21-E107 10 Perch Pond Way°TOWN OF YARMOUTI�
h x 1146 ROUTE 28, SOUTH YARMOUTH, MA 026644451 R '
Telephone (508) 398-2231 Ext. 1292 -Fax (508) 398-0836
OLD KING'S HIGHWAY HISTORIC DISTRICT COM ITTEE J "`
APPLICATION FOR ALUINCiflc:i':r�Y
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 of propo ed work: d d" I Map/Lot #
Owner s}: Phone #;�^�
All applications must be sub itted by owner or accompanied by letter from owner approving submittal of application.
Mailing ad ress: a ) [fYear built: &A)
Email: Preferred notification method: Phone _. -_Email
CnJ-4 a rld—t—
Agent/Contractor: Phone #:
Mailing Address:
Email: Preferred notification method: Phone Email
Description of Proposed Work (Additional pages may be attached if necessary):
Signed (Owner or agent):
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:
. flul
Amount aa 0
Cash/CK #: Lf 517
Rcvd by: L %•
Date Signed:
V52017
Approved
Reason for denial:
Signed:
Approved with changes Denied
APPLICATION #: dM -910
°Y TOWN OF YARMOUTH
o 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664451
-
`� r$ Telephone (508) 398-2231 Ext. 1292 Fax (508) 398-0836 RECEIVED
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMI, TEE
NOV 16 2021
WAIVER OF 45-DAY DETERMINATION OLD KING SUHIGHWAY
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; bort in an�� event ivithin 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 up lication will be scheduled as soo as the
situation allows.
Applicant/Agent Name (please print): \44 1
Applicant/Agent signature: Dme:j i
Application #: 3
312020
SMITH RESIDENCE
10 Perch Pond Way
Yarmouth Port, MA
ECEIVE
NOV 16 2021
EXISTING BARN
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