24-D003 26 Whippoorwill LaneRECEIVE
q{ TOWN OF YARMOUTH MAY 1 32024
1146 ROUTE 28. SOUTH YARMOUTH, MA 02664-4451 I YAktVIUU I r,
Telephone (508) 398-2231 Ext. 1292-Fax (508) 398-0836 OLD KING'S HIGHWAY '
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
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 (4) COPIES
OF SITE PLAN AND PHOTOS ALONG WITH APPLICATION FORM AND ABUTTERS LIST.
Type or print le Ibl : 2("Address of of proposed work. m0l ek d % i Map/Lot # ' r q +
Owners) eTt �1 RLIL Phone #: C2rf'x -4 I IfO26
All applications must be submitted by owner o�lr accompanied by letter_ from owner approving submittal of application.
Mailing address OG wW&4)P r40'1f &"- , "OM4PIorT- Year built `fa9 7li
Email �l CFF I�i� ��l �O +@ 6P711 [L- • t! fQ
referred notification method. —_US _ US Mail Email
Agent/contractor
Mailing Address � a or 1 CD1a
Email '410-lC Daa.m o��elr� rr sc
Phone#:J
n7A o 563
notification method: US Mail Emaill
Description of Proposed Work
�,� v-cwe,
Signed (Owner or agent)�,CieDate- -6 -/.3 f Zel-I
Photos (4 sets) showing all sides of building MUST accompany application ow 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
r Owner/contractorlagent 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 per:od required by the Act
n This certificate is good for one year from approval dale or upon date of expiration of Building Permit, whichever date shall be later
Rcvd pate
Amount
Cash1CK
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Rcvd by
45 Days:
("/()&l 2q
Date Signed
22020a
Approved Approved with modifications Denied
Reason for nial:
Signed
APPLICATION A 2"" 03
RECEIVED
t°. MAY 1. 24
3 20TOWN OF YARMOUTH YARM 320
�W3 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-4451 OLD KINGS HIGHWAY
OUTh
Telephone (508) 398-2231 Ext.1292 Fax (SOS) 398-0836
OLD IQNG'S HIGHWAY HISTORIC DISTRICT COMMITTEE
WAIVER OF 45-DAY DETERMINATION
I'he applicant/applicant's agent understands and agrees [hat duc to the current declared National
and State public health emergencies the determination of our Application for a Certificate of
Appropriateness/Demolition/Lxemption may not be made within 45 days of the tiling 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 Ffighway Regional Historic District Act.
SECTION 9 -Meetings, Hearings, Time for Making Determinations
"As soon as convenient offer such public hearing; but in any event within forty-five (45) days
after the filing of application, or ivithin such f erther time as the applicant .shall allow in ►+•riling,
the Committee shall make a determination on the application_ "
Applicant understands that the review of this application will he scheduled as soon as the
situation allows.
Applicant/Agent Name (please print): 41EXEV
Applicant/Agent signature_ �A", iz, -
MOM
Ltb DIEV
Date: �j�13/21j
Application 0, 94' 00O3
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