8815_FORM A - CARMEN AVE. - MASSOIAFirm A
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RECtED
JAN 0 5 2917
AG M.
PLANNING BOARD
i MP, Request for Payment
Department
Date
Planning Board
1/5/17
Vendor #
Vendor's Account #
Remit #
Vendor Remit Address:
Scott & Bonnie Massoia
23 Carmen Avenue
Feeding Hills, MA 01030
Description
Reimbursement of payment for Form A, application was withdrawn
Check # 7670 was deposited into the Planning Board account 22010/42400 on 12/28/16
Invoice #
Amount
Invoice Date
Purchase
Order #
Org
Object
70.00
1/5/17
22010
42400
Total
70.00
1, having knowledge of the facts, certify the materials and/or services have been received or said services
rendered; said certification being based upon signed delivery slips or other reasonable procedures.
Approved:
Mayor
Department Head
No:
Town of Agawam
Schedule of Departmental Payments to Treasurer
DATE 12/2812016
ORG. AND OBJECT SOURCE AMOUNT TOTAL
22010 42400 Scott & Bonnie Massoia 70.00 70.00
0 ° - _
0 0 0 - -
0 0 arm A -
0 0 0
0 0 0
0 0 0
0 0 0 -
0 0 0
0 , • -
° SCOTT L MASSOIA 7670
RONNIE J. MASSOIA 23 Carmen Avenue �7o�11a
0 Feeding Hins. 01030
°
0 TD Bank
0 _
ar
0 �+ -
1:2ii37❑5E.S.4 45068886� 7670
0 -
0 0 0
Total I 1 70.00
NO. Date: 12/28/2016
To the Accounting Office
The above is a detailed list of moneys collected by me, amounting in the aggregate to
the sum of 70.00 Dollars,
for the Form A ending 12/28/2016
which I have paid to the Treasurer, whose receipt I hold therefor.
Planning and Community Development
gate.
'.2)2W2UI b
To the Department Officer making the Payment:
_ Received of Scott & Bonnie Massoia
the sum of 70.00
for the Form A
for collections as per schedule of this date, filed in my office.
1212812016
as Listed Above
Dollars
Treasurer
PAYMENT SUMMARY RECEIPT
Town of Agawam
TOWN HALL
36 MAIN STREET
AGAWAM MA 01001
DATE: 12/28/16 CUSTOMER#: 000000000
TIME: 09:09
CLERK: karen_dr
RECPT#: 1191144 PREV BAL:
TP/YR: MS/2017 AMT PAID: 70.00
BILL: ADJSTMNT:
EFF DT: 12/26/16 BAL DUE:
MISCELLANEOUS PAYMENT
---TOTALS-----------------
PRINCIPAL PAID: 73.09
INTEREST PAID: .00
ADJUSTMENTS: .00
DISC TAKEN: .00
AMT TENDERED: 70.00
AMT APPLIED: 70.00
CHANGE: .00
PAID BY: PLANNING
PAYMENT METH: CHECK
PAYMENT REF:
■
Town of Agawam
Interoffice Memorandum
To: Erik Wight, Building Inspector
CC:
From: Planning Board
Date: 12/28/16
Subject: Form A -- Carmen Ave. - Massoia
Please review and comment on the attached Form A for The Massoia Family Trust for
Carmen Ave. prior to the Planning Board's January 5, 2017 meeting.
Please also return the copy of the plan upon your review.
Thank you,
PRK:amb
Attachment
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
1-�
TOWN OF AGA
Application for Endorsement,
FILE ONE COMPLETED FORM WITI•
WITH THE TOWN CLERK IN ACCOR
SECTION 11-B
TO THE PLANNING BOARD:
oval
WA
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 l41 -1 A 0 04 F
Address '2k
Phone # Fax # email
2. Name of Surveyor S Q 4 �z0fintz
Address 3 7 -'5- U16 Sr. 8 7'�
Phone#zlib 52 - t 9 Fax#q� 273??71,email Rom M1k)L,CDAk
3. Deed of Property Recorded in m n[ L,
Book ; 3 31 Page 2 '71 _
4. Location of Property . •
5. Describe the proposal in this submission: Cq.KOTe 0tg1~ eop-t oa wi i N&
BUMAk by Lbw
ATTACEWNTS - Two originals and three copies of plan by certified land
surveyor. Filing Fee - $50.00 plus $20.00 per lot.
Signature of Owner Address76
1V e
Ol 030
V
1-�
TOWN OF AGAWAM, MASSACHUSETTS
FORM A
AP12fication for Endorsement of Plan Not Believed to Re uire A1212roval
FILE ONE COMPLETED FORM WITH THE PLANNING BOARD AND ONE COPY
WITH THE TOWN CLERK IN ACCORDANCE WITH THE REQUIREMENTS OF
SECTION 11-B
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 ),,,.jjA,5Aojj4 F
Address Z
Phone # Fax # email
2. Name of Surveyor D
-- —6?'QM,3xb ;�'A""-T)
Address 3 7.5-Wt0,t Sr. mxr,
Phone # 41b 525-4r1q9 Pax # - email RoN Mli ,)L, COAk
3. Deed of Property Recorded in 't M P A
Book 6 3 31 Page
2 "7 l
4. Location of Property,
5. Describe the proposal in this submission: A- e D N S CON 1l -0R r i r N&
3utiA% by 1-t'n
ATTACHMENTS - Two originals and three copies of plan by certified land
surveyor. Filing Fee - $50.00 plus $20.00 per lot.
Signature of Owner Address
oz r. e
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