17C-066 (12) /
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ENDORSEMENT OF APPROVAL NOT REQUIRED (ANR) PLAN
File with the Office of Planning and Development
' 'v i Cityof Northampton, Massachusetts
.,
1. Deed recorded in_I ampshire County egistry of Deeds or Land Court: Book 2182 Page 210
2. Street Aiddfis$ arfl`terr�r�
3. As -s Map 17c Lot(s): 066 Additional property description: rear land
4. Number of newly created lots: 0
5. Check list of filing requirements (check the supplied items. Applications MUST have these items.)
Original, reproducible (mylar) Plan, with endorsed Seal of a Massachusetts Registered
Professional Land Surveyor.
Six (6) prints of the Plan.
Original and Six (6) copies of the fully completed and endorsed ANR Application form.
$150 per sheet fee plus $50 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 1983 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.
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
Plans show all buildings owned by subject landowner(s) within 100' of any newly created
property lines.
Plans include a statement that the Planning Board's endorsement is not a determination that the
lots shown are buildable lots.
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 information required in the checklist above; and
(3) The plans submitted are now in the public domain and may be copied freely in any form.
Applicant (print or type): City of Northampton Signature:
Address: 210 Main Street Phone: fl a 7- /2 6)
Northampton MA 01060
Owner (print or type): Joanne Montgomery Signature:
Address: 155 Chestnut Street Phone: Ai Ge.� - y c
Florence, MA 01062
Surveyor (print or type): Si nature4
Y (P �'p ) Berkshire Design Group, Inc g
Address: 4 Allen Place, Northampton, MA 01060 Phone: (413) 582 -7000
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 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. nn
Date Submitted: Date Decision Filed: t/C 1' r /L i l t C"&
City Clerk (signature): City Clerk (signature):
(ANR Application, Form A: last revised 1/23/2002)