21-E058 i
lrvfYAR'1rO TOWN OF YARMOUTH .r} ` , _
, _
�°, , 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
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 ofproposedwork: 111 C t I CeCI 31-rCet `(arnmul-Rork Mk O?1'i5 Map/Lot# (Q{ 131
Owner(s): idward b and Nelmn A dohnsan Phone#:508_241.I I I
All applications must be submitted by owner or accompaniedAby letter from owner approving submittal of application.
Mailing address:P O. U I b 1O Sr fti minis MN 002(46 Year built: (`1/ 12.
Email: ebjohnSOn51e.0Mal l . corn Preferred notification method: / Phone Email
L
Agent/Contractor: dward. U Jh Ifon Phone#: 5OU 24-1II itr/
o
Mailing Address: p 0. 64 L O FAith Dennis NA O2 oO
Email: .)j3hh n 5I!QImi I.COm Preferred notification method: / Phone Email-
Description of Proposed Work(Additional pages may be attached if necessary):
Replace. deck on back e f house . RECEIVED
; ,A,' PROVED JUN 29 2021
JUN 0 8 2021 1\ Y AhHi H
OLD KING'SS HIGHWAY
YARMOUTH
)1�KING'S HIGHWAY
Signed(Owner or agent): (...Lu�1 � wG--•. Date:
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:(0 ) 6ai /Approved Approved with changes Denied
Amount U
(0 .00 Reason for denial:
Cash/CK#:l (.0
Rcvd by:
C&Th._:-
7 C Z
Date Signed: J Signed: 1-44;iver
,:.:24...,r, -/-,Ult�.ti APPLICATION#: OSS
V5.2017
NOT TO SLAKE 1'�'! EI LEN 5 TREJ T yApIoum/po. r MA 02675
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