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HomeMy Public PortalAboutCertificate of Exemption OKH Cert Exemption 22-5-13 Application # ___________________________ Fee: Date Paid_________________ Check # __________________ MAP_____________________ LOT______________________ CERTIFICATE OF EXEMPTION Application is hereby made for the issuance of a Certificate of Exemption under Section 6 and 7 of Chapter 470, Acts and Resolves of Massachusetts 1973, as amended, for proposed work as described below and on plans, drawings or photographs accompanying this application. This Certificate expires one year or upon the date of expiration of any Building Permit Issued, whichever expiration date shall be later. You must file an extension before the expiration date. IMPORTANT: ALL FEES DOUBLED IF WORK IS STARTED BEFORE APPROVAL. Address of Proposed Work _______________________________________________________________________________________________ Owner Name______________________________________________________________________________________ Owner Mailing Address___________________________________________________________________________ Owner Email_______________________________________________________________________________________ Contractor Name__________________________________________________________________________________ Company Name ___________________________________________________________________________________ Contractor Address____________________________________________________________________________________________________________ Contractor Email________________________________________ Contractor Phone___________________________________ This application is for exemption of proposed exterior construction on the grounds that (check applicable box): □ It will not be visible from any way or public place and/or □ It is within a category declared entitled to exemption by Old King’s Highway Regional Historic District Commission. Describe and furnish plan of proposed work showing location on lot and, if an addition is involved, showing location of existing building. __________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________ ____________________________________________________________ Applicant Signature ============================================================================== ________________________________________________________ _____________________________________________ Historic District Committee Signature Date This Certificate is hereby ______________________ OKH Cert Exemption 22-5-13 WAIVER OF 45 DAY DETERMINATION OPTIONAL The applicant/authorized agent understands and agrees that the determination of the submitted application for a Certificate of Appropriateness 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, Hearing, 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.” (Page 11, Old King’s Highway Regional Historic District Bulletin) Applicant understands that the review of this application will be scheduled as soon as the situation allows. Applicant/Authorized Agent Name____________________________________________________________________ Applicant/Authorized Agent Signature______________________________________________________________________________________________ Date_______________________ Property Location__________________________________________________