8691_FORM A - 116 ADAMS STREET.pdf6(00 I -
Form A-
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Exisfing Residenc~
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T,,15 plo.n does not constitute 0.
s..<bdivis'on therefore o.pprovol
uncier the Subdivision Control
Lo.w is not ~equlred.
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Parcel A
244,298 s. f.
5.61 Acres
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SCALE: 1 "
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I.p. Set
40'. DATE: August 2012
GRAPHIC SCALE
( IN FEE! ol
l·inch = 40' ft.
ANDERSON ASSOCIATES .' .
LAND SURVEYOR,LAND.
PLANNING CONSULTANt
SI TE IJESIGN .
375 WALNUT STRE':n E':XTENTION
P.O" BOX 382·. .'. ..... ".
AGAWAM, MASSAOHUSETTS 01001
Tel. 413 525-4145
Fox 413.273.,.1776
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PREPARED FOR:
. Anotoliy . Poliy
116 Adams Street
Agawam, MA
This plo.n prepor"d In, occorcio.nce
with therulesClnd regu(O-tlons of
the RegistrY of Deecis, .
Do.te' A 1)(" , 2 1 ,2-0/2-. ?
D.RAWING NO ..
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Town of Agawam
36 Main Street Agawam, Massachusetts 01001-1837
Tel. 413-786-0400 Fax 413-786-9927
September 6,2012
Anatoliy Paliy
. 105 Hampden Street
West Springfield, MA 01089
Dear Mr. Paliy:
At its duly called meeting held ori September 6, 2012, the Agawam Planning Board voted to
approve your plans under "Subdivision Control Law Not Required" for a parcel ofland located
on Adams Street. Plans drawn by Ariderson'Associates and dated AugUst 2012,
Sincerely,
Please he advised that failure to record the plan within six (6) months and provide proof of
recording will negate the action of the Board. Detach on.dotted line and return to the Agawam
Planning Board, 36 Main Street, Agawam, MA 011001.
To Agawam Planning Board
Please be advised that the Form A plan that was filed by Paliy and approved by the Agawam
Planning Board for a parcel of land lozted. on Adams Street has been recorded at the Hampden
County Registry of Deeds. Book. "t.J, Page t; 7 .
Signature of Applicant' !2~. . . .
Town of Agawam
36 Main Street Agawam, Massachusetts 01001-1837
. Tel. 413-786-0400 Fax 413-786-9927
September 6, 2012
Anatoliy Paliy
105 Hampden Street
West Springfield, MA 01089
Dear Mr: Paliy:
N>
At its duly called meeting held on September 6, 2012, the Agawam Plarining Board voted t~
approve your plans under "Subdivision Control Law Not Required" for a parcel of land loc~
on Adams Street. Plans drawn by Anderson Associates and dated August 2012. "
Sincerely,
Please be advised that failure to record the plan within six (6) nwnths and provide proof of
recording will negate the action of the Board. Detach on dotted line and return to the Agawam
Planning Board, 36 Main Street, Agawam, MA 011 001.
............................. ," ...................... , ..................... .
To Agawam Plarining Board
Please be advised that the Form A plan that was filed by Paliy and approved by the Agawam
Plarining Board for a parcel of land located on Adams Street has. been recorded at the Hampden·
County Registry of Deeds. Book , Page ____ _
Signatnre of Applicant _____________ _
~--:-
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Tl
Date. lil271201l
To the gepartment Officer making the Payment:
Received of Anatoliy N. Paliy as Listed Above
ihe sum of 70.00 -;:O'""o"'''-ars---
fur the ~F~o-nn~A~f~ee------en~dm~g------_-_-_-_-_-_~_~_~_~_-_-_-_-~~8~n~=7~/~2~0~~1~2~ ____________________ __
for collectic
MISCELLANEOUS pAYMENT RECPT#: 818309
Town of ~9awam
TOWN HALL
36 MAIN STREET
AGAWAM MA 01001
DATE: 08(27(12
CLERK: hpg
CUSTOMER#: 0
COMMENT:
TIME: 14:27
DEPT:
CHG: MISC MISCELLANEOUS C
AMOUNT PAID: 70.00
PAID BY: PLANNING
PAYMENT METH: CHECK
CK# 101
REFERENCE:
AMT TENDERED:
1\M.'T APPLIeD:
CHANGE:
70.00
10.00
.00
70.00
TOWN OF AGAWAM, MASSACHUSETTS
FORMA
Application for Endorsement of Plan Not Believed to Require Approval
FILE ONE COMPLETED FORM WITH THE PLANNING BOARD AND ONE COPY
WITH THE TOWN CLERK IN ACCORDANCE WITH THE REQUIREMENTS OF ~
SECTION 11-8 i !c
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TO THE PLANNING BOARD:
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The undersigned, believing that the accompanying plan of his property in the Town ~
Agawam does not constitute a subdivision within the meaning of the Subdivision 0
Control Law, herewith submits said plan for a determination and endorsement that ~
Planning Board approval under the Subdivision Control Law is not required.
Name of Applicant /2r2C2:f0-t3y Paf'/y
Address U6 Ildaf?15? ~I Il(f&Wr9-/?1 Mil-{2It20/
Phone # *3 -23 Z 3$"3.2 Fax # 9'13 ~ 1'63 -Ilf Z email, ______ _
1.
2. Name of Surveyor /If'Jciers:C?J1 AS:[QC?l&feC' .
Address 37S-WalAu-f 2fre.e1 &1
Phone # !.fJ3-:3Lltf -Jerr Fax # t(!3-273-J176email, _____ _
3. Deed of Property Recorded in ________________ _
4.
5.
Book I q 3 J 2-
Location of Property -./1'--I-/'--L&~--1.#t~C.::!fk,<lJ·1kluq,_..J_1-· __ = .... f~J.'-----------Page ~S.=2"-.!2..=--_
Describe the proposal in this submission: .. {)'~Ci.i7jn v I b V1 /0 /01.
ATTACHMENTS -Two originals and three copies of plan by certified land
surveyor. Filing Fee -$50.00 plus $20.00 per lot.
Signature of Owner /lrtfli~ Address {W f(aft7~f
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Existing Residence
to be removed
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ResIdence
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This pio.n aoes not constitute 0.
subdivision therefore o.pprovo.i
under the Subdivision Control
Lo.w is not required,
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Agawam PI~nnlg.\lB'~~;J I
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Parcel A
244,298 s. f.
5.61 Acres
1.1'. Set
SCALE: 1" -40' DATE: August 2012
GRAPHIC SCALE
IN FEET)
1 inch -40 It.
ANDERSON ASSOCIATES
LAND SURVEYOR, LAND
PLANNING CONSULTANT,
SITE DESIGN
375 WALNUT STREET EXTENTION
P.O. BOX 382
AGAWAM, MASSACHUSETTS 01001
Tei. 413 525-4145
Fax 413 273-1776
NO.
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PREPARED FOR:
Anatoliy Paliy
116 Adams Street
Agawam, MA
DATE DfSCF?IPTION
This pio.n prepo.rea In o.ccorao.nce
with the rules o.nci regulo.tlons of
the Registry of DE'eas,
Do.tel Auea, 2.1, WI1
7
DRAWING NO.