HomeMy WebLinkAbout19-E105TOWN OF YARMOUTH� . x 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 a
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�.- Telephone (508) 398-2231 Ext. 1292—Fax(508)398-0836 8 Z019
HIGHWAY HISTORIC DISTRICT COMMITTEE'j
j)OLD ANG'S �''viAy
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`� APPLICATION FOR
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CERTIFICATE OF EXEMPTION
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Application is hereby b ma's for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of
mended for the proposed work as described below and on plans, drawings, or photographs
Acts of 197 3, as a p P
accompanying this application.
Type or print legibly:
/ /(fl' -7 l%ee Y r 4.40-) e Map/Lot #
work: '�`
Address of proposed
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Owner s). 'G— Phone #:
Allapplications must be submitted by owner or accompanied by letter from owner approving submittal of application.
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Mailing address.
�' �r-"C* r->6 e r- At o Year built: 1 ^? a
Preferred notification method: h
Email: one Email
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Arc
nt/Contractor: �� �V L
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Mailing Address:
Email.
Pc zwjL- -!5- ® Pvl54 Preferred notification method: Phone Email
Description of Proposed Work (Additional pages may be attached if necessar
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Signed (Owner or agen
Date : 7z/—Y--
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: J
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Cash/ #: _C140k!St_\
Rcvd by:
/,Approved Approved with changes 1ied-'
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Reason for denial:
OLD KING'S HIGHWAY
Date Signed: 1� Z 0 Y Signed: ��� APPLICATION
V5.2017
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RECEIVED
NOV 2 0 2019
TOVvN CLERK
SOUTH YARMOUTH, M -A
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