21-A171 42 Sisters CircleTOWN OF YARMOUTH
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1146 ROUTE 28, SOUTH YARMOUTH, MA 02684-4451 I
RECEVED
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Telephone (508) 398-2231 Ext. 1292 -Fax (508) 398-0836
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMIE ffl 2921
APPLICATION FOR
OLD KINGS lOF-
CERTIFICATE OF APPROPRIATENESS
Application is hereby made for issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts of 1973 as
amended, for proposed work as described below & on plans, drawings, photographs, & other supplemental info accompanying this
application. PLEASE SUBMIT 4 Copies OF SPEC SHEET(S), ELEVATIONS, PHOTOS, & SUPPLEMENTAL INFORMATION.
Check All Cateqories That Apply: Indicate type of Building: Commercial Residential
1) Exterior Building Construction: New Building Addition _Alterations Reroof X Garage
Shed Solar Panels Other:
2) Exterior Painting: Siding Shutters Doors Trim Other:
3) Signs/Billboards: New Sign Change to Existing Sign
4) Miscellaneous Structures: Fence Wall Flagpole Pool Other:
Please type or print legibly:
Address of proposed work: ,Dldfrrn K,�, Z- figy1ik(,U,/_ Map/Lot #
Owner(s): �� {�aM Phone #: 6697'/ 7G
All applications must be submitted by owner or accompanied by letter from owner approving submittal of appli oc is is n.
Mailing address: ?' Year built: '�Po2 I
Email:ELe&6aM.c- C /cctL! (reznq Preferred notification method: Phone Email
Agent/contractor:
Mailing Address:
Email:
Phone #: 50S 73%J,7/
Preferred notification method:
Description of Proposed Work:
�G1�'i �i e rcx�L �cU►e �� C�G�q,�'� � �a
foo
Phone Email
49- /Ma
Signed (Owner or agent): Date: /Z_ 9_21'
Owner/contractor/agent is aware that a permit is required from the Building Department. (Check other departments, also.)
If application is approved, approval is subject to a 10 -day appeal period required by the Act.
> This certificate is good for one year from approval date or upon date of expiration of Building Permit, whichever date shall be later.
All new construction will be subject to inspection by OKH. OKH-approved plans MUST be available on-site for framing & final inspections.
Rcvd Date: I IcD
ff nn
Amount W
Cash/CK 6
Rcvd by:
45 Days:
Date Signed:
Approved
Reason for Denial:
Signed:
Approved with Modifications Denied
APPLICATION #: Qi ., n r '
V,ja TOWN OF YARMOUTH
d' 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-4451
F Telephone (508) 398-2231 Ext. 1292 Fax (508) 398-0836
4 l OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEJ RECEIVED
NOV C 8 2021
WAIVER OF 45 -DAY DETERMINATION I . YAtWOUTn
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 (tearing; 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
►c,riting, 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):_ AEL& 2a)z '
Applicant/Agent signature: Date: 9-2
Application t 91441-1
312020
TOWN OF YARMOUTH
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
ABUTTERS' LIST
Applicant's (Owner) Name:
Property Address/Location:
Hearing Date: 91)31,91
RECEIVED
Nov 0 S 2021
YARMOU T H
Notices must be sent to the Applicant and abutters (including owners of land on any
public or private street or way) who's property directly abuts or is across the street from
the Applicant. Please provide the Assessor's Tax Map and Lot numbers only. The
OKH Office will send out notices using the addresses as they appear on the most recent
applicable tax list.
Note: Instructions for obtaining the abutters Map and Lot numbers can be found on the Old King's
Highway Department page on the Town website: www.yarmouth.ma.us
Map Number Lot Number
Applicant Information:
Abutter Information
Application #: a -An
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