HomeMy WebLinkAboutApp# 18-E089 -
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"4 y1it}a +r.te TOWN •OF� YARMOUTH
eA -$ 1146 ROUTE 28, SOUTH YARMOUTH, MA 026644451
Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836 IR- EC
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REC(9y 5ING'S HIGHWAY HISTORIC DISTRICT COMMI EEAUG 2 7 2018
• APPLICATION FOR YAKMUU i ti
AUG ?_ G 2018 OLD KING'S HIGHWAY
CERTIFICATE OF EXEMPTION
SO(1THTOy N CLERK
Application Is h @Ky4)TA4eifgr 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:
Address ofproposed
�work: 4'! r 14Q' ONZS
T/J /Ze Map/Lot I . $
V /O
Owner(s): N /C o 5 e Z l " Phone#:
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: Al/ NSW 71-10 2 2.f Year built /917/
Email: Preferred notification method: 4—Pfione Email
Agent/Contractor: OW•4110 u/,4ell P&YE4692 Phone#: 5-0e-6a- 64/17-/
Mailing Address: c )7 E/L 49A.)ST* y/y ten 1114 eZGx
Email: D I /-I f Lv!Z (DS r9} ,yt5n7. eerkPreferred notification method: i Phone Email
Description of Proposed Work(Additional pages may be attached If necessary):
/4_' k /6 ' 64)31-e STyL-e Eoorn o-v Exlcr, & 23Peie-
0o{••uG g %el, -/- %6o/ To /rinrc/1 C3(ts/iiic7G
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S✓c 4/,,0a ,Uo05 /a / 'Lia-ez
Signed(Owner or agent): .P�n/G6 9 'CL' � Date: 9�'3/20/S
> Owner/contractodagent 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: a.
ri,..o� 7-1 2liApproved Approved with changes /� _De`niedd
Amount a0 Reason for denial: APPROVED
Cash/CK#:C ASH AUG 27 2018
Rcvd by: /J-l/ YAKMUU I ti
OLD KING'S HIGHWAY
Date Signed: ��/�7 Z Signed:
/ / �/� g` -/�J
e - APPLICATION#:1 8 - E 0 8 9
V5.2017
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RECEIVED
AUG 2 s 2018 APPROVED RECEIVED
AUG 2 7 2013
TOWN CLERK AUG 2 7 2018
SOUTH YARMOUTH, MA YARMOUTH YHrcivtUU l H
OLD KING'S HIGHWAY OLD KING'S HIGHWAY
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�{ 1 R. t I YARMOUTH ' - .. W�C- I
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AUG 2 6 2018 . r n,.�NouTH U c y
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SOUTH YARMOUTH, MA -
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e+ 41 HAWTHORNE RD YARMOUTH PORT, MA 02675 ;,
.' 1 inch = 84 feet W `dpt-E
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c ) Data and scale shown on this map are provided for planning and informational purposes only.YARMOUTH (MA) and Vision
•C1 Government Solutions are not responsible for any use for other purposes or misuse or misrepresentation of this information. 8/27/2018