19-E114a
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TOWN OF YARMOUTH ffiH{:ffi$yHtr
REC
Application is hereby made
Tvpq.or print leqiblv:
Address of proposed work:&
Owner(s):
All applicati be submitted by owner
Mailing address:
Aq.e[UContractor:ntL
by letter owner approving submittal of application.
Year built:-l
Phone 4ait
1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
Telephone (508) 398-2231 Ext. 1292-Fax (508) 398-0836
NG'S HIGHWAY HISTORIC DISTRICT COMM
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Y
Acts of 't973, as amended, for the proposed work as described below and on plans, drawings, or photographs
accompanying this application.
APPLICATION FOR
CERTIFICATE OF EXEMPTION
for the issuance of a Certificate of Exemption under Seclions 6 and 7 of Chapter 470 of
e v {Map/Lot #,\2"* TZ
Phone #, fu&-V6 1-1159 5
1.Lb Preferred
n14 LL L tlf
Y\{L 3 **t-Prefened notification method: Phone Email
Description of Prooosed Work (Additional oaqes may be attached if necessarv):
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Phone #:TTq- LaW '" tzql,
relrhq _
a1Mailing
Email
Signed (Owner or agent):
For Committee uge onlv:
Date Signed:
mrTr Is tr&ffi
I,/V Approved
Reason for denial:
_Approved with changes Denied
> Owner/contractor/agent is aware that a permit may be required fom the Building Depa(ment. (Check other departments, also.)> This certificate is good for one year from approval date or upon ctate of expiration of Building Permil, wtrichever date shall be later
Date: /# * 1.: l.t
Amount 'f*
cash/cK # tg7 /
Rcvd by:sn
v5.2017
IZ Signed:#
APPLICATION #: / ?* FIl {
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ll Montebello Restaurant - Google Maps
Go*gle Maps ll Montebello Restaurant
12/17/19, 2:31 PM
lmagery @2019 CNES / Airbus, MassGlS, Commonwealth of Massachusetts EOEA, Maxar Technologies, USDA Farm Service 1000 ft
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