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•- 44 \\ TOWN OF YARMOUTH' � ED
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v:-..„..,,,;„,,,;6 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 FEB 2 6 2020
Telephone (508) 398-2231 Ext. 1292—Fax (508) 398-0836
!ARiMOUTH
REC 1 ERING'S HIGHWAY HISTORIC DISTRICT COMMITT,E <IN's HIGHWAY
FEB 2 7 2020 APPLICATION FOR
CERTIFICATE OF EXEMPTION
TOWN CLERK
Applic250114latiWAPiiigfbflAthe 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: J 7 (-t .( -i4 .1.-. Map/Lot#
Owner(s): t t CAA i-\tee.,,- $'V )CCk Phone#:91 ec>F.V2`c.
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: Year built:
Email: Preferred notification method: Phone Email
Agent/Contractor:3'C} 0 (3 ce..k3 ���Ja-vik.O u' Phone#:-‘5 Z C. I s-c ta_
Mailing Address: �,
Email: �‘Sc,..,, k� �ok ��- r�� rete ed notification method: Phone Email
Description of Proposed Work(Additional pages may be attached if necessary): r`
� CE Exp 1e i 3 ‘stiRA. �4 .-V, _ -Nc 4 '- 'r
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Signed(Owner or agent): i / Date:02 . . Z�ZC)
opp
: 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: /
�/ Approved Approved with changes Denied
Date: �,�(C••� i9
Amount a0 Reason for denial: APPROVEI
Cash/CK#: 50 i
�I FEB 2 7 2020
Rcvd by: 44,1 YARMOUTH
OLD KING'S HI(;HWAY
Date Signed: /L7 zc�c' Signed: `J APPLICATION#: ctI(;---Z%70 l
v5 2017
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FEB 17 ?020 FEB 2 7 2020 FEB 2 6 2020
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,r,';' :' / TOWN CLERK OLD YARMOUTH YAI MUU i H
`0: _ _ •UTH YARMOUTH, M KING'S Hi HWAY QLD KING HIGHWAY
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