HomeMy WebLinkAboutOKH approval TOWN OF YARMOUTH RFF1 VED
it. .:Trt,t4 c. 4.4taper .:31 1146 ROUTE 28,SOUTH YARMOUTH, MA 02664-4451 DEC 16 2019
. Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836
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RECEntiED OLn
KING'S HIGHWAY HISTORIC DISTRICT COMM iNGs HIGHWAY
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-'.- .- • 7 2:i it) APPLICATION FOR
CERTIFICATE OF EXEMPTION
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Application itss 1' . , ..- for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of
Acts of 1973, as am: ..', for the proposed work as described below and on plans, drawings, or photographs
accompanying this application.
Tvoe or orbit lectiblv:
Address of proposed work: Ili P 1W-I woe:) ) L-ear Map/Lot# /24 1//51 Y8
Owner(s): F-1.4 n-CY phone#: 411 •6114-1°74
All applications mushe suNfiltW by owner or accompanied by letter from owner approving submittal of application.
Mailing address: i Year built:
Email: I-4 F1e1)114-y Gitickse.4011 Preferred noUflcatiomethod: Phonti ma 10/'
Aoent/Contractor: fiticatf it4fi1he/ . 08.) 733- 9 083
Mailing Address: ChM AI KA) r r. atraimit onft 614w
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Email: Ati,x4 12-Athsty rzetoksirealCOM Preferred notification method: kr-Phone Email
Description of Proposed Work(Additional Dales may be attached if necessary):
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Signed(Owner or agent): — Date: I VII P//
) Ovmerkontractchlagent is aware that a permit may be required from the Building Department(Chedt other departments.ethic.)
) 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:
APPmved —APPrilved"h APPROVED4'4
Amount a 0 Reason for denial:
Cash/CK*: c?c-i i e IfL 17
Rcvd by &V YARMOUTH
OLD KING'S HIGHWAY
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Date Skpled:jsg1174 Eigeutd 404, 16/7 did.. 1 4 r i...414:e,44 0 41 AppucATioN#:
V5 2017 ttt:141::**4361)
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