HomeMy WebLinkAbout21-E038 Resubmission Y pTTi.Mi) k6`(TOWN _L KX
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fY TOWN OF YARMOUTH :A G ip*4:2 FC
. .'.z' 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
Telephone(508) 398-2231 Ext. 1292-Fax(508) 398-0836
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMIE. -Q.eo-P#1;cd
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APPLICATION FOR MM' 1 7 2021 0`�
CERTIFICATE OF EXEMPTION
I YARMOUTH a j.:(
1 OLD KING'S HIGHWAY v/"'`"'
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: 16 5I(i )3 et,- ,. _ Map/Lot#
Owner(s): '5.(0-1t. C(e4.)-e3 Phone#:
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: 411.( Year built: i-i %C
L.Email: je.r(e I( C I e41/4.1--C S ct. Ccol c .5'-1" Preferred notification method: Phone Email
Agent/Contractor: J . .,..)4.0.- 0...) Phone#: i 5- - 661- 6 763
Mailing Address: 11 Ff71,5 r r4--,,aa...4 oreu;-;fir o263 i
Email: --513r4'5.--C(..+- L.A00 . CO i-1 Preferred notification method: 17 Phone a Email
Description of Proposed Work(Additional pages may be attached if necessary):
ci, f(0.=) 1- door 3 ylt . pl,eot. eldort . C ram
+0 be. C kw o bcvr- o( , /Jo i. ),Jo
of Afpltiza,_ 4k pt { wi..Jdo,,•? 7/`4'4 `t- Sit,
Signed(Owner or agent): q (4 �.._ 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:51 f 4/202/ Approved Approved with changes k---Denied
Amount -O]..[0n0 Reason for denial: , {�
...----
41
Amount /1�jS�
Cash/CK#: /v`c & AIM _ W� a P to ::117 T _ / -il( A
Rcvd by:01Z. L k
Date Signe J Signed: Sir -- ,
L APPLICATION# FP-O 3
V5 2017
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