HomeMy WebLinkAbout21-E054 1Oe J )UTH _N CtR'K
°FC TOWN OF YARMOUTH
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1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 ),`Ii_I 2riy,�l0:1a. +FL.
' 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. 3
A tJD CD o CT IN�„3c->,.,3 v VV1E.� -
Type or print legibly:
Address of proposedoswork: 33 OAK E 4---€-
A/ 14\'NVS vuo.,1, CSS i\l} ,Map/Lot#
Owner(s): Vl u(.fi" I ;is)J rA GG 0 64E- Phone#: 5-0 8 -2,�.)- 3171
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: .3ci /J k'-' Cil 6'1v `( WLt'ku l/i PC)ter 1{`V A Year built: 1 q9,
Email: ra)pcx.),11.5 C(J ANArt((i)G AM Art„CL M Preferred notification method: Phone Email
Agent/Contractor: CAP CO5 At lid(. 1lic i wC , Phone#: Co 0 f fo L 1 l b4----
Mailing
—Mailing Address: 9 30oAtki ( 1-CvRNA ,1)g-I VZ pc,rj*q"=)5ezT' N 1l 07_6'6q
Email: p,t- Chi,►f't 4 , CSM Preferred notification method: V Phone Email
Description of Proposed Work(Additional pages may be attached if necessary): CP 17` 4C ' l I —
iNCrA-L— ti'''$ lam' Y TRArit A.JJtVAt•3G OV'�z i.5.-_- .44 Srt06 OEC-A.
X33 Fo,3tk;(--- t-i,,,t=-•2 RECEIVE®
w01. rRPM� 7700
'7.-67)) — °� JUN 1 4 2021
YARMOUTH
c:::= OLD KING'S HIGHWAY
Signed(Owner or agent): . u-% Date: (p'11 \? 1
' Owner/contractor/agent is aware that a permit may be required from the Building Department.(Check other departments,also.)
Y 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:6 / 02l/ Approved Approved with changes Denied
Amoun ''. _ 0(��0 Reason for denial: mg I ' ' S '��4 ' ` ` -
Cash/CK#CJ'�J(I ° L . 0 I A ♦� �I i�i1�'���1.
Rcvd by: C"� JUN 2 2 2021
f AHMOUTH
LD NG HIGHWAY
Date Signed: Signed: ' _E 0 SL1
APPLICATION#: t�� lel
V5.2017