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• °mac TOWN. OF YARMOUTH
h x 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 RECEIVED
Telephone(508)398-2231 Ext. 1292—Fax(508)398-0836
RECEIVQOD KING'S HIGHWAY HISTORIC DISTRICT COMM TTEEEP 11 2018
YARMOUTH
SEP 14.2018 APPLICATION FOR OLD KING'S HIGHWAY
TOWN CLERK •
CERTIFICATE OF EXEMPTION
Ap�1 tYls I�e ebUy 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:
Address of proposed work:L4 J i n9re55i n-vt 'hi VQ mwI-1 p0rMap/Lot# I \W
I Ir
s): 1o\\ \IQPJ
a- ¶t\6n4-P-Lt4LP Ecf rtile in phone#:5085 -3to; •99(4
All applications must be submitted bi owne ora accompanied by letter from owner approving submittal of application.
Mailing address JClCf11
3 ie5Sicndd Dr ) rmcothr•- (0[
Fo03(075 Year built: I"l
aS�
Email: I`fl rn E 0I II-•T( g AOL. . cam Preferred notification method: ✓Phone v Email
Agent/Contractor: Phone#:
Mailing Address:
Email: Preferred notification method: Phone Email
Description of Proposed Work(Additional pages may be attached If necessary):
Cons1ruci- 1?eld 5-Ivne rckitnln9 wall
Close in 30 4. or walKou-i- -Pu(,•;tn9 and r ,tee One wind&u)
)s ll Fltl from -Gtrled raitroad s area 40 new rebdtot69 wall and grade_
4-0, na{vral grade-
Signed(Owner or agent)��- (2( y Co &A/ytat/ Date: �'I II I IR
> 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: 9"i/ Approved _____Approved with changes A�yQ Q�ed VE
Amount ami o Reason for denial: ��J lllA
ca /c : a Cfq SFP -j 3 ?f to
Rcvd by. 61 YARMftITH
OLD KING'S HIGHWAY
Date Signed: 9/A3/Zo/: Signed: 67654'r+*++Ve 1 8 E 1 0 0
APPLICATION#:
V52017