HomeMy WebLinkAboutGANDY, GERALDINE L, TOWN a cnTH OVER, twtASSAC�
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HISTORIC DISTRICT COM 41SSIoll
Application for Certificate of Approoriateness
Application is hereby made for the issuance of a CERTIFICATE OF
APPROPRIATENESS under Chapter 40C for proposed work as described below
and on plans, drawings, or photographs accompanying this application.
CHECK CATEGORIES THAT APPLY:
I . Exterior Building Construction:
( } Addition
Type of 'guilding ( Alteration
{ Home
{ )
Garage
( ) Commercial
( ) Other
2 . Demolition or Removal of:
3 . Signs or Billboards : ( ) Vow Sign
( ) Existing Sign
( ) Other
4 . Structure: ( ) Foncr_
( ) Wall
( ) other
(Type or print legibly) •
Address of Proposed Work:_� ;abokve)7�:V� j
c 4.Ir Date:Owt2er. : i'1 �:( CY l %l� 7' ' CU� Telephone tt �Home Address (if different from
Agent or Contractor: �� I ( ` U:r/� ��C 'I! �/ !� /' 'relephone :
4.
Address: i' Ncl) ,• f
Assessor's Map Lot N : o;.'Q
• r ;
Detailed Description of Proposed Work: Give all particulars of work
to be - done (see 08 below) , including materials to be used, if
specifications do not accompany plans. In case of signs, give
locations of existing signs and ` proposed locations of new signs.
(attach additional sheet if necessary.)
ydoY
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e�Irr ��� c�, i c� �r/� �• ~� ;'c- y- =Agent,
actor)
DO NOT WRITE BELOW THIS LINE
RECEIVED FOR HISTORIC DISTIRCT COMMISSION:
TIME:
DATE
BY:
APPLICATION # :
THIS APPLICATION FOR CERTIFICATE OF APPROPRIA'1'1?.NESS :
( ) APPROVED
( ) DISAPPROVED
Reason for Disapproval :
( ) NO CERTIFICATE OF APPROPRIATENESS REQUIRED
A CERTT=FICATE OR APPROPRIATENESS is for work described
in the application above an =ach documents.
Chairman: /�� - Secretary:`A
Vice chairman: •
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