36-074 (6) l N/
FNDORSEAENT OF APPROVAL NOT REQUIRED (ANR)PLAN
File wife.the Office of Ptanning and Development
: Qy of Northampton, Massachusetts
1. peed recorded in Hampshire.County Registry of Deeds orb#: Book 5311 page Bog
2. Street Address: _WE5THAMPtDN RbAp(QbLk G-) 4 CAA-DiNIAt- WAY
3. Assessor's Map:- 3(o Lot6i)!014- 30�, Additional property description:
: 4. Number of newly created lots. 05
5. Check list of filing requirem66.(check the supplied items. Applications MUST have these items.)
(3 Original, reproducible (itiytar) Plan,with endorsed Seal of a Massachusetts Registered
Professional Land Surveyor.
2 Six (6)prints of the Plan,
0 Original and Six(6) copies.-of the fully completed and endorsed ANR Application form.
•. C� $150 per sheet fee plus$5t}for each newly created lot (payable to"City of Northampton").
0 If any portion of a plan.fWls'within 500 feet of a published control point(see
North amptonPlanning.org.�::four centimeter-accuracy points on each sheet tied into the
Massachusetts State Plane:.Coorditatc System (NAD 1983 datum),using said published control
paints or the global posii o6 i .g system and noting the coordinates of the tie-in points,the datiun,
and the source and locat-whzf monuments used for data.
..J6 An electronic version of the,pl8n in model space in DWG,DXF,or Shape format including:
o All property lines;buildings and geographic features shown on the plans.
o Closure of all pipeity boundaries of one part in 20,000
El Plans show all buildings ovi ned by subject landowner(s)within 100'of any newly created
property lines.
!' 3 Plans include•a statement-that the-Planning Board's endorsement is not a determination that the
lots shown are buildable fois.
We believe and understand that
(1) The attached plan is not a division as defined in the Subdivision Control Law and we submit
it for endorsement that Planning Board approval under this Law is not required; and
(2) we have provided all the iri&imatiou required in the checklist above; and
(3) The plans submitted are now in the public domain and may be copied freely in any form.
VJ20RE;kAM It_Y `y'���W "l �l
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Applicant(print or type): INye5TtHl=1 TZLLS Signature:
Address: Bo.t:k 1039 Ea,s}hau�P�v MA Phone:
;. 413 584 Z&13
t'
Owner(print or type): INVESCMv� 'RU.tST Signature:
Address: P_o. Eo\x ►039 Eas4L,a r• M& . Phone. 413 584 2813
Surveyor(print or e): HVM Ak0C14-Te5 P.G . Si natu
. Address: Nca-:[ Phone: 413. SIR4 --1444
Allow 21 days for processing. It is the applicant's responsibility to pick up the original drawing and
record it at the Registry of.Deeds br Land Court within the time limits established b y e the Registry. All
� .
copies and forms remain with the City. Applicants may file one copy of this ANR form with the City Clerk
j' to protect their ap eal tights.
Date t:� tC> Date DecisionFilc UCJ
O R U
City g City Clerk(si •
(ANR,Qppicotton,FormA:loftrevtted! 2002)