HomeMy WebLinkAbout21-E110 54 Great Western Road APPROVEDTOWN OF YARMOUTH
F 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
Telephone (508) 398-2231 Ext. 1292 --Fax (508) 398-0831 REcEell"VEn
OLD KING'S HIGHWAY HISTORIC DISTRICT COMM�TTq2021
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APPLICATION FOR rHivuir
CERTIFICATE OF EXEMPTION OLD KING'S HIGHWAY
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: C�,�yv�S�Yv��� Map/Lot # 10 y13�
Owner(s): C�Yro� (�w�Su�1 Phone #:
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: _ I l,' `1k5$ ��� Com' Year built: I Iia �
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):
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Signed (Owner or agent):
Phone #:
Phone Email
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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: f
Amount
&CK #:
Rcvd by: `
V Approved Approved with changes
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Reason for denial: NOV 2 4 2021
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Date Signed: 11 2 `f -1 Signed: -/(6-1 ' V
.1 APPLICATION #: +
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°1.YTOWN OF YARMOUTH
p H 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 026 - ^F-1VED
Telephone (508) 398-2231 Ext. 1292 Fax (508) 398-0836 �"
OLD KING'S HIGHWAY HISTORIC DISTRICT CO ITTIRP 2 2 2021
WAIVER OF 45 -DAY DETERMINATIOIVI OLD KINGS HtGHW
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 ant° event within forty five (45) da��s
after the filing of'application, or within such further time as the applicant shall allow in writing,
the Committee shall stake 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
NOV 2 4 2021
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Application #:4T� I�
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