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HomeMy WebLinkAbout19-E103o.J Email: ffitrr:p" TOWN OF YARMOUTH $ffiFr I'ri i1r, "J :/ \r1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 Telephone (508) 398-2231 Ext. 1292-Fax (508) 398-0836 Rffi'cffilwD KrNG's HrcHwAy HrsroRrc DrsrRrcr coMl/r ITTEE APPLICATION FOR CERTIFICATE OF EXEMPTION Application is hereby made for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of Acts of 1973, as amended, for the proposed work as described below and on plans, drawings, or photographs accompanying this application. Twe or print leoiblv: Address of proposed work:Map/Lot # /15,9 ? Owner(s):law't krnn.\,z-c Phone *, bt2-hq €. to/O All applications must be submitted by owner or accompanied by letter from owner approving submiftal of application. Mailing address:9a^r1-1,€-Year built l? 25 Emair: orn; ,Htle o q$.)t ,brn Preferred notification method: Phone Email\r fi zog I t1 Y o Mailing Address: t o Preferred notification method: Phone t A"flc..r:J 42oad cllhoad an Srer'* afihoo* rr2"'Hr -Satne,(9at ^+rA y>u*e)o UAc{- b ,Atlnrl ^j Pa-'.n*al c\-:i1'tzs(u"4 anlcrrr slde e* w'>se dr'..14t" *J^ttta sht,ilt os -\c? ba ?aJ, $"tna;\ni :J fot 6*ecr*h\yl$ to 'rfl a ted a+& t Signed (Owner or 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, wtrichever date shall be later For Committee use onlv: Date:il/bl?t; Amount -#aC cash/cK#: ffi1 Rcvd by:bA/ Date Signed: _Approved with changes Denied /i'/ APProved Reason for denial NOv 7 2019 YARMOUTH v5.2017 //olZ Signed APPLT.AI.N *' ,9^Fl8 AqenUContractor: Phone #: I nt r rtvuh t,l - 'l d:i} - a-, ta. t.\:q r-? "?. -'- *.-1-:-' _ --\+ \j_- =-== $