDS, RIVERS, OCEANS, BOGS, BAYS, MARSH
.LAND, ETC:
HEALTH DEPARTMENT: DETERMINES COMPLIANCE TO STATE AND TOWN REGULATIONS, I.E. : REQUIRE-
; MENTS FOR SEPTAGE DISPOSAL AND OTHER PUBLIC HEALTH ACTIVITIES.
FIRE DEPARTMENT: DETERMINES COMPLIANCE TO STATE AND TOWN REQUIREMENTS FOR PERSONAL
SAFETY, PROPERTY PROTECTION, I.E., SMOKE DETECTORS, SPRINKLER SYSTEMS,
ETC.
THE FOLLOWING DEPARTMENTS MUST SIGN OFF, IN THE RESPECTIVE ORDER, PRIOR TO BUILDING INSPECTOR
ISSUING THE REQUIRED BUILDING PERMIT:
REVI BY: -
WATER DEPARTMENT 1, %` 4DATE: 16 \ . IS N/A: •
2. ENGINEERING DEPAR DATE: N/A:
3. ONSERVATION: a DATE: N/A:
UK-HEALTH DEPARTMENT alitgarallir DATE: Kik: /Q ? N/A: '
INDUST', AND/OR COMMERCIAL PERMITS
5. WIRING INSPECTOR: DATE: N/A:
6. PLUMBING INSPECTOR: DATE: N/A:
7. FIRE DEPARTMENT: DATE: N/A:
PLEASE NOTE
ALL STUMPS AND/OR BRUSH MUST BE DISPOSED OF AT AN APPROVED SITE. A SIGNED RECEIPT FROM THE 4y
DISPOSAL SITE MUST BE SUBMITTED TO THE BUILDING DEPARTMENT PRIOR TO ISSUANCE OF THE BUILDING
PERMIT.
COMMENTS:
,fjaMG, Use 4 x g R LICE .?a,+�� //1
•
•
BLM/89
TOWN OF YARMOUTH
BUILDING DEPARTMENT
• HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE /929-7-&JOB LOCATION a/V/e5A/ Sc Adl2ieV/j/,/,Vi
BER STREET ADD ESS/ SECTIIONN OF TOWN
"HOMEOWNER" � l//Veri9 /�e` i _ &C-2-4541
NAME HOMEPHONE WORK PHONE
PRESENT MAILING� ADDRESS /�J 4y)//�N/ Sr.
/1e-Z77wrw%Ar
CITY OR TOWN TATE ZIP COD
THE CURRENT EXEMPTION FOR "HOMEOWNER" WAS EXTENDED TO INCLUDE OWNER-
OCCUPIED DWELLINGS OF ONE OR TWO UNITS AND TO ALLOW SUCH HOMEOWNERS TO
ENGAGE AN INDIVIDUAL FOR HIRE WHO DOES NOT POSSESS A LICENSE, PROVIDED
THAT SUCH HOMEOWNER SHALL ACT AS SUPERVISOR. (STATE BUILDING CODE SEC-
109. 1.1)
DEFINITION OF HOMEOWNER:
PERSON( S) WHO OWNS A PARCEL OF LAND ON WHICH HE/SHE RESIDES OR INTENDS TO
RESIDE, ON WHICH THERE IS, OR IS INTENDED TO BE, A ONE OR TWO FAMILY
ATTACHED OR DETACHED-STRUCTURES ASSESSORY TO SUCH USE AND/OR FARM
STRUCTURES; A. PERSON WHO CONSTRUCTS MORE THAN ONE HOME IN A TWO-YEAR
PERIOD SHALL NOT BE- CONSIDERED A •HOMEOWNER, SUCH "HOMEOWNER" SHALL SUBMIT
TO,THE BUILDING OFFICIAL, ON A FORM ACCEPTABLE TO THE BUILDING OFFICIAL,
THAT:lIC/SHE SHALL BE••RESPONSIBLE FOR ALL SUCH WORK PERFORMED UNDER THE
BUILDING"PERMIT. ' (SECTION 109.1.1)
THE' UNDERSIGNED "HOMEOWNER" ASSUMES RESPONSIBILITY FOR COMPLIANCE WITH THE
STATP.BUILDING',CODE,AND-OTHER APPLICABLE CODES, BY-LAWS, RULES AND REGU-
LATIONS: ' 1 ' L' .
THE.UNDERSIGNED "HOMEOWNER" CERTIFIES THAT HE/SHE UNDERSTANDS THE TOWN OF
YARMOUTH BUILDING DEPARTMENT MINIMUM INSPECTION PROCEDURES AND REQUIRE-
MENTS AND THAT HE/SHE WI L COMPLY W TH SAID PROCE RES 1ND REQUIREMENTS.
HOMEOWNER'S SIGNATURE ` X/�J
APPROVAL OF BUILDING OFFICIAL
•
INSURANCE COVERAGE:
I have aYusrr n liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
No
If you have checked yes, please Indicate the type coverage by checking the appropriate box •
A liability Insurance policy 0 Other type of Indemnity 0 Bond 0
OWNER'S INSURANCE•WAWER:•J am aware that the licensee does not have the insurance coverage required by
• Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner 0 Agent 0
Signature of Omer or Owner s Agent
•
•
c
=t • COMMONWEALTH OF MASSACHUSETTS12.2 rr . .
•
. DEPARTMENT OF INDUSTRIAL ACCIDENtS
a=41' 600 WASHINGTON STREET
JamesCampbell BOSTON, MASSACHUSETTS 02111 •
rpmn:ss,oner WORKERS' COMPENSATION INSURANCE AFFIDAVIT •
•
I, c—,ri_ /e.--/t/.416-/W ( je L,.
(licensee/perminee)
• with a principal place of business/residence
%.P,/27eii..cw ter GQ'2675
(City/State/Zip)
do hereby certify, under the pains and penalties of perjury, that:
[ ) 1 am an employer providing the following workers' compensation coverage for my employees working on this
job.
•
•
Insurance Company Policy Number
( ) I am a sole proprietor and have no one working for me.
•
( J I am a sole proprietor ; neral contractor dr homeown circle one) and have hired the contractors listed below
who have the following w. • rs' compensation 1 - ce policies: •r •. • • •
O',A 1/ f ' fae,9(JEGcaes. (Os4,(7ContractorssName of Insurance Companlicy Number .
•
3/L,9.roe- <
Name of Contractor - Insurance Company/Policy Number ..
Name of Contractor • Insurance Company/Policy Number
0 I am a homeowner performing all the work myself.
NOTE _Please be aware that while homeowners who employ persons to do maintenance.construction or repair work on a
dwciiirt of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto are not generally
considered to be employers under the Workers' Compensation Act(GL C. 152.sect. 1(5)),application by a homeowner for a license
or permit may evidence the legal status of an employer under the'Workers' Compensation Act.
I understand that a copy of this statement will be forwarded to the Department of Industrial Accidents' Office of Insurance for coverage
verification and that failure to secure coverace as rcauired under Section 25A'of MGL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to 51500.00 and/or imprisonment of up to one year and dw penalties in the form of a Stop Work Order and a
fine of 5100.00 a day against mc. /�
�Siened this _L /l/ r.��� I �„t� day of Or. , 19 f.'-�
i-.._. tor;Pcrrima
Suggested Affidavit for Home Improvement Contractor Permit Application
•
For Office Use Only NAME OF CITY/TOWN
Permit No.
Date
AFFIDAVIT
Home Improvement Contractor Law
• Supplement to Permit Application
MGL c.142A requires that the"reconstruction.alteration.renovation.repair,modernization.conversion,innrovement,removal,demolition.
orconstrvction of an addition to any preesisung owneroccuoied building containing at least one but not more than four dwelling units....or
to structures which are adjacent to such residence or building"be done by registered contractors,with certain exceptions,along with other
requirements.
•
Type of Work: AV 4QC,j am "ae- Zoo" E71v. 07,
st. Cost% ,
Address of Work �� G/Ai/nil/ Sr./l/eerjivirN�
T 5
Owner Name: /,eL ,ttAwer4/ Lj, -7cz
•
\ Date of Permit Application: OL.-y. /99&
I hereby certify that:
• Registration is not required for the following reason(s):
_Work excluded by law
Job under $1,000
Building not owner-occupied
Owner pulling own permit
_Other (specify)
Notice is hereby given that:
•
• OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
' • ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL
c. 142A.
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
OR: •
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property:
•
Dat / Owner Name
eco`
.0 - e ins eccion pin.,
-' ppluattt' Anti norrE location. of-property: So,1)Jurn:routt —
� , it t3
„ch.,/ ...
i
14•11alLOt 1
�-iowit o fIatb0iG09i5E
o � z
/_S�otwelLi °o
36't'
I
l at
• In
IN\
• 1 1 '
\ - /05:00' .
• -Union Stf rEt
ref 4832/34 flood panW: 2500/5 000iD flood Bone: G , ;„of ��
A
5 hereby certi-ytactics mortgage inspection wcrs.prepared-for PAUL! sy
LCa T. y,
A.iT i coins \'r Sorgt Jr I u GOVER ,,,
O'Ct/s� Ho 31711
t3he welting shown, hereon,does not f"alt in.a, special Ta k-Rood. .. ,ce,S,e�yoa.;f
hazard' arta with an, effective date of 7-2-92 and. mite location, oP st,INE -
the dwelling o es confonn Ito -tire local zoning 6y-laws huffed), .i 7 • --
at-the the of construction with, respect-to horizontal dimensional Scale: 1" 30
setback. regru.irentents or is extmprfrom. violation ertf'oreetnertx' Date: 3-25.93
action, under Mass. General laws Charter-to A.-Seen-on. 7. File No.j/4393_
PLEASE NOTE. the structures as shown on this plot plan are approximate only. An nil survey is necessary for a precise
determination of the building location and encroachments, if any exist. either way across property lines This plan must not he
used for recording purposes or for use in preparing deed descriptions and must not be used for variance or building plan
purposes. This plan must not be-used to locate property lines Verification of building fixations. property line dimensions, fences
or lot configuration can only he accomplished by an accurate instrument survey which may reflect different information than what
is ahhwn hereon Please note that this is "NOT A BOUNDARY SURVEY" and is "FOR MORTGAGE PURPOSES ONLY".
I
COLONIAL LAND SURVEYING COMPANY, INC.
_ 269 Hanover Street • Hanover, Mass. 02339 • Phone: 617-826-7186 • Fax: 617-826-4823
•
Application to •
r „ t. ,;,,.• Old King s Highway Regional Historic District Commit
• , , . in the Town of Yarmouth fora = 9tee
._ 3 13 3 .
,fr CERTIFICATE OF APPROPRIATENESS
• .-
Application is hereby made in tri plicate,for the Issuance of a Certificate of Appropriateness under Section 6 of Chapter 470..-.
Acts and Resolves of Massachusetts,1973,for proposed work as described below and on plans,drayrings or photographs _ .
accompanying this application for-s..T (...,',4 , . c
Zo
• '' •'---=01;/`"a CHECK CATEGORIES THAT APPLY: r. _ PI- _fl
1.Exterior Building Construction[ ❑New Building IltidditiOn. III-Alteration - - .10 •ya
(•j' -. }
Indicatetype of building:❑Hoise" Edarage ❑Commercial ❑Other - '--S' • S
\"771
2. Exterior Painting: ❑ "-'3>
3.Signs or Billboards:❑New sign- ❑Existing sign ❑Repainting existing sign rAu •,' • IT) .•
4.Structure: ❑Fence ❑WaliFlagpole ❑Other v
'❑ FS G
. ., (Please read other side for explanation and requirements). - '1'4.
. g
TYPE OR PRINT LEGIBLY DATE F�� • 2 / 3
ADDRESS OF P OPOSED WORKe � ea JTx:=T ASSESSORS MAP NO. 1/4)3
OWNER !--1/e- LeT7r // • ASSESSORS LOT NO. ' '/
HOME ADDRESS IW 6/V2d c/ 3 • • TEL NO. -5/12' 41- 7J
FULL NAMES AND ADDRESSES OF ABUTTING OWNERS.Include name of adjacent property owners across any public
street or way,(Attach additional sheet if necessary). /�”" • -
r. AN C 7G9/L / 4WD�1J�'• /*Ate =
2!////!? /gee 4027�/.vynN S. fir7,0.e,
/0,94 5-C'ld - ,5 4. 9 fol✓ Zif//a-y.
,t ✓ /712ete -- - - .
AGENT OR CONTR CTOR F //T''r« TEL.NO. 7� - /✓~�
ADDRESS 'Q. ,sc 5°2 .al.-i!�'•`,19,�%$ zeo2.6bg'
•
DETAILED DESCRIPTION OF PROPOSED WORK:Give all particulars of work to be done(see No.8,other side),including
materials to be used,if specifications do not accompany plans. In the case of signs,give locations of ting signs and
proposed locations of new signs.(Attach additional sheet,if necessary). foo h IIPPROVEDt2-`--
T -"7.46. l ''r .77e. Sr7N4 g as •. MOUTH COMMITTEE
• RD
.. �e9/2%Jtt'/ ..e. 40 / Signed at-Vi %,
Owner-Contrac •r-Agent - •
soar*below lint for Committee use. - '" — - , ., -4 .
Received by H.D.C. APPROVED AS AMENDED ON PLANS—M2 ROOF PITCH • • RAG ADDITION.
Date Ill� ertl Ie1 ate is hereby ,Tr
.+''1 e r/j . /.1�•-- Da''te �,
'
',v./ /';
Time I?&D / ../ �J /� -T . i/ ? ,/'
By ee 4/.% /,.-'n.• / ) .1? : -
-:•:%ei: 0 IMPORTANT: If Certificate is approved,approval is subject to the 10 day appeal period '
• proviced in the Act.
_•sa::rovec 0 Please return to: Yarmouth Historic District Committee
Town Hall. 1146 Ht.28.South Yarmouth, Mass.02664
�,� �R. {t ADDITIONAL INFORMATION FOR MAKING AND FILING AN APPLICATION ,
ye ..•y ` O� .. . . . _, FOR A CERTIFICATE OF APPROPRIATENESS
.. . ,• .
The four categories for which a Certificate of Appropriateness is required are: (application for demolition or removal is a
separate form). = - • • < -
1. EXTERIOR BUILDING CONSTRUCTION (new or existing,,buiildings): An;applica-}ion�s�e`q�ired for any exterior of a
building to be erected or altered including windows,doors.siding.roof,light etc.,that will bay Bible from any public street,
way or public place.The following scale drawings are required In duplicatejithgppGcatiom.two plot plans(if addition-show
existing buildings in outline),four sets of elevations.Also required are snap shots of existing buildings,where additions or
alterations are to be made.No plot plan is required for addition or alteration which does not touch the ground.
2.EXTERIOR PAINTING:Anapplication isrequired for any portion ofabuildingi,{tructureor igntobepaintedthatisvisible
from a public street,way or public place.Color samples must be attached to these appl.calions,A i application is not required
when repainting existing colors,changing to white,or using colors approved by the Town I4Thtoric District Committee.
3.SIGNS OR BILLBOARDS:An application is required for any sign or billboard to be erected within the District,with the
following exceptions: •t • .;•:\.-
t
a. Existing signs or billboards on November 27,.1974 shall have until Novem a .--,.n1'
Certificate of Appropriateness. 'T:.. . "s‘.‘,y ,)�-- �-t0- n�approved
b. Temporary signs for use in connection with any official celebration orparradeor nycharitabledriveaslongasthey
are removed within three days of the event.Certain temporary signs that theCommitte feels eelsdoesnotdetractfrom
the Act may be allowed with the prior permission of the Committee. •
e. Real Estate signs of not more than 3 square feet in area advertising the sale or rental of the premises on which they
are erected or displayed.
d-. A single sign of not more than 1 square foot in area showing the name,occupation or address of the occupant of the
premises on which they are erected or displayed in a residential zone. -
4.STRUCTURE:An application is required to build or alter any structure'within the District which is defined by the Act as a
combination of materials other than a building,sign or billboard,but including stone walls,flagpoles,hedges,gates,fences. -
etc. .
1
- GENERAL REQUIREMENTS C.\ •\
5.Work on projects requiring approval shall not be started until the Certificate of Appropriateness has been filed with the
.. Town Clerk by the Committee.Approval Is subject to the 10 day appeal period provided in the Act.
. 6.No changes shall be made from the original approved specifications without advance approval of the Commission on an
amended application filed with the Committee. �
- . . ^.k. �;• �i N , .• -t z.• • :•::� ..�\. Th.- ••-• .��
7.A separate application must be filed with each project requiring a Certificat of
•
y
6. Under heading of "Detailed Description of'Proposed Work" give detailed data on such architectural features as:
foundation,chimney,siding,roofing,roof pitch,sash and doors,window and door frames,trim,gutters-leaders,roofing and
pant color. - •
9.Unless application is complete and legible and all material required is supplied,application will not be accepted or acted
upon.
Copies of the Act establishing the Regional Historic District may be obtained at the Town Hall.
• Yarmouth Old King' s Highway Committee
SPECIFICATION SHEET 3o 3
• • (Submit 3 copies) _`
APPLICANT. (OWNER) : &,e2.--/'(rz21 �iC- ‘02/
FOUNDATION (18" max. exp.),�5:_I CONCRETE/OTHER
Vg-II-TING TYPE: 11/ xpG1 � 1� � • COLOR: 7e /t1
_49/J449.e.6 To /7794 asci iCJ4 ae- A4
CHIMNEY (indicate brick/stucco/woodfaced)�
ROOF MATERIAL:= �' PITCH: 7/11C4 COLOR:�//TL 64-er
--2-.5"5",— d�A „ (7/12 minimum) earez1v-
WINDOWS (grilles�re/q/uuired) --Indicate sizes if not listed on elevations:
/
- DOORS: vaN - , SIZE: . COLOR:
TRIM: (all windows & doors trimmed 1x4/1x5)ra lent/ COLOR:
SHUTTERS (wood/vinyl) : • COLOR:
GUTTERS (wood/aluminum) : SV #/TS Selene-esS ,94 e?"2 . CALOR: `'N/fr
GARAGE DOORS: IZ) ug/iy SIZE: (iLOR:Wa
2 LSfn. 5 door 2c
�7m . ..
STORM WINDOWS & DOORS: SIZE: C R: i t X
-1IT3 yv '.t �� n:
SKYLIGHTS (FLAT ONLY) TYPE/SIZE: CPR: ?,
(7L'
L3 C7
• t�"X
T1114
DECK:' , SIZE: COLOR:
FENCING (max. ht. 6 ' ) : STYLE: l LO
(show layout & running footage on site plan) (o bpPR�CDMt.;SZEE
YpRMBup NFA
ADDITIONAL INFORMATION:
NOTES: Color chips required. Outdoor lighting, electric meter and
landscaping--show on site plan for new houses only.
rev. 6/93
,Sigiet9 - 3 ?,13
�� neo` .
sz„,e_vemovice. : . -,------- ------------------------------ ----------------------:_
,.„ R Gam- ✓ e ins ecttof p1an7
•
• splicanTETAIthworr.e location, of .property: So,jarurou —
. I tori
/--
106,C81 -
f • I
elf ,1,0t 1
rU
G �f 'YA=10,609+ 5f.Satmou% o NO. /28 .WZ2
0 � • 0
/'StoryGAwe A.
o
4 rat 36'} •
IS;,
IM
if I
.. /acoo' -
•
/
ZU2lOt2 s'c zcet
.
•
:_ .
. • : . =.5.
( g' r�
> re ).....d 44
r�w •
A�b I APPROVED
• 47....4 MOUT"COMMI
fes. pz °KIND £f
J..;
.
•
.:I..:. . ,'Applicatiori to, , t.
P'P OLP S4 P ;: '''''gr.,'
lr r.
C'�; °Pk °111? Old Kings-Highway Regional Historic District Committee �
f ' .
in the Town of Yarmouth"fora . r:.
' CERTIFICATION OF EXEMPTION • ,
Application Is hereby made, in triplicate, for the issuance of a certificate of exemption under Section 6 and 7 of Chapter 470,
Acts and Resolves of Massachusetts, 1973, as amended for proposed work as described below and on plans, drawings, or photo-
graphs accompanying this application. IC:
•
TYPE OR PRINT LEGIBLY DATE Jt 2°/'7. 0_ /9q---5 •
ADDRESS OF PR POSED WORK ' ' / c'V, ,t/ c.J�' T— ASSESSORS MAP NO. /03
OWNER �L-7C_AJ ASSESSORS LOT NO. R
•
HOME ADDRESS' ,/1 A/M/l/' 'c-- r-, c- TEL. NO. ' d/ ' .00-- ' do /,
AGENT OR CONTRACTOR 6-tic ��' " �I r�e��� • • •• ' ' - "(sed)
ADDRESS - •d' •J01C ctL2 2/ • 4F/fit")-S.
•. ' ' TEL. NO. '- "1 O - 244/g(sed
This application is fo exemption of proposed exterior construction on the ground that: ' . '
❑ (1) It will not be visible from any way or public place. - .
(21 It is within a category declared entitled to exemption by Old Kings Highway Regional Historic District Commission." -
(Check applicable box) • ,
PROPOSED WORK: Describe and furnish plait of proposed work, showing location on lot, and, if an addition is involved, show-
ing location of existing building.
. Zer SeN/2414/. . 4, . , e„,z..„ .de...O„.__ 72., ..• .,
_ .
... _
‘ .
/k%N�T"� � 6/ed.,— ( a,40 i �ai� . :
ta
. .1/4 . ,,,c . . . \....... - . . .‘ fielf - • .
YARM.t.
DUTH COMMI TEf E
o • b offj.. .• ... . WIRD
iui ts
•
• . .•
. . SIGNED _ : Al i .. . .
/ j / .
Space below line for Committee use. Owner•Con[raci• /
Received by H.D.C. . The Cert ica • 'a:,ereb• — � / _ e' / Haire/� .
Date lir=art arfel� �i✓��. � 1 ///�
Time �� ff On.' IL' /
•
Approved 0 The categories of work entitled to exemp ift:are listed on
Disapproved 0 • the back of this form.
•
-,:fu e" AOS
•
' 'x'n
44
g . .
. •« .-
Te.
I/4 . .
'::.:,•:' :W.
•
'•I Fh
/
of,. WilikS so* '`..4.. '
/ - - - - -- vV\' -. -- - --- -- - - . :i __/. 4_t"` .%F. ,• •../''.' s.
•
•
BOO c ....0°....±^ ''' i 2 .% •••••
c.../.....
O a III •... t.'...'g 3' i f l /';i`C
iv
/I/ .. •-•-. '•ti; • I T~ :. #`'.' /I� TOWN
e. '` /
�.00 II / A •
-"1
/I it . �/�t �' ��
.0- _J
Doer'. • I/ TOWN 01 YS 114041r WATER DEPT. •.i W,.01111 WATTS DEM
It Te ..,•$'
` , ,..7..
.
i
..•:•••••%.--•"'
'��`
Ai 1120 • O4' SA �.. i�i. �' , ''; .,i,
o -.
en ''F ;.
ra-, F�
•
121 itV . I.N 1111 •
11
— �' •
D
CD
0 As r4 .,.., ...hn t�4 t"�NO "IO% rl{ �y fQP�� r 6`1' QP�� ET 1•�
ROAD
cQ� "1 r
v .' a.
w m rn /\� • fiy•, h
\Jzs 1 0
O� Qa • O� .fir ee O �2h eN
I p p �a no 0.
meg; ( / �ay1 .. ,�P • '~ s:, �4' ..
Q • ' i
.ti FR Q�R�� 1 eq ,. ,.
_eiew C q.H Q Q ••• -70 .
MTh
• `fit ° �' tw . aE f1
�, � Q era 1' :<., u
NCR S - 4rat WOi ,._ I ix
a4a000
• ;• ', �"*"'�,FISCAL YEAR 19921•^ •
DATE MAP MADE 8-26-76 94 MASS; COORD.SYSTcM D t-;MAS$'WORD:SYSTEM.** .
_,,.. • . . • • 206 • 0
i,.:. :,:
to