18-E113 a
it
Ott TOWN OF YARMOUT •
3z. : c WZECEIVED
ties 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
tznd? Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836 OCT 18 2018
OLD KING'S HIGHWAY HISTORIC DISTRICT COM IugARMOUTH
RING'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: rte,' / , / '/�
Address of proposed work: 37 �/✓7/Gzi /� yy/ �J[/ } Map/Lot# t
Owner(s): �/f/[�' { s /.—PO ti�1C •
Phone#:,l / 9
All applications ust be submitted by owner or acc(ompanled by letter from owner approving submittal of application.
Mailing address: cSAii6 Year built:
Email: / /�J p Preferred notification method: v'��PPh�onne Email
Aoent/Contractor. J,�l A / /I6 fe-1/7 h ,y Phone#: J
Mailing Addr ss: 7d d615i,/ 5� 1, ' J L/ . ,i4g. c C $
Email: IJIJ✓ r 2 `7 5 ilj✓1/ - C Gpreferred notification method: Phone VEmail
Description of Proposed Work(Additional pages ma be attached if necessar*
/ c'‘'‘ /g-, I '1- -ecc / C- Zan
tA( 77- ent,,2A-..b- RECEIVED
OCT 18 2018
TOWN CLERK
SOUTH YARMOUTH, MA
(114 ,,, .
Signed(Owner or agent) Date: )0—I&-f i'
....--
>
> 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: / ] y/_
Date: 1r7-1g—ig y Approved _Approved with changes APPROVED
Amount d' T Reason for denial: OCT 1 g 2018
oaswcK#: YARMOUTH
�2
OLD KING'S HIGHWAY
Rcvd by. i34
Date Signed: Ielita/2OIT Signed: R•e APPLICATION#: /i 4:7/
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X39 , 'Recent
Ly Rep 8 OCT 18 2018
t�?os• YAR
motim
4%44: . HIGHW
O x AY
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• 0
LOT 62
90• 10,463 S.F.
moo.
APP.' AVED
Ili 0 18202
ARMOe,4-45.,74,6, 204ic ' OLD ING S HLIGHWAY
l ////,
�!! RECEIVED
0
p" 4e0,„-S474,5 PED OCT 18 2018
•
TOWN CLERK
G! A SOUTH YARMOUTH, MA
L
ti
ROBIN eoyG
RECEIVED ,osoo• t, WILLIAM 134+
o WILCOX ti
OCT : 7 2018No. 31341 re i
HEALTH DEPT. `l''s/ Q/STOtt
'...'•°,444.L LAT.s ..
TO THE BEST OF MY INFORMATION, "PROPOSED" PLOT PLAN
KNOWLEDGE, AND BELIEF THE YARMOUTH, MASS.
STRUCTURES SHOWN ON THIS PLAN ' LOT 62; PL 'BK. ' 187- PG: 149
HAS BEEN LOCATED ON THE GROUND DATE OCT. 11, 2018 SCALE 1" = 20'
AS INDICATED. L✓ai/ JOB 8076-00 CLIENT MACKENZIE
10/11/2018 i ( SWEETSER ENGINEERING
DATE PROFESSIONAL LAND SURVEYOR 203 SOUTH DENNIS,T ROAD
PO HOX 713 SOUTH DMA 02660
OFF. 5063656900 FAX. 506-365-6991
C: 1 58 1 PROD 1 8076-00 I dwg 1 8076-CPP.DWG ® 2018 SWEETSER ENGINEERING
64113
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