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App# 18-E117
.. 0 r • TOWN OF YARMOUTH r ='y 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 'RECEIVEDk' `� Telephone(508)398-2231 Ext. 1292-Fax(508) 398-0836 • RECEIVED OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE OCT 2 4 2018 OCT.2 5 2018 APPLICATION FOR TOLD KINGS HIGH CERTIFICATE OF EXEMPTION HWAY TOWN CLERK SOVSOLATOng9PRAAmade 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: Jr" ,/ /� Address of p"� osedd wort el el UrAs-Fr�No t07///d,C��Map/Lot# �/a• `l "Wx I.CBRyifs .,4,yaee.a O eel,rbz J;ewr'JE5 of 7 / Owners : rathe-.D, Cd/Lps4.✓ .Pf.027y T-Avs-r Phone#j44)?P/67`b 'All applications must be submitted by owner or accompanied by letter from owner approving submittal of application. - Mailing address: ?7d Orem id ' /Cf/ 0JCt9Year built: /13&± Email: /11441,( 9 (�¢r 4'O i j4.4tt/. /£T Preferred notification method: Phone ✓ Email Agent/Contractor: Phone#: Mailing Address: Email: Preferred notification method: Phone Email Description of Proposed Work(Additional pages may be attached if necessary): Tinnitto17e•4/ QV=/7�i £ C4 Mrdaw 71016£I- 'x ?4.av—t/M- #44.S ;l I" 7/ne{f (01) rg,Tro 'f ' am/antis ani in f- / Air bIt swc AO/try riletrg 4I.-Ade() /?aXEC dirwq RE z/fflfl, , ..h T; )74e1/4C- t er 4/4&e ,rnn lfiyc (-lert! cAe4- . F int T4f a 3) 6//-'&'S• Signed(Owner or agent): 7 A 1 gturgC Date: /1I0r/1P > Ownedcontractoda4e/Ware'that ApeImiAit4 -quired from the Building Department.(Check other departments,also.) > This certificate is gobd for one year from approval date •r upon date of expiration of Building Permit,whichever date shall be later. OCT 252018 For Committee use only: W/e,t�,,�ga Yi�KMOUTH Date: /C5 /- OLD G' • nab'Y /Approved with changes _Denied Amount aD Reason tt lnk %Kwsw,.� - •ra e i4, j ' '��' �-1` Casaft: /062/ �rIrrre . T�z C 2( / 2,< . - ot� Rcvd by: ARµ-^ ,ft.4-a ,m, - �.e - t- • % 4.4-e. T U C t . -e.•lJ ,�.. . Date Signed: /r`ZS/ y� Signed: /77- r ti .�" - APPLICATION#:; / '0'//7 V5.2017 • l sl, f.�i'T• �.i ]- 0'•�i - ar.. : - 1 • ♦ -��Ti f IF. 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