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8793_FORM A - 56 FEDERAL ST.V q 3 5L ��@ee►r�► 5. TOWN OF AGAWAM, MASSACHUSETTS FORM A ADDlication 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-B iou� i 20 TO THE PLANNING BOARD: Q' The undersigned, believing that the accoa "° of Agawam does not constitute a subdivisic� Control Law, herewith submits said plan Planning Board approval under the Subd 1. Name of Applicant - Address 51k Eldffw I P�.C'(-\ WN 67 Phone 4 C4137 %b3 ` 311 LP Fax 4 LLr 0 2. Name of Surveyor j6Rt11 ULS © A, Address 3? S- W ✓9 , K)JT Phone 4 Ll 13 5 Z.S - � t q1 Fax il .e� 3. Deed of Property Recorded in _ Book I `J. Page 07 q L/ -5 7 4. Location of Property 5. Describe the proposal in this submission: ! IW0 V fi �& A f Vy � `d �7 ZVr iP4i -t, e- f ATTACHMENTS - Two originals and three copies of plan by certified land surveyor. Filing Fee - $50.00 plus $20.00 per lot. Signature of Ownerdress 51P " T 1r1� (51 Qlt) '�V ACO:G A L— 8JV RE TOWN OF AGAWAM, MASSACHUSETTS FORM A Application for Endorsement of Plan Not Believed to Re wire Approval FILE ONE COMPLETED FORM WITH THE PLANNING BOARD AND ONE COPY WITH THE TOWN CLERK 1N ACCORDANCE WITH THE REQUIREMENTS OF SECTION 19 -B fh0 6j } 20 M TO THE PLANNING BOARD: The undersigned, believing that the accompanying plan of his property in the Town of Agawam does not constitute a subdivision within the meaning of the Subdivision Control Law, herewith submits said plan for a determination and endorsement that Planning Board approval under the Subdivision Control Law is not required. 1. Name of Applicant ' lw s- Address ,p� Lo Phone # (H 10 %63 - 311 (P Fax # email ei —M 4Orna'. or �r� G t� 2. Name of Surveyor to" Address 7S' QJA4-)UJt S? r,Ijg)6kA Phone # W 3 S Z.S - Y i 4S Fax #q(6 )1 �'). L email jZc rJ R 4,; l c'd.I'/ 3. Deed of Property Recorded in C Boole 1EJ Page 4. Location of Property 07 q Y 7- ci 7 5. Describe the proposal in this submission: 111.q NS fiG1L rGti' � id r ATTACHMENTS - Two originals and three copies of plan by certified land surveyor. Filing Fee - $50.00 plus $20.00 per lot. Signature of Owner LM s ress 610 FRJIkWJ �J- Town of Agawam 36 Main Street Agawam, Massachusetts 01001-1801 Tel. 413-786-0400 Fax 413-786-9927 April 21, 2016 Melissa Theriaque 56 Federal Street Agawam, MA 01001 Dear Ms. Theriaque: At its duly called meeting held on April 21, 2016, the Agawam Planning Board voted to approve your plans under "Subdivision Control Lava Not Required" for a parcel of land located on Federal Street. Plans drawn by Anderson Associates and dated March 30, 2016. Sincerely, Please be advised that failure to record the plan within sir (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 01001. To Agawam Planning Board Please be advised that the Form A plan that was filed by Theriaque and approved by the Agawam Planning Board for a parcel of land located on Federal Street. Plan has been recorded at the Hampden County Registry of Deeds. Book , Page Signature of Applicant Jate. 411)2016 To the Department Officer making the Payment: the sum of for the for collectic Received of Melissa Theriacque 50.00 Form A Filing Fee 4I712016 as Listed Above Dollars L12� Treasurer I - PATIENT SUMMARY RECEIPT Town of Agawam TOWN HALL 36 MAIN STREET AGAWAM MA C1001 DATE: 04/07/16 CUSTOMER#: 000000000 TIME: 09:32 CLERK: Amy.Boyd RECPT#: 1140829 PREV BAL: TP/YR: MS/2016 AMT PAID: 50.00 BILL: ADJSTMNT: EFF DT: 04/07/16 BAL DUE: MISCELLANEOUS PAYMENT ----------------- TOTALS ----------------- PRINCIPAL PAID: 50.00 INTEREST PAID; .00 ADJUSTMENTS; .00 DISC TAKEN: .00 AMT TENDERED: 50-00 AMT APPLIED: 50.00 CHANGE: .00 PAID BY: PLANNING BOARD PAYMENT METH: CASH PAYMENT REF: Town of Agawam Interoffice Memorandum To: Erik Wight, Building Inspector CC: From: Planning Board Date: 417/16 Subject: Form A - Federal Street - Theriaque/Baker Please review and comment on the attached Form A for Theriaque on Federal Street prior to the Board's meeting on April 21St, 2016. Thank you, PRK:amb FROM THE DESK OF... YOUR NAME TITLE TOWN OF AGAWAM 36 MAIN ST AGAWAM, MA 01001 Email address Here 413-786-0400 X Extension Fax: 413-786-9927 AGAWAM PLANNING BOARD