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° � � . <br /> NW0��^�N�0���� Historic ��Qm~��Qm�� ��m�N�NN��NM������� i <br /> m~m ��mm mmmcwmm�mm,~ �~.���� mv�� ~�m�...~~...~.~.~... <br /> ~~ m~-�� � <br /> Application for a / <br /> �������� N�� NON-APPLICABILITY � <br /> m�v_m�n �w =m�*�wu_ ��u / <br /> i <br /> Application Is hereby made for the Issuance of a Certificate of Non-Applicabilityunder M.Q.L. Chapter 4O<, The � <br /> Historic D|aLddo Act, for proposed wm[h as described below and on plans, drawings, or photographs <br /> accompanying this application. <br /> PLEASE TYPE OR PRINT LEGIBLY <br /> ADDRESS OF PROPOSED WORK <br /> ASSESSORS MAP NO. 36 ASSESSORS LOT NO, <br /> 0NNE <br /> HOMEADDRESS <br /> AGENT C)RCONTRACTOR <br /> ADDRESS <br /> This mppUUsm0mn is for exemption of proposed exterior construction or other work on the grounds � <br /> that(check applicable box): ! <br /> 19 (1) It will not be visible from any public street,public way, public park nv public body ofwater. <br /> O (2) It is temporary structure orsign, (subject, however, to such conditions aotoduration or use, location, <br /> lighting, removal and similar matters as the Commission may reasonably . <br /> [] (3) it involves only reconstruction, substantially similar In exterior design, of building, structure,or exterior <br /> architectural features damaged or destroyed bvMm4 storm or {pnm|dwd oud� reconstruction |o � <br /> -' � <br /> begun within one year thereafter and carried forward with due dU|gmnce). <br /> [] (4) l1 Involves only ordinary maintenance,repair or replacement of any exterior architectural feature which io <br /> damaged or worn provided the work does not Involve a change In design, material, color (non-residential <br /> structures on|v)/o[outward appearance of the structure. <br /> [] (5)It|a within a category declared entitled to exemption byMoshpee Historic District Commission. <br /> PROPOSED WORK., On a separate sheet or sheets, provide a description of the proposed mmd, Including m <br /> site plan showing location on lot and all other applicable Required Application Materials (see page 2). The <br /> Commission may waive certaV application materials as'appropriate, but a Certificate may be.disapproved If <br /> sufficient Adcrl o Wpp e work Is not Included with this application. <br /> W Owner El Contractor El Agent DATE: <br /> Signed <br /> (Must b signed byy Owner, or,,by Agent Contractor with written authorization by'Owner) <br /> Application Received bv Town Clerk: Date Time_______--_ <br /> Application Received byH'D.[.: Da <br /> The Certificate is hereby []Approved [] Disapproved [] Approved with conditions(see attached) <br /> Date <br /> (�gnn��ofCbmmHs�� ma <br /> (Signature ny Commissioner) Date <br /> � <br /> Decision Time 8y��' <br /> . <br /> / <br /> / | <br />