HomeMy WebLinkAboutApp# 18-E098 •
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ie tc TOWN OF YARMOUTH
may. 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 —.
Telephone(508) 398-2231 Ext. 1292-Fax(508)398-0836 'RECEIVED
• & 4-k urn 2a110.
RECRYILD RING'S HIGHWAY HISTORIC DISTRICT COMM 1 1 EE
SEP 10 2018 "
SEP 112018 APPLICATION FOR YARMOUTH
CERTIFICATE OF EXEMPTION OLD KING'S HIGHWAY
TOWN CLERK
SOUTH YARbMOUT'�i,f
Application is here y mance Tor 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: /� J �/ Oo�o1S
Address of proposed work: t 0 M AeSN yn 1 tJf 1 Aemoi11'�ge* Map/Lot# Pi S
Owneris): \Vkanse WO Rail LIS. KI LLI OS Phone#: ?DD t, Sat-c5te
All applications must be submitted b�y�owner or accompanied by letter from owner approving submittal of application.
Mailing address:" SQ.1j1\t tCls; OJoc4t Year built (Oj cq
Email: (VAC 1 t k 18A W M L. cowl Preferred notification method: Phone ✓ Email
AoenUContractor. \/t G1130...' S Pict kvrt t\-)Cs Phone#:
Mailing Address:
Email: Preferred notfication method: Phone Email
Description of Proposed Work(Additional pages may be attached If necessary):
PIM t- c t antsboa_oc NAtJSC, 1tJt- Uolti06
61D►t-16 = NC - t9O S-kbtattlCaT'D AQA?
'tea M. = wt-ttTi.
SlAtilctQS: co\le.t:rgR con ., 10L- 1(11
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0e02 = 4AC - 151 PkAtLIPS210QCt BLUS (ALL epet.1kM,lt3 M.00u. eA"I`S�
Signed(Owner or age �1�PAr i // ' Date: q . la le.)
> Owner/contractor/agent is ware 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: 9-1,0 is' Approved _Approved with changes _Denied
Amount ad Reason for denial: AFF901m o
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rtcvd by: �'V YARMOUTH
�r
of n KING'S HICI NAY
Date Signed: /Man' Signed: C126,,1�1� APPLICATION#: J8-Eon
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