HomeMy WebLinkAbout15-E056 68 Pine Street Approvedtea. TOWN OF YARMOUTH
°�. 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
w Telephone (508) 398-2231 Ext. 1292-Fax (508) 398-0836
OLD 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. PLEASE SUBMIT APPLICATION FORM & ACCOMPANYING INFORMATION
(INCLUDING PHOTOS).
Type or print lealbly:
Address of proposed work: G � Y t h-r- d�t : 1/Q, )rA mA . _ _ 22
x.. v
Owne s): I Phone #: ,Td - J &
Mailing address: �_I 11,1i1� Year built: My
Email:
Agent/contractor:
Mailing Address:
Preferred notification method: hone Email
Phone #: , i1�,3 9 � -
Email: Preferred notification method: _____VOhone Ei, mil
Description of Proposed Work Additional pages may be attached if necessa
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lc pans to PO4 - L cke for L4e., 6 a_JREC�_zivD f' u o 20
f 15
Signed (Owner or agent):
AUG o -9 z015
TOWlV CL&F . .
SOUTH Y'"OUTH, MA
OLD ,' A'FiA!", UT,
Date: ���
i
➢ Photos showing all sides of building MUST accompany application.
➢ Owner/contractor/agent 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 dote or upon date of expiration of Building Permit, whichever date shall be later.
For Committee use only:
Date: �- `s— / S
Amount aU
Cas h Cam: �V3�' ��33 (�
Rcvd by: U`tl
VApproved
Reason for denial:
Approved with changes
-ARVE D
AUG- l 2014
YARMOUTH
71 i k Y
Date Signed: Signed: APPLICATION
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