22-D004 15 Railroad Aveof TOWN OF YARMOUTH
REED 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
Telephone (508) 398-2231 Ext. 1292—Fax (508) 398-0836
NOV 10 20OLD KINGS HIGHWAY HISTORIC DISTRICT COMMITTEE
YARMOU 1 h
(ING'S HIGHWAY APPLICATION FOR
CERTIFICATE OF DEMOLITION OR REMOVAL
Application is hereby made for the issuance of a permit for the Demolition or Removal of a building or structure or
part thereof, under Section 6 of Chapter 470, Acts of 1973, as amended, for the proposed work described below
and on plans, drawings, or photographs accompanying this application. PLEASE SUBMIT FOUR `) COPIES
OF SITE PLAN AND PHOTOS ALONG WITH APPLICATION FORM AND ABUTTERS LIST.
Tvue or print leuibly:
Address of proposed work: 1��+2��t_�_ Map/Lot #
Owner(s): \/-\-I UE W 1 L jE } Phone #:
All applications must be submi ed by owner or accompanied by letter from owner approving submittal of application.
Mailing address: 11; 94\�Lj217A0 piE.,1"M[)l)TH_��T,.MPt!bWS Year built:
Email: ]G,�11Q. -1 �J 4Qe5(!A Preferred notification method: US Mail ® Email
Agent/contractor: QL\iL WC Phone #: SLO 3b Z 132�
Mailing Address: I OOb
Email: A��1K,- (2 E T&Rtk1 rNFL"t5. C 0 M Preferred notification method: US Mail Email
Description of Proposed Work
'(zA Z>~ 4, aize [#-1tg lEw-'STiN 4 L'. P'ZRA<
Signed (Owner or ag
Date: 40' h - 10 - Zv Z 2
➢ Photos (4 sets) showing`afhstG�f building MUST accompany application, ➢ If building is to be moved, give new location.
➢ If relocation is granted, Certificate of Appropriateness application is required if new location is within the Yarmouth OKH District.
➢ Owner/contractor/agent is aware that a permit is required 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 or upon date of expiration of Building Permit, whichever date shall be later.
For Committee use only: Approved Approved with modifications Denied
Rcvd Date:
Amount `7� Ut.i
Cash/CK #: --�-��
Rcvd by: �1
45 Days:
Reason for denial:
Signed:
Date Signed:
212O2Oa
APPLICATION #: :-,P- o l ti
o�Yo TOWN OF YARMOUTH
G 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 far 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):_ 7r4kA ei blega & T� Uas , l.x1
Applicant/Agent signature: Date: W \O
RECEIVE[) N
NOV 10 2022
YARM0i1I"11k
312020
Application #: Z, 0cz) I
TOWN OF YARMOUTH
OLD KINGS HIGHWAY HISTORIC DISTRICT COMMITTEE
ABUTTERS' LIST
Applicant's (Owner) Name:
Property Address/Location: :`S i l ibael A-YL< .
Hearing Date:
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.
Note: 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:
Rm sVED
NOV 10 2022
YARMOUI r'
Map Number Lot Number
112 ;)I
PIS 1L/3y0
Application #: �;p - 0 004 _
11/10/22, 11:48 AM
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