19-E029• i V
M UTH
TOWN OF YAR O RECEIVED i
H 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
Telephone (508) 398-2231 Ext. 1292—Fax (508) 398-0836
HC -170 HC -170 Mii.' R
_b KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE:.-;mhi;.tu i h
y OLD KING'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:
Address of proposed work: 141ASa nj Map/Lot # j -49 l
a 0
Owner(s): JMfj-1 n C4'- .J O kn 1 -P V 1 Phone 4 6.33 1 — 0%
All applications must be submitted by owner or accompanied by letter from' owner approving submittal of application.
Mailing address: 5D cerdd ,_Y1. tttl� &54 A -J 6- LAVArA Year built: 1 q7 -Z--
_ / 02�z
Email: V Ylde11 ! 1/LL IOD.S ID Q� 4a iii .CO i'�. Preferred notification method: Phone Email
Agent/Contractor:
Mailing Address:
Email:
Phone #:
Preferred notification method: Phone Email
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YtM+ QL"-64 4"P- �IoLu'2..
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Signed (Owner or
40- -11'D (we 4)Ow-e 0,
Date.
➢ 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:
Amount
r
Cash/CK #!
f RECEIVED
V Approved Approved with
Reason for denial: MAR
SOUTH YARMOUTH, MA
f I OLD KING'S HIGHWAY
Date Signed: J ,Z6' �Signed: V 6 ` �''"" "� APPI ICATIC)N `'Ori /
A . <t, , I ir, Yarmouth, MA 02675 1 MLS# 72307993 1 Redfin
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RECEIVED
MAR 2 b [019
TOWN CLERK
SOUTH YARMOUTH, MA
)s://www. redf i n.com/MA/Yarmouth-Port/19- Pheasant -Cove -Cir -02675/h ome/135766486
3/22/19, 8:37 AM
REDFIVED
MAR 2 2 20 9
YAKIV1UU I H
OLD KING'S HIGHWAY
AP ' PROvEb
MAR 25
YAKNIUUI-H
OLD KING'S HIGHWAY
Y
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