HomeMy WebLinkAbout21-E115 35 Kathryn Michael RoadTOWN OF YARMOUITkCEIVED
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N. 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451;
Telephone (508) 398-2231 Ext. 1292 -Fax (508) 398-083P DEC 0 3 2021
OLD KING'S HIGHWAY HISTORIC DISTRICT C0M.M TjpZ1 "„A,A„
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.
Tvoe or print leaibly:
Address of proposed work: 25 1404 ti'Lz-t lus IA 1 G�1 41 L Map/Lot # Z (CJ /Cqt
Owners . '1�04_ M�&_5 &'�Z Z7 i e Phone #: y (3 616
All applications must be submitted by onwiper or accompaniedy letter from owner approving submittal of application.
Mailing address: 35 dAT-z 1►9 2N I gVt 16144 6 L. `���toQr 14Pt QWj Year built
Email: �A M t�� y (045 e C J3WA ST- OZ l Preferred notification method: Y Phone Email
A ent/Contractor: 'VL6 vL 2 Uf iv
Mailing Address: -- 1<(U VJ6 x&40 Pef OZU/
0
Email: C �4flr ,MG 1 L�O06 Preferred notification method
Phone #:'50 S So! ' �j6 Y()
Phone IJ Email
Description of Proposed Work (Additional aaaes may be attached if necessary):
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�1 ry C._ aV9 1\) 're t�'
1 � 2 CL1 � i � G� S 1 yC,+✓ Su r rtJ CrC.I� ,
Signed (Owner or
rcw -r c12 JAJ 00-V �4 cz2
Date:
➢ Owner/contractor/agent is aware that a permit may be required from the Building Department. (Check other departments, also.)
9 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: �rT �✓ �1
Amount 0)0.
CashICK #: J�
Rcvd by:
Date Signed:
Approved
Reason for denial:
Signed:
Approved with changes
Denied
APPLICATION #:, —0 11-5—
V5.2017
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