HomeMy WebLinkAbout19-E111I
° TOWN OF YARMOUTH
N -:M x 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-0451
Telephone (508) 398-2231 Ext. 1292 -Fax (508) 398-0836
REC EF6ING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
DEC - 9 2019 APPLICATION FOR
CERTIFICATE OF EXEMPTION
TOWN CLERK
AppIARW1AYAWM-i*RA 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: (_9ZO 'Roi1ft (1-4 Map/Lot # _A�I'_11_ _
Owners: &Ss Z V {f kad .1 Gt 0 If IIh Phone #: 508 - AUZ • 9�fl
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: O . � o + �A( Al0A I d, M0 021115 Year built: q 5 U
Email resforeir I blin AP adL0t)K_.CQAA Preferred notification method: Phone Email
AgenUContractor: ! +nd QI 6D(Phone #:Qr 08 `-1W Z VW
Mailing Address: 05g ay-cen Anne- Znad Arwid. 1 15
Email: I Dfin _ I bbl`, 64-4 i Preferred notification method: ✓ Phone Email
Description of Proposed Work (Additional pages may be attached if necessary):
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Signed (Owner or agent):
Date:
)o Owner/contractor/agent is aware that a permit may be required from the Building Department. (Check other departments, also.)
B 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: la -5-1 /
Amount DO
Cash,6KI: 3 a (p (D
Rcvd by:
v Approved Approved with changes Denied
Date Signed: j Z) 7 12e, f ? Signed: J-7 (' y
APPLICATION #: 19-
VS 2017
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FLAW Of LARD IN YARMOUTH. MASS.
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