HomeMy WebLinkAbout21-E116 33 Kathryn Michael RoadJFY k� TOWN OF YARMOUT RECEIVED
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1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4481
�. Telephone (508) 398-2231 Ext 1292 --Fax (508) 398-0836 Q � 0 7 Z0 1
OLD KING'S HIGHWAY HISTORIC DISTRICT COM ITTEEAwAou i
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:.) �,QrT LI A Q �it� } `l �,Iiir4r;L QJ� Map/Lot # [ ZS �i Ctil14
Owners : f -t t- Q E t< Phone #: W3 3 916 t276
All applications must//be submitted by o;716k46
r or accompaniedPyaetter from owner approving submittal of application.
Mailing address j7 (It�ITy/ tl��iiV JJJ��JJ,, %%/K( /"I�LFji_ Year built 1 q10
Email: Preferred notification method. / Phone Email
Agent/Contractor: tALL16e ZC
Mailing Address: (S /41 rn/&--
Phone # -S&, s- 5-6 �y�
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EmailLCA L1yj>�t�17�1 /+1rz� r/C� L+�• Preferred notification method: PhoneEmail
Description of Proposed Work (Additional pages may be attached if necessary) -,
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Signed (Owner or agent): _ Date: lZ - 7 -2-r
9 Owner/contractortagent is aware that a permit may be required from the Building Department. (Check other departments, also.)
D This certificate is goad 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 a: 00
Cash/CK #: S.1 FM
Rcvd by: L,
Date Signed.
V5 2017
Approved Approved with changes
Reason for denial
Signed:
Denied
APPLICATION #: 21 - +tom l l G
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