HomeMy WebLinkAbout20-E012�F-YRS TOWN OF YARMOUTHCEVj'jrsVA1
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1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
Telephone (508) 398-2231 Ext 1292—Fax (508) 398-0836
RECEb KING'S HIGHWAY HISTORIC DISTRICT COMMIT
FEB 1 ,9 2020 APPLICATION FOR
TOWN CLERK CERTIFICATE OF EXEMPTION
SOUTH YARMOUTH
Application is hereby madewo 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 grint le ibl :J \V 1 "a0A J-1"
Address of proposed work: ""[ K� tl 1 1� �b 1 Map/Lot #
Owners): 1, F_ $DTI _ 13 c Phone
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: 3_a. 4 o 1ij oT- _kb Y r PO a T_ Year built ? d / J
Email
Arc enVContractor:�1 P
Mailing Address: 37
Email
Preferred notification method: t--' Phone Email
Phone #: SD � -3 6 4 - } 4 �L 4
Preferred notification method: Phone Email
Description of Proposed Work (Additional pages may be attached if necessary):
Signed (Owner or agent):
Date:
0wner,+contractor7agcg9 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 shalt be later.
For Committee use only:
Date 11- t I- 9 L
Amount d�
Cash/4
Rcvd by L.Z' i
✓ Approved Approved with Changes
Reason for denial:
Date Signed: �K13 2ozo _ Signed:
V5 20!7
Denied
APPLICATION #: a�G'�G/a
Signed (Owner or agent):
Date:
0wner,+contractor7agcg9 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 shalt be later.
For Committee use only:
Date 11- t I- 9 L
Amount d�
Cash/4
Rcvd by L.Z' i
✓ Approved Approved with Changes
Reason for denial:
Date Signed: �K13 2ozo _ Signed:
V5 20!7
Denied
APPLICATION #: a�G'�G/a
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