23D-136 (2) ENDORSEMENT OF APPROVAL NOT REQUIRED (ANR) PLAN
,,,,; File with the Office of Planning and DevelopmentffilP
! City of Northampton,Massachusetts
1. Deed recorded in Hampshire County Registry of Deeds or Land Court: Book 3838 Page .252 .
2. Street Address: 83 WARNER STREET
.AliaamAssessor's Map: 23D Lot(s): 136 Additional property description:
lir—Number of newly created lots: 1 .T - ((��
5. Check list of filing requirements(check the supplied items. Applicat1141 _414sgt_e_1.
11
NJOriginal,reproducible(mylar)Plan,with endorsed Seal of a Mos gis etered^
Professional Land Surveyor.
® Six (6)prints of the Plan. \,n\ SEP - 7 2004
alOriginal and Six (6)copies of the fully completed and endorsed ANR ' plication form.
® $150 per sheet fee plus$50 for each newly created lot(payable to't`City RptigorIVIONS
❑ If any portion of a plan falls within 500 feet of a published control oint sew.^n+At'^TON ►'' 1060
NorthamptonPlanning.org): four centimeter-accuracy points on eac eet 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
® 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 pied free iinnaanyfo.
Applicant(print or type): RONALD M. ROGERS Signature: 1.17 —e i.4/
.017
Address: 101 WARNER STREET Phone: 586-8828
Owner(print or type):
typ ): SAME Signature:_ ,
(:
Address: Phone:
4cJSurveyor(print or type): HAROLD L. EATON & ASSOC.Signature �•
Address: 235 RUSSELL STREET, HADLEY MA 01035 Phone: 584-7599
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 ap eal rights.
Date Submitte : 0'4 Date Decision Filed: Y •
City Clerk(si City Clerk(signature): ;
(ANR Application,Forst A:last rev'e 1/23/2002)