HomeMy WebLinkAbout22-E015 42 Pompano Rd}
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REC#EI
FEB 2 3 202
YARMOU i tl
TOWN OF YARMOUTH
1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
Telephone (508) 398-2231 Ext 1292 --Fax (508) 398-0836
KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
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 propos3
led work: ��Z C �,� �.� O 1j Map/Lot # I y l _
Owner s) ,N_M-0&2e-.� SCICLIL Phone k 7iz - 2-96 J�
All applications must be submitted by owner or accompanied 6y letter from owner approving submittal of application.
Mailing address: t (Z 1]v, 2?.J 0 2-0 zc� „ _ _ Year built:
Email i 35� " �rVlG�r ' Ccan� Preferred notification method: Phone Email
Agent/Contractor: J ", , C� L4m�= Cc., �ke tK -- - Phone #: T7 % z 7 ' l SZo &
Mailing Address
Email: Preferred notification method: Phone Email
Description of Proposed Work (Additional pages may be attached if necessary):
, c e- .
Signed (Owner or age
Date: 2
> Ov+nerlcontractorlagent is aware that a permit may be required from the Building Department. (Check other departments, also.)
D 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:
Bate,
Amount
Cash/CK #: 63
3
Rcvd by: S
Date Signed
V5 2017
Approved Approved with changes
Reason for denial.
Signed:
Denied
APPLICATION #: d `— ED 1-5-
TOWN OF YARMOUTH
p H 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-4451
Telephone (508) 398-2231 Ext 1292 Fax (508) 398-0836
OLD TONG'S HIGHWAY HISTORIC DISTRICT COMMITTEE
WAIVER OF 45 -DAY DETERMINATION
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 any event within forty-five (45) days
after the filing of application, or within such further time 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): *C. .—
Applicant/Agent signature: ( -''' Date: 3 Z Z
EC iE VED
FEB 2 3 2022
YAR1410W h
Application #: e AS -
3/2020
RECEIVED
FEB 2 3 2022
YAHIVIOU'i i7
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