HomeMy WebLinkAbout21-E110 54 Great Western Road°0 TOWN OF YARMOUTH
H „ 4 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
Telephone (508) 398-2231 Ext. 1292 --Fax (508) 398-0836
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
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: 1 ` V1 ` �V"e �U�� Map/Lot # D 03i�
Owner(s): �1G�Y`{0� "V�——_..._ Phone #: -ISL f1 — R ^ 0535
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: . I f�hs0h ��� ole c ati� Year built: ( 1 i a Il
Email: Preferred notification method: X. Phone Email
Agent/Contractor:
Mailing Address:
Email: Preferred notification method:
Description of Proposed Work (Additional pages may be attached if necessary):
,(.� �►,�re�1 a 1
Sidi - sfi/ek�- Src'k v V.F
Signed (Owner or agent):
Phone #:
Phone Email
— o -ze b a a'i(�
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: III 22P I
Amount au`
Cas CK #:
Rcvd by: L .
Date Signed:
V5.2o17
Approved
Reason for denial:
Signed:
Approved with changes Denied
APPLICATION #: di " iE i! V
TOWN OF YARMOUTH
p ►� 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-4451
Telephone (508) 398-2231 Est. 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, Tirne for Making Determinations
"As soon as convenient after such public hearing; but in any event within forte five (45) dans
after the filing of application, or within such further time as the applicant shall allow in writing,
the Coinrnittee shall mike a determination on the application, "
Applicant understands that the review of this application will be scheduled as soon as the
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Applicant/Agent Name (please print):
Applicant/Agent signature:
312020
Date:
Application #:� —� f