HomeMy WebLinkAboutApp# 18-E131 TOWN OF YARMOUTH
%�` 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
Telephone (508) 398-2231 Ext. 1292-Fax (508) 398-0836
RECEIVE;:
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
- 1: -. 1 0 2018
APPLICATION FOR i HKiv]Uu I h
CERTIFICATE OF EXEMPTION OLD KING'S HIGHWAY
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: //� / /� /� , //
Address of proposed work: U (♦• IVG'f/ff'A,3 I all? ,47 , ��-(7 �/Cr' �a Ll"l��/'l�1 Map/Lot# �S L/ U /
Owner(s):-J4 Phone#: ,S CS" -7$ ?_ 2 ?
All applications must be submitted// by owner or accompanied bye� letter from owner approving submittal of application.
Mailing address: (1 Cr //G f 17 Ai J.4 Gili1 !//%� f ��/t`,'aG%'7'J,717774 �/
Year built: f i ;
Email: C/J,rn/64 <<2.e Cf'O o (G' I iT Preferred notification method: Phone Email
Agent/Contractor: /0 /7/4v-i4-',- 5a c//a ( V 3710 C Phone#: —5-6)S-6� l— rG /�
Mailing Address:c lc/Ai/4.1 Pe- ( J U, Ye. 1416.4,1/) H*7 • 0. G Ci(l
Email: /70 1 •. s ,zf1 do//ar(U 5 k/v7.5. Preferred notification method: Phone mail
Description of Proposed Work(Additional pages may be attached if necessary): i
S A I ,�� .e A,57zi-f6" io ' (0- 7 �� 7 ��'�� Q 4-mo� � 1 { sc._ „keEr.
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RECEIVED •
DEC 1 1 2018 ,
TOWN CLERK
SOUTH YARMOUTH, �i
Signed(Owner or agent): � Date: //a///U
> 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: 4.R--/G- /Approved Approved with changes
Amount ::26 Reason for denial: .
Cash/CK 9 DEC 1 0 Mp;8
Rcvd by: 6(/ YARMOIJTH
ULD KING'S HIGHWAY
Date Signed: 1 -/('__/ Signed: ,JC �� s 1 3
APPLICATION#:
V5.2017
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