HomeMy WebLinkAboutOKH Exemption a1Y4e, TOWN OF YARMOUTH
I RECEIVES
1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
R E C E I V >t Telephone (508)398-2231 Ext. 1292-Fax(508)398-0836 1 JUL 2 3 2019
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMI EE YARIVIOUTH
JUL 2 6 LU1 OLD KING'S HIGHWAY
TOWN CLERK APPLICATION FOR
SOUTH YARMOUTH, MA 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: 2 .6c,.,s\-. .\\ PC.d Map/Lot#
Owner(s): /A;0 ,o c„..,As-c_;CA— Phone#: *)7 Li-A I a- 7O
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: C 2.c +'L.mk g e_t p.�.-,,-,,,Q'. t. Year built:
Email: ✓ 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):
\ace Gb`w S L(a r ) w: c-e-ci' cdo CAA-13 b 56,
r '\0.cebv\12,1r,ec Like- Id -
Signed(Owner or agent): r __ _
Date: 7'-0d 3 /9
> 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: )tea ,3.-/5 y Approved Approved with changes Denied
Amount Reason for denial:
Cash/CK#:C'z-\
't i U! .t
Rcvd by:
YARMOLI IH
_nLD KING'S HIGKAJA . I
Date Signed: 7 2 /z /7 Signed: C.`�/ APPLICATI Q APPLICATION /7 4.
V5.2017