HomeMy WebLinkAboutUntitled °F-Y TOWN OF YARMOUTH
1146 ROUTE 28, SOUTH YARMOUTH, MA 026644451
Telephone(508)398-2231 Ext. 1292—Fax(508)398-0836
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.
Type or print legibly:
Address of propose -wor : Q00272,7- Map/Lot#
Owner(s): / / C ifs, �)C//7`I� Phone#: j 07—d d 7/rd 7
All applications must be subm' ed by owner or ac ompanied by letter from owner approving submittal of application.
Mailing address: ft-- /r/� -7 Year built: /7 7f
Email: / {;/rdl✓� r /://:( .eon ,L4Preferred notification method: Phone '/ Email
Agent/Contractor: Phone#:
Mailing Address:
Email: Preferred notification method: Phone Email
Description of Proposed Work(Additional pages may be attached if necessary):
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APR I. 4 2021
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UW KING'S HIGHWAY
Signed(Owner or agent): ( 3ezer / Date: i)'"cy/
> 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: ( 4 '(?!(11\ Approved Approved with changes Denied
Amount U
11) �V Reason for denial:
�
Cash/CK#:"1�C11
Rcvd by:( '
Date Signed: Signed: ( 1- 7,47E02
APPLICATION#:
V5.2017
rY44ra TOWN OF YARMOUTH
$'' H 1146 ROUTE 28,SOUTH YARMOUTH,MASSACHUSETTS 02664-4451
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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 11 be scheduled as soon as the
situation allows.
Applicant/Agent Name (please . '�� ' / a e~A
Applicant/Agent signa ., _ _ Date: 4 .?
Application#:
3/2020
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