21-E080TOWN OF YARMOUTH ,e+i
1146 ROUTE 28, SOUTH YARMOUTH, MA 02664.4451
Telephone (508) 398-2231 Ext. 1292-Fax (508) 398-0836
/approu"a Approved with changes
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!,fugp,nOLD KING'S HIGHWAY HISTORIC DISTRICT COMM
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.
by letle. from owner approving submittal of application.
Year built:
Preferred notillcation method:/rnon.
eoenvcontactor: E4-( f€rtJ Pro Pa nQ- enone *:
Mailing Address:
Email:
Date:
erornt 00
cashtcK#: qh
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must be submittsd by own
Mailing address:
Owner/contractor/agent is aware that a permit may be required from the Building Department. (Check other departments, also.)
Thas certiflcate is good for one year from approval date or upon date of expiration of Building Permit, whichever date shalt be later.
For Committee use onlv:
sts*a, (iZ f 4-,**z*APPLTCAIoN#: Ql-8090
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Address orprop€se onon t.< HeA tl zL Xa.*-o- nr"prL"t* l[5/31
pnone*: Lt7-?')o-4051Owner(s):
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Date Signed:
v5.2017
Bsasorrfoftraialj
Denied
TOWN OF YARMOUTH
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-4451
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, Timefor 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
situation allows.
ApplicanVAgent Name (please print):4t1e5
Applicant/Agent signature :
application will be scheduled as soon as the
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Application #:el -t0s0
EAS'ERII
Propane&O Srnce1932
SOUTH DENNIS MA 02660 8OO.
Proposal
Proposal Name: NEW TANK INSTALLName: JAI\4ES KIRBY
Address: 15 HEATHER LANE
Proposal lD:
30000013441 1252City, State, Zip: YARMOUTH PORT,MA,02675
Email: NONEPhone: 617-276 4300
Proposal Comments: THtS PROPOSAL lS TO INSTALL 1 120 GALLON TANK WITH GASLINE TO THE HOUSE
Sale of:
. 123201801
'4r MISCELLANEOUS MATERIAL
Applicable Sales Tax: 6.25%(On items shown above $400.00)
ROVED
PERMIT - GAS FITTING
PERMIT - TANK STORAGE
Amount of llems Shown Above:
Total Amount Less Deposit:
lnstallment payment plan available, subject lo credit approval. Payments are determined by dividrng the total installment purchase amount, less
the down payment, by the number of paymenl months. Final installment payment schedule will be senl by mail after completion of work.
Tank Rental lnvoice Amount:B] Annual fl rvtonrhly
100 Gallons of Fuel @ 53.99 (Purchase price for addrtional fuel subject to increase or
decrease wrth market cond trons and Eastern s posted pr ce.)
Grand Total (less deposit) Oue: Upon lnvoice $ 1474.00
Customer Responsibilities: ALL TRENCHING AND BACKFILLING
Proposal does not include any necessary permit fees not quoted above. Time & Materials lobs wrll be billed according to actuallabor hours, and
actual materials including applicable taxes, as required for the Job and according lo rates applicable on the date work is performed. lnvoiced
amounls are payable in full upon receipt of the lnvoice. A late payment charge of 1.5% per month is applicable for amounts past due. Equipment
warranties are provided solely by the manufacturer. Work is warranted lo be completed in a workmanlike manner according to standard industry
pTactices. ALL OTHER WARRANTIES AND REPRESENTATIONS OF ANY KIND ARE EXCLUDED, INCLUDING WARRANTIES oF
i,4ERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE (specific state limitations on exclusions of warranties may apply). Any
changes to the above specifications requiring additronal labor or materials are subject to additional charges. Any additional site work or
requirements (e.9., plumbing, electrical, trenching, concrete fencing, etc.) not specifically included above are the responsibility of the Customer.
All orders and fuel deliveries are subject solely to lhe terms stated in this Proposal, togetherwith Eastern's current standard terms and conditions
for Heating Oil & Kerosene Supply and/or Propane Supply and Equipment, as applicable, a copy of which has been delivered herewith, as
amended by any addenda thereto executed by Customer and Eastern. Customer is responsible for maintaining its own insurances (property,
casualty, liability and olher necessary insurance). Any changes, additions or delelions by Customer (handwritten or otherwise) to this Proposal
shall not brnd or be accepted by Eastern.
This Proposal shall be deemed withdrawn if not accepted by Customer within 30 days of the date hereof.
Eastern Propane Gas, lnc.:
Authorized Representative:
PROPOSAL SUBMITTED TO
Account #:
Oatei 0913012021
s400.00
$ 25.00
Amount of Labor:$450.00
Other:
1CT 0 5 tnr $ s0.00
YARMoT lrq $ 50.00
I ULU ruNG'S H'GHWAY I $975.00
Deposit Amount Due:$o. oo
$975.00
Equipment Rental, Fuel and Additional ltems
$100
$399.00
---'/?'-4
File numher: 210308-8 TINRECIS'TERED LANt)
IAW OFFTCES OF ALBERT J. SCHUI..Z,LLC Oeel Book 333il Pase 1fi
THE CAPE COD FIVE CENTS SAVINGS BANK p1o, 3oo11 198 Pape 39 Lotk) 12
Ott LEWIS BAY REALTY IWESTMENTS. INC REGISTERED I-ANI)
Rep, Book Sheet l.ot(s):
3t11t2021 Cedificate of Tille
RTK:f ,ol Census Trscl
MORTGAGE INSPECTION PLAN Sica/c.. 1"=30'
;;trf:Hb V m ffi-f* ,HER L,tNE' YARM,^H' MA
I orrosz,?1 i
KING'S H qt,'{rb
LOT 11
I
LOT 12
14,120* S.F.
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CERTIFICATION
I1IE MAIN BT'ILDING, FOUNDAT'ION OR DWELLING WAS IN COMPLL{NCf, WTTII TIIE LOCAL ZONING BYLAWS IN EFFf,CT WHEN
CONS-I'RUCI'ED (WTTH RESPECTTO STRUCTURAL SETBACK Rf,QUIRf,}IINTS ONLY) OR IS EXEMPT FROM VIOI-A'[ION l:NT'OR(:EMEN't
{CTION UNDER MASS. CENERAL LAW 'I'I'I'LE VII. CTIAITTER 4OA. SEC:TION 7.
FLOOD DETERMINATI0N
Y SCALE. l'}IE DWELLING SHOWN HERE DOES NO FALL WITHIN A SPECIAL ITLOOD HAZ^RD ZONE AS DELINEATED ON
^
MAP OF COMMUNITY
25OO ICO578J AS ZONE X DA1'EI) 7116/14 I}Y I'HE NATION/\I, FLOC)D INSIJRANCE PROGRAM
Alde Stone Plot Plan Service,
P.O. Box 7166
Lakeuille, ilIA A2347-
Tel: (8OO) 993-3302
?a-x: (8OO) 993-3304
LLC
#r*s
.i I LABNIE 1:5l N^ z^r,ac I A
GA|IY S.
LABNIE
No. 40(139
PLEASE NOTE: This inspection is not the result of an instrument survey, The structures as shown are approximate only. An instrument suruey
would be requircd for an accurate detemination of building loetions, encroachments. property line dimensions, fencs and lot contiguration
and may reflect difierent infomation than shown here. The land as shown is based on client furnished intomation only or assessof s map &
occupation and may be subject to further out-sales, lakings, easements and rights of way. No esponsibility is exlended to the landowner or
surveyor, or occupant. This is merely a mortgage inspection and is not be be reBrded.
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