21-E033 (COA filed in staead) °F4Y TOWN OF YARMOUTH
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o,,,,.,‘,L,,,,,...,,-', 4' 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
Telephone (508) 398-2231 Ext. 1292-Fax (508) 398-0836
I RECEIVED
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
MAY 0 4 2021
APPLICATION FOR YARMOUTH
CERTIFICATE OF EXEMPTION OLD KING'S HIGHWAY
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: .�I � / /
Address of proposed work: 2.v 1 n ,,,` t� `�-f�6p'4- Map/Lot# /Lf 0 ( 3 7
Owner(s): f�)�1 I ' - 4- J cr S- ��l�/ Phone#: Co 6J O`� OL .5
All applications must be submitted by owner or accompanied by letter from owner pproving submittal of application.
Mailing address: lb 1 c �h t TOcrnO`)�OA-Year built: 2_00
Email: 1(A-1 rye J(�1 (�/ d'(-Of " �M Preferred notification method: v Phone mail
Agent/Contractor: IY\C Cir $ o 4 V -C;:VI'l Ca • Phone#:50?--q°7-2
Mailing Address: ( C.JIUQ�ii /\ rC_ • /4 to f 01-6(a—
Email:
`Email: Preferred notification method: Phone El Email
Description of Proposed Work (Additional pages may be attached if necessary):
C/ „ ,'cf a nJ2.W S I\e_
k
/36 /
Signed (Owner or agent): - nr_____— Date: O I Z'(
��
• 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: v/ -j
J Approved Approved with changes Denied
Amount 1,20.00 Reason for denial:
Cash/CK#:/I0 01
Rcvd by: !_,` l_
Date Signed: Signed: APPLICATION#: ? I-.2 OE
V5 2017
4., , ,-'o TOWN OF YARMOUTH
H 1146 ROUTE 28,SOUTH YARMOUTH,MASSACHUSETTS 02664-4451
V' ' V 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): J
0\ii ��,P t,e�
,----
Applicant/Agent signature: ,,,k-yr- ---
Date: 000/Z4
v
Application#:
3/2020
PLOT PLAN
31
FOR LOT #
Indicate location of garage or accessory building
Additions with dashed lines
Sewerage disposal (cesspool) 69
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LARK NORTH POINT
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i Z 326 Yarmouth Rd. I Hyannis,MA 02601 1 508.771:5007 I Fax 508.771.7070 1 hyannis@pineharbor.com
'INE HARBOR 259 Queen Anne Rd. 1 Harwich,MA 02645 1 508.430.2800 1 Fax 508.430.1115 1 infogpineharborcom Schedule Date
WOOD PRODUCTS 1.800.368.SHED I Customer Service 1.866.SHEDKIT I www.pineharbor.com
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