Untitled °FYI TOWN OF YARMOUTH
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APPROV-'ik Ii ,`41146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
Telephone(508) 398-2231 Ext. 1292—Fax(508) 398-0836
FEB 1 7 2021 OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
YAFS HiG
OLD KING'S
APPLICATION FOR
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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. Yf=1 c' _
LType or print legibly: `
Address of proposed work: 3 ci Pjt4 E ST, OY-1140J Tl4 Map/Lot# 121" Z
Owner(s): L(cj 04 Afib i4' NL-tt> i.441 Phone#: (77tf)3S4 ..;‘'E.11
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: `SA414(1.) Year built: Via/
Email: 0 I4Sl Lt e LESLIE-Ill JC. ,We Preferred notification method: Phone V/
Email
Agent/Contractor: c,XP'NOOZ. 41140 Phone#: (5c 1-%) 73 "41143
Mailing Address: 9 t MAIN &T. O$ AA-E. AAA Cl.6v, _
Email: Atii,X gA'NIV' R-.Li`'l,CN6t '4 4 1.004 Preferred notification method: LI Phone I
C ►' Email
Description of Proposed Work(Additional pages may be attached if necessary):
Datk “Pans to civil u4ujoity , Nim► toz-44 SniditC Alk, In4:Qic
REi IV
34i ,; ,-axles1MX vass3lt- ; % Puamc way.� ZS s.� or � IIAN -_
2 6 2021
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I rAhi�iUiJ i r,
I ow KING'S IIGH4VAY
Signed(Owner or agent): Date: I I i L f
il
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:
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Date:\ rlr�`i-CIA V Approved Approved with changes Denied
Amount 5,C(,, ,C0 Reason for denial: , .
Cash/CK#: \')
Rcvd by: Q.g-
Date Signed: I l t Signed: (,y 'APPLICATION#: . . l =-
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Yqk;_ TOWN OF YARMOUTH
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1 146 ROUTE 28,SOUTH YARMOUTH,MASSACHUSETTS 02664-4451
s Telephone(508)398-2231 Ext. 1292 Fax(508)398-0836
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
WAIVER OF 45-DAY DETERMINATION
The applicant/applicant's agent understands and agrees that due to the current declared National
and State public health emergencies the determination of our Application for a Certificate of
Appropriateness/Demolition/Exemption may not be made within 45 days of the filing of such
application.
The applicant agrees to extend the time frame within which a determination is to be made as
required by the Old King's Highway Regional Historic District Act.
SECTION 9 Meetings,Hearings, Time for Making Determinations
"As soon as convenient after such public hearing; but in any event within forty-five (45) days
after the filing of application, or within such further time as the applicant shall allow in writing,
the Committee shall make a determination on the application."
Applicant understands that the review of this application will be scheduled as soon as the
situation allows.
Applicant/Agent Name(please print): At r!LioDgamty
Applicant/Agent signature: Date: 1 I u 12-1
Application#: \ - E00 5
3/2020