03-010 ENDORSEMENT OF APPROVAL NO x REQUIRED (A.NR) PLAN
File with the Office of Planning and Development !1
03--0 ( 0 City of iVorthanzpton,Massachusetts r;
L Deed recorded in Hampshire County Registry of Deeds or Land Court: Book 5121 Page 193
2. Street Address: 565 COLES MEADOW ROAD
3_ Assessor's Map: 3 Lot(s): 10 Additional property description:
4_ \umber of newly created lots: 1
5. Check list of filing requirements (check the supplied items. Applications NI ST have these items.)
X Original, reproducible(mylar) Plan, «-ith endorsed Seal of a Massachusetts Registered
Professional Land Surveyor.
® Six (6)prints of the Plan.
i Original and Six (6) copies of the fully completed and endorsed AiINTR Application form_
® S 150 per sheet fee plus S50 for each newly created lot(payable to"City of Northampton").
❑ If any portion of a plan falls within 500 feet of a published control point(see
NorthamptonPlanning.org): four centimeter-accuracy points on each sheet tied into the
Massachusetts State Plane Coordinate System(NAD 1953 datum), using said published control
points or the global positioning system and noting-the coordinates of the tie-in points, the datum,
and the source and location of monuments used for data.
IM An electronic version of the plan in model space in DWG,DXF, or Shape format including:
• All property lines,buildings and geographic features shown on the plans.
• Closure of all property boundaries of one part in 20,000
IN Plans show all buildings owned by subject lando«-ner(s) within 100'of any newly created
property lines.
IN Plans include a statement that the Planning Board's endorsement is not a de(ertnj tion.that the
lots shown are buildable lots. �
l
We believe and understand that:
(1) The attached plan is not a division as defined in the Subdivision Contiol<L'Av and we submit
it for endorsement that Planning Board approval under this Law is-not required; and
(2) we have provided all the information required in the checklist above; and
(3) The plans submitted are now in the public domain and may be copied freely in an)�f'orm_
BRUCE D. ROTH
Applicant(print or type): JOYCE MORRISON Signature: C
Address: 565 COLES MEADOW ROAD Phone:_ 585-9023
Owner(print or type)-SAME Signature: A
Address: Phone:_
._:�?Surveyor(punt or type):HAROLD L. EATON & ASSOC. Signatura:n�kk � L-
Address: 235 RUSSELL ST HADLEY MA 01035 Phone: 584-7599
Allow 21 days for processinj. It is the applicant's responsibility to pick up the original drawing and
record it at the Registry ofDeeds or Land Court within the time limits established by the Registry. All
copies and forms remain with the City. Applicants may file one copy of this ANR form with the City Clerk
to protect their appeal rights.
Date Submitted: Date Decision Filed: 33 2a)
City Clerk(signature): City Clerk(signature): ""'
(ANR Application,Form A.last revised 1113x002)