HomeMy WebLinkAbout21-E111 98 Valhalla Drive.ofYAe TOWN OF YARMOUTH
1146 RUTE 28, SOUTHTelephone ( 08) 398-2231 ExtRM 92TFaOUH,x (508)664-4451 398-083 RECEIVED
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMIfttrO 2021
YAHtti OU'I'ti
APPLICATION FOR I OLD KING'S HIGHV+
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: QF V PL•44LL-tp4 D(LWiii_ Map/Lot # [,Q
Owner(s): �'1�2� S �-SSA 5 Phone #: z
3P6-3(ok - Q034 -
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: (1,9-;)V V -V -tAAU -A V(W44 S. YAL013- t �' 0Z'Pb Year built:
Email: Ce14kU) S` 0 [?PqA 1V 1f LOU(X_�CAA• Cc Vk/ Preferred notification method: Phone ✓ Email
Agent/Contractor. Phone #:
Mailing Address:
Email: Preferred notification method: 11 Phone El Email
Description of Proposed Work (Additional pages may be attached if necessary):
4U1)cv2' S4 --n — Ate- Cf. ->L -a( TU NV*Tmt'� GY4SANC1-
Signed (Owner or agent): Date: 11 i i Z
> Ownertcontractorlagent 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:
Amount
Cash/CK #: e'5
Rcvd by:
Date Signed:
Approved
Reason for denial:
Signed:
Approved with changes Denied
APPLICATION #: )1- E_z1 1 �
°YRk� TOWN OF YARMOUTH
;p 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664- 04
x p c c }
--RECEIVED
Telephone 508 398-2231 Ext. 1292 Fax 508 398-0836
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMI TEENOV 2 2 2021
Y Miviuu i r,
WAIVER OF 45 -DAY DETERMINATION OLD KING'S HIGHWAY
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, Tinie for Making Determinations
"As soon as coni,enient after such public hearing; but in any event within forty-ftve (45) days
after the f ling of application, or within such further tune 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): IS S
Applicant/Agent signature: Date: //////Z/
Application #: pl, E- 11
3!2020
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