31B-051 (13) 10/11/06 WED 15:19 FAX I' �i ED NOJTA la001
ENDOMEMENT OF APPROVAL NOT REQUMED(ANR)PLAN—Form A
File with the Office of Planning and Development; ---i"f Nprthampton,Massa,-husetts
I Deed recorded in Hampshire County Registry of Deeds or 1,md Court 13coQ) t '_Page ,
2. Street Address: / 1 � At nor S
3. Assessor's Map-�1J'sue Lot(s); lldditional property description:
4. Number of newly created lots:
S. Check list of filing requirements(check the supplied items. Applications MUST have these items.)
ITS Original,reproducible(mylar)Plan,with endorsed Seal of a Massachusetts Registered Professional Land
Surveyor.
❑�Six(6)prints of the Plan.
I2K Original and Six(6)copies of the fully completed and endorsed A,NRApplicatlon form.
l2r/$1.50 per sheet fee plus$50 for each newly created lot(payable to"City of Northampton").
13" If any portion of a plan falls Within 500 feet of a published control point(see NorthamptonPI2 nning.org):
four centimeter-accuracy points on each sheet tied into the Massachusetts State Plane Coordir ate System
(NAD 19$3 datum),using said published control points or the global positioning system and noting the
�ordinates 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 Slape format including:
o All property lines,buildings and geographic features shown on the plans. ?
o Closure of all property boundaries of one part in 20,000
V lans show all buildings owned by subject landowner(s)within 100'of any newly created property lines.
ans include a statement that the Planning Board's endorsement is not a determination that th.-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; ad
(3) The plans submitted are now in the public domain and may be copied freely in f rm�
Applicant(print or typ4- ez
d Signature
Address:,7,fC� r�ru r,"/vim; r R n s Fca�. Phone- - -Ore
Owner(print or type); ' ignature. =�
Address:3a v Cree ,. ea s 1 phone:
Surveyor(print or type):YAtO-W�'G` Cc � Signature-
1 It
Address: r�a at.� M� d't o 1 Phone: C, i S9 O 1
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 Regis,7. All
copies and forms remain with the City. Applicants may file one copy of this ANR form with tt.e City
Clerk to protect their appeal rights. (form dated 518103)
Date Submitted: . ' fa !�° Date Decision Filed Uv
City Clerk ign u : City Clerk(signatur
CJt....
Northampton Subdivision Regulations-----PAGE 47