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__________________________________________________