21-E102 84 Wianno RoadRECEIVE[)
TOWN OF YA R M O U T
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1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
Telephone (508) 398-2231 Ext. 1292 --Fax (508) 398-0836 NOV 0 5 2021
OLD KING'S HIGHWAY HISTORIC DISTRICT COMIVrI�n`Ir`��"w 7,«,...
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 pril
Address of I
Owner(s): J
All appli
k-tap/Lot #
Phone 40-1 KU
ier approving submittal of application.
Mailing address:
AS '4,8001'
_ Year built:
Email: L rr-C-[}
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j
M I -- Cem
Preferred notification method:
Agent/Contractor: CA jec Q i�A Mt' ATEA �- 10c) h qe/w
Mailing Address:
M
Phone V/' Email
Phone #{ ` 7, Q q -
Email: r� ChCA 8I of -AIQLf�1lf [ � (_/?rl1 Preferred notification method: � Phone i " t Emai
Description of Proposed Work (Additional paces may be attached if necessary):
o r3. � 11 � r� �''" Etq-5
.. 2epkoenw I ncu-. cl-n s
eaaSigned (Owner or agent): Date. t J0 C�
)o- 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: 15
471
Amount D6. 00
Cash/CK #: e7 6g
Rcvd by: is —S -
Date Signed:
V5.2017
Approved Approved with changes
Reason for denial:
Signed:
Denied
APPLICATION
° Y 0 TOWN OF YARMOU CEIVED
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1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 0 64-4451
Telephone (508) 398-2231 Ext. 1292 Fax (508) 398-0836 �Q � 0 , 202
OLD HING'S HIGHWAY HISTORIC DISTRICT CO TTAfi
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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):
Applicant/Agent signature:
312020
Date:
Application #:
Nov 0 5 1021
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RECEIVED
NOV 0 5 2021
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