23D-125 AUG 18 2006 Li
ENDORSEMENT OF APPROVAL NOT REQUIRED (ANR) PLAN—Form A
File with the Office of Planning ; ev lop ent,CipS of Northampton,Massachusetts
f. LL.';.;I1
1. Deed recorded in Hampshire County Registry of Deeds or Land-eourt:Book 6135 Page 85,87 .
2. Street Address: Wood Avenue
3. Assessor's Map: 23D Lot(s): 125 Additional property description: Wood Avenue
4. Number of newly created lots: 5
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").
El 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:
o All property lines,buildings and geographic features shown on the plans.
o Closure of all property boundaries of one part in 20,000
El 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•• .. • • ••.
Applicant(print or type): 1/?...est/no/) O,4Signature:
Address: 7 G' k Phone: 9" / j
Owner(print or type): Benton D. Cook AllSignature:
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Address: 5 Adams Rd. Williamsburg, MA Phon-. 413-26+-0229
Surveyor(print or type): Holmberg & Howe, Inc. Signature:_/, Ts7 /
Address: 87 Union St. , Easthampton, MA Phone: 413-529-1700
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. (form dated 5/8/03)
Date Submitted: Date Decision Filed: HU UST /7
City Clerk(signature): City Clerk(signature): ataCA—.
Northampton Subdivision Regulations PAGE 47