HomeMy WebLinkAbout21-E108 60 Bray Farm Road North°FYI TOWN OF YARMOU .
1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-44MECEIVED
Telephone (508) 398-2231 Ext. 1292 -Fax (508) 398-p83
OLD KING'S HIGHWAY HISTORIC DISTRICT CO4I 1JJE�21
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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 print legibly:
Address of proposed work:
Map/Lot # J 1 Z
Owners): I E klkzy M&*t OG 7)Zt35 r (/,W, f WQ--,�� Phone #:,50F 3S5- —402 k
All applications must a submitted by owner or accompanliie by letter from owner approving submittal of application.
Mailing address:60'FRAY �k 1`Cft J X- —(f )'lt'PtDlJii'I� AA Year built: 92T
IH-� 0 GIa cam. Com, awe s
Email: l�l Preferred notification method: Phone€mail
Agent/Contractor
Mailing Address:
Email: �ICVC'C
Description of proposed Work (Additional tmaes may be attached if necessary):
F-c'Gurcy:> Ao�> ExgAvAN::- s Uppc L.c�'tc�Z o►.} fZc 2
0F 5 SZ
Signed (Owner o(o) : Date: zI
v
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 state shall be later.
For Committee use only:
Date: i
Amount 0,bj)
Cash/CK #: 4
Rcvd by: f 's,
Date Signed:
Approved Approved with changes
Reason for denial:
Signed:
Denied
APPLICATION #:
of �'gR
0 TOWN OF YARMOUTH
p y 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, 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)_ Z;;�G LGLnie-, C-CW3(t
Applicant/Agent signature:
Application #:
312020
Date: A —5 Z(
ECEDIVED
NOV 1 7 2021
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RECEIVED
NOV 17 2021
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Scale:1 "= 30'