28-078 ENDORSEMENT OF APPROVAL NOT REQUIRED (ANR) PLAN
File with the Office of Planning and Development
City of Northampton, Massachusetts
Use Tab Key To Move From Field To Field
1. Deelld recorded in Hampshire County Registry of Deeds or Land Court: Book 3831 , Page 42
2. orthampton,MA,01062
3 (; .Additional property description:
4. Nurxi er of newly created lots: 2
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.
A 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.
X An electronic version of the plan in model space in DWG,DXF,or Shape format including:
X 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 Platming 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;
d
3 The plans submitted are now in the public domain and m co 1 in y form.
.�
Applicant(print or type) Karen Koryek, Signature:
-- r Phone: (413) 584-6 558
Address: 173 West Fams Road i
Northampton,MA 01062
Owner(print or type): Estate of Kathryn Lindner Signature:
Phone: (413) 584-6558
Address: 173 West Farms Road -
Northampton,MA 01062
Surveyor(print or type): Ronald P. Sassi PLS
Signature: PE >` -
Address: 52 Cronin Hill Road, Hatfield, MA 01038! Phone: (4113)2417'6080
Allow 21 days for processing. It is the applicant's responsibilitY to me limps established by the raving and
record it at the Registn)of Deeds or Land Court within the
copies and forms remain with the Cih'. Applicants may.�ile one copy of this ANR form with the CitY Clerk
to protect their appeal rights.
Date Submitted: Date Decision Filed: � �� Q 067
City Clerk(signature)
City Clerk(signature):
C :
(ANR Application,Forin Ar last r erised 1/213 2002;