Untitled "k' , TOWN OF YARMOUTH
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`:a 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 proposed work: 1 0 Gun Rock Road Map/Lot# 1 36-45
Owner(s): Paula MacNiece Phone#:508-394-4923
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: 10 Gun Rock Road Year built: 1978
Email: psmacnlece@comcast.net Preferred notification method: Phone X Email
Agent/Contractor: Phone#:
Mailing Address:
Email: Preferred notification method: Phone Email
Description of Proposed Work(Additional pages may be attached if necessary): RECEIVED
Installation of a 8x12 wood shed: APR 2 1 2021
Clapboard front painted Benjamin Moore Platinum Gray to match existing house
B & B sides and rear painted Benjamin Moore Platinum Gray to match existing house YARMOtJ l t,
Asphalt 3-tab roof shingles-Certainteed Moire Black- to match existing house LiLo KING'S HIGHWAY
To be built in backyard, bF yo fen e (see photo)
1
Signed (Owner or agent): C ` -- Date: Li. I I
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: \rr\J.(r-\ Approved Approved with changes Denied
Amountj,0 ,c%) Reason for denial:
Cash/CK#: \\i\
Rcvd b
Date Signed: Signed:
APPLICATION d f. 3 2 ,
V5.2017