HomeMy WebLinkAbout22-E021 9 Bray Farm RoadTOWN OF YARMOUTH
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ss- 1146 ROUTE 28, SOUTH YARMOUTH, MA 42664-4451
i Telephone (508) 398-2231 Ext. 1292–Fax (508) 398-0836
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�LD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
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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.
Tyne or print legibly:
Address of proposed work
Owners : S�s? n&
All applications must be submitted by owner or
Mailing address: d (�
Email 0�r)
AgentlContractor
C Ddu Map/Lot #
[`Q \- �� \ _ Phone #50'R { l a
ied by letter from owner approving submiittacll of application.
Q� Year"buiit: ` \�
Preferred notification method: _��Phone ✓ Email
Phone#
Mailing Address: c=r)- \ \ \\\ N'—NZAL K._Cm 2 -W LAPn C�' �� 1
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Email: �. �(� ( 1 '� ��( � ' Preferred notification method: ✓ Phone _Email
Description of Proposed Work (Additional pages may be attached if necessary):
Signed (Owner or agent) Date:
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 Pen -nit. whichever date shall be later.
For Committee use only:
Date: 7f lA k4y
Amount____,
Cash10K A.
Rcvd by:
Date Signed
VS 2017
Approved Approved with changes
Reason for denial.
Signed:
Denied
APPLICATION #: C�p )
TOWN OF YARMOUTH
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-4451
Telephone (508) 398-2231 Ext. 1292 Fax (508) 398-0836
OLD KING'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):��-
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Applicant/Agent signature: Q X C7A Date: • $ a
ECEIVED
MAR 0 8 2922
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Application#. 2D -e wr�
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MAR 0 8 2022
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