HomeMy WebLinkAbout16-A104-A1 275 Setucket Road ApprovedTOWN OF YARMOUTH .4
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!
AMENDMENT FORM G`r' a
("MINOR CHANGE REQUEST")
A minor change request must be submitted within one year of the original approval date or while the work is still in
progress. Only a minor change may be approved by the Committee without the filing of a new application.
PLEASE TYPE OR PRINT LEGIBLY
Original Application #: /—ICI (� Lf Original Approval Date:
�( Address of proposed work: 2 75- 15,:9_
Owner(s): /?-E r' tACc.,-W Ma_i- c (jj1-_ __r� [�� 6A. Phone #:
Mailing address: Z 1 5 S erGc.`i FCx-�- 0-1- l�,_0 -D U`~L
Email: Preferred notification method: —Phone _Email US Mail
x Agent/Contractor:",e ze-� Phone 7 Z-L- <9 tod
Email:
Preferred notification method: Phone Email
Please describe proposed change(s) and attach plans/photos (as necessary):
1�, 1UVv�-�V l�v�� �iCn��t��L. C� i A��� C�'•'�^-'��C GZG'��! i
Signed (Owner or Agent),
..................................................
Approved by OKH
R
JAIL I 7 2017 JAN 17 ZU17
YARMOUTH TO1NN CLERK
P v �
.......................................
Denied by OKH
6 Date [ - 1 "1 I _}-
.................................................................................
New CIA required? Yes No
Signed OKH Chairman Date _ �� /ZOO 7
AMENDMENT # 1(0— •A")QL4— /+ I
1112015
RECEivEt)
JEAN 17 Z017
TOWN CLERK
SOUTH YARMOUTH, MA
APPROVED
JAN 17 2017
VARM 0 U - F H
AY
0 L 1) H W
0
JAN 17 2017
"-IIGHWAY
7
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