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113 TOWN OF YARMOUTH
1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
Telephone (508) 398-2231 Ext. 1292—Fax (508) 398-0836
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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 n GI Map/Lot #
Owner(s): ffuc Q .SII S DSC:.. �S ! ti on Phone
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: _
Email:.
Agent/Contractor:
Mailing Address: .
Email:
Description of Proposed Work (Additional paces may be attached if necessary):
Tine- -Flic 1�--,un c -e {?c7z t1'ZA
Year built:
i. Phone z�—' Email
Phone #:
Phone Email
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Signed (Owner or agent): , �_ �!J Date:
Ownerlcontractorlagent 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 Rater.
For Committee use oniy:
Date: '.11 0
Amount �/� `u `�
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Cash/CK
Rcvd by:
-/ Approved
Reason for denial:
Approved with changes
d
Date Signed: 1 A2 1 Signed: i rc-it!2" jllc��
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V5 2017
Denied
APPLICATION
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Rogers, Grayce
From: Richard Gegenwarth <r.gegenwarth@comcast.net>
Sent: Friday, April 30, 2021 1:19 PM
To: Rogers, Grayce
Subject: Re: Certificate of Exemption - 1 Katharyn Michael Road
Attention! This email originates outside of the organization. Do not open attachments or click links unless you
are sure this email is from a known sender and you know the content is safe. Call the sender to verify if unsure.
Otherwise delete this email.
I approve.
Richard
let Rosa know.
On 04/30/2021 12:59 PM Rogers, Grayce <grogers@yarmouth.ma.us> wrote:
Hello Richard,
Please, review the Certificate of Exemption for 1 Katharyn Michael Road.
Thank you,
Grayce Rogers
Office Administrator
Old King's Highway Committee/ Historical Commission
508-398-2231 Ext. 1292
1