HomeMy WebLinkAbout21-E111 98 Valhalla Drive APPROVED4
10
TOWN OF YARMOUTH
1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
Telephone (508) 398-2231 Ext. 1292 -Fax (508) 398-083
ECEIVED
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMIfitbe 2021
APPLICATION FOR
CERTIFICATE OF EXEMPTION
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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: a_gy i L-44t-� -Da-w& Map/Lot # l [ S " {p f
Owners): W45 i�u.S S to 5 Phone #: Z�jD�` 3(A - i q
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All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: %9---)1�t�'`-l�,n�L.i� �{z�Ju �. Y�}' i� a2bro Year bot:
Email: CCI-�k U) S [J ?P"—RV-n- RJ'-L.jy-CA.S. Co N,k Preferred notification method: Phone ✓ Email
Agent/Contractor:
Phone #:
Mailing Address:
Email: Preferred notification method: 11 Phone Email
Description of Proposed Work (Additional pages may be attached if necessary):
1,0 % x vL 'Sir+&D — F�-LL CQDt_e3(L-3 TU MW-c—ti 6 S4 t NWq
Signed (Owner or agent): C� e""el
APPROVED
NOV 2 4 2021
YARMOUTH
LD K NG'S HIGH
Date: // !l Z t
Owner/contractorlagent 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 shalt be later.
For Committee use only:
Date:
Amount
Cash/CK #: �� C'�
Rcvd by: -�) '
Date Signed: -- t
i Approved
Reason for denial:
Approved with changes
Denied
{
Signed: 1
APPLICATION #:�
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TOWN OF YARMOUTH
p H 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS -4 454 Telephone (508) 398-2231 Ext. 1292 Fax (508) 398-0836 'RECEIVED
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMI TEENOV 2 2 2021
Y AHlviou h
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 fling 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 far Making Determinations
"As soon as convenient after such public hearing; but in arty event within forty-five (45) days
after the f ling of application, or within such further tirne as the applicant shall allow in writing,
the Cornrnittee 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): 1, L.15 L S
Applicant/Agent signature: Date:
APPROVED
NOV 2 4 2021
YARMOUTH
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Application #: aj - E I i 1
3!2020
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