20-E079o� y TOWN OF YARMOUTro
SEP 01RECT
1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451C UU
Telephone (508) 398-2231 Ext. 1292 -Fax (508) 398-0836EVELOPMENT
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
APPLICATION FOR
CERTIFICATE OF EXEMPTION
Application is hereby made for 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.
Tvoe or print leaibly:
Address of proposed work: ZK O f +' r-'_ S)0' • "� '? Map/Lot #
Owner(s): UkUi 0, 'ua rw h� r -L a u'f& M Pyl Phone # � (1 � �
All appiic ns must be s mitted by owner or acc panied by letWr from owner approving submittal of application.
Mailing address: Year built: J U 3
Email: Preferred notification method: one Email
Phone #: 56 3 9 q - Mo?,
C. c <SL Ab "ate &, _ WM r►A� -
L-) h. 4-4 9_a v`°tl G✓- -1
Signed (Owner or agent): �`�— Date:
`L--ZG 2-v
➢ 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:q1
Amount
Cash/CK #: 441415'G y
Rcvd by:
Date Signed:
VS 2017
XApproved
Reason for denial:
Approved with changes
ROVED
SEP 0 2020
Approved b OKH Chairman -VARM -UTH
PP Y OLD KING'S HIGI-
via email on 9/2/20 (20-E079)
Signed: APPLICATIONM o -E0`19
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APPROVED
Sheathing 07;� SEP 0 2 2020
YARMOUTH —`
OLD KING'S HIGHWAY
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1st Floor Deck Cross .. ladgerloks 18" o/c • ,
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DATE:
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SCALE:
SHEET:
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