22-A029 140 Cranberry LaneRECEIVE =°Fri = TOWN OF YARMOUTH
r z 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
FEB 2 4 202? Telephone (508) 398-2231 Ext. 1292 -Fax (508) 398-0836
YARLNi:;OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
vinr'c 411f[-iWAY
APPLICATION FOR
CERTIFICATE OF APPROPRIATENESS
Application is hereby made for issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts of 1973 as
amended, for proposed work as described below & on plans, drawings, photographs, & other supplemental info accompanying this
application. PLEASE SUBMIT 4 copies OF SPEC SHEET(S), ELEVATIONS, PHOTOS, & SUPPLEMENTAL INFORMATION.
Check All Categories That AT
Indicate type of Building: Commercial Residential
1) Exterior Buildin Construction: New Building n Addition Iterations Reroof nGarage
Shed Solar Panels Other:
2) Exterior Painting: oSiding Shutters 0 Doors ❑Trim IIOther:
3) Signs/Billboards: n New Sin Change to Existing Sign
4) Miscellaneous Structures: Fence Wall IIFlagpole
IIPool FIther:
Please type or print legibly: n
Address of proposed work: Map/Lot # I �J
Owners): Phone #
All applications must pe submitted �1� owner or accompanied b etter from owner approving submittal of
application.
Mailing address: �� L� Year built N-\ p
Email - referred notification method: Phone Email
Agent/contractor:
Mailing Address:
Email:
Description of Proposed Work:
Phone #:
Preferred notification method: Phone 1:1 Email
Signed (Owner or agent):
I \ \
Date: �X\ X��X
Owner/contraclorlagent is aware that a permit is requited from the Building Department. (Check other departments, also.)
If application is approved, approval is subject to a 10 -day appeal period required by the Act.
This certificate is good for one year from approval date of upon date of expiration of Building Permit, whichever date shall be later.
Alf new construction will be subject to inspection by OKH OKH-approved plans MUST be available on-site for framing R final inspections
Rcvd Date:
Amount i
Cash/CK #: czsh
Rcvd by: Li 5,
45 Days
Date Signed:
Approved Approved with Modifications Denied
Reason for Denial_
Signed:
APPLICATION #:.1
GENERAL SPECIFICATION SHEET
Project Address:
FOUNDATION: Material: Exposure (Not to exceed 18"):
CHIMNEY: Material/Color: GUTTERS: Material/Color:
ROOF: Material: Pitch (7/12 min) Height to Ridge: Color:
SIDING: Material/Style: Front: Sides/Rear:
COLOR CHIPS
Color: Front: Sides/Rear:
TRIM: All windows & doors to be trimmed with: 1x4 1x5 (Circle one.)
Material: Color:
DOORS: Qty: Material: AAColor: ��
_..
RECEAlt
Style/Size (if not listed/shown on elevations):
STORM DOORS: Qty: � Material: \`\ r\%
FEB 2 4 2022
-%Ur Color:
GARAGE DOORS: Qty: Mat'I: Style: Color:
YAhi4i(j _i } ; t
OLD KING'S NIUHW�gy
WINDOWS: Qt�side: Front: Left: Right: Rear Color:
Manufacturer/Series Material:
Grilles (Required . Pattern (616, 2/1, etc.) Grille Type: True Divided Lite:
-
Snap4n: ` Between Glass -'I= Per anently -plied: =Exterior interior
STORM WINDOWS: Qty: - — Material. Color:
SHUTTERS: MatT Style Paneled Louvered Color:
SKYLIGHTS: Qty: Fixed Vented Size Color:
DECK: Size: Decking MatT Color:
Railing MatT Style: Color:
WALLSIFENCES* (Max 6' height): Height: MatT
Style: Color
(Show running footage & location on plot plan.) "Finished side of fence must face out from fenced in area.
UTILITY METERS/HVAC UNITS: Location: Screening:
LIGHTS: Qty: Style: Color:
Location(s):
LIGHT POSTS: Qty: Material:
Location(s):
Additional information:
2 -General
Color:
APPLICATION
TOWN OF YARMOUTH
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
FEB 2 4 2022 ABUTTERS' LIST
2 'pplicant's (Owner) Name. _ blw5m C p
Property Address/Location: I L10
Hearing Date: _342022-
Notices
3 022
Notices must be sent to the Applicant and abutters (including owners of land on any
Public or private street or way) who's property directly abuts or is across the street from
the Applicant. Please provide the Assessor's Tax Map and Lot numbers only. The
OKH Office will send out notices using the addresses as they appear on the most recent
applicable tax list.
(Vote: Instructions for obtaining the abutters Map and Lot numbers can be found on the Old King's
Highway Department page on the Town website: www.yarmouth.ma.us
Applicant Information:
Abutter Information:
8.2018
Map Number Lot Number
Application #:
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TOWN. OF YARMOUTH
N 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-4451
Telephone (508) 398-2231 Ext, 1292 Fax (508) 398-0836 //+� _
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMIT ARECFAV 1I
FEB 2 4 2022
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 aniI event within forty five (5) clayv
after the filing of application, or within .suc17further 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):
Applicant/Agent signature: __7 Date:
s/za2o
Application
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