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OFFICE OF
PLANNING BOARD
Town Of Belchertown
P.O. Box 964
Belchertown, Massachusetts
01007
FORM E
APPLICATION
FOR MODIFICATION OF
AN APPROVED
DEFINITIVE PLAN
, 20
This approval for the modification of an approved
definitive subdivision plan is under the requirements of the Subdivision
Control Law, M.G.L. Ch. 41, Sec. 81W, and the Code of the Town of Belchertown,
Chapter 270, §270-34.
File one complete application form together with
seven prints and other necessary documentation with the Planning Board and one
copy and the fee with the Town Clerk according to §270-34.
1.
Applicant
Address Telephone
2.
Owner
or owners of land
Address Telephone
3.
Engineer
Address Telephone
4.
Surveyor
Address Telephone
5.
Deed
of property recorded in the Hampshire Registry of Deeds,
Book , Page
6.
Definitive
subdivision plan recorded in the Hampshire Registry of Deeds,
Book , Page
7.
Title
of definitive plan
8.
Date
of Planning Board decision on the definitive plan
9.
Attach
a cost estimate for the construction according to §270-31E(5), (Form N).
10.
Attach
a list of the names and addresses of the abutters and property owners within
300 feet of this subdivision as received from the assessors' office (Form D).
11.
The
following are all the mortgages and other liens or encumbrances on the whole or
any part of
the above described property:
12.
Attach
a municipal lien certificate from the Belchertown Town
Treasurer-Collector. According to §65-2
of the town code, the Planning Board "may deny…any…permit…on or about real
estate whose owner has neglected or refused to pay any local taxes, fees,
assessments, betterments or any other municipal charges…"
13.
The
applicant hereby covenants and agrees with the Town of Belchertown upon
approval of the definitive plan:
a.
To
design and construct the ways, and to design and install the municipal
services, according to Chapter 270, Subdivision of Land, in the Town of
Belchertown.
b.
To
design and construct the subdivision according to the rules and instruction of
the Belchertown Board of Health, the Belchertown Conservation Commission, and
other appropriate departments.
c.
To
construct the ways and install the municipal services according to the
definitive plan and its accompanying material as finally approved and endorsed
by the Planning Board.
d.
That
at the laying out and acceptance of the subdivision's ways, all the municipal
services within the ways shall become the property of the Town of Belchertown
at no cost to the town, unless otherwise agreed upon in writing.
--- on page 3 ---
This agreement shall be binding upon the heirs,
executors, administrators, successors, and assigns of the undersigned owner or
owners of record:
Owner 1
______________________________
_____________________________
(print or type name) (signature)
Address
_____________________________________________________________________
Owner 2
______________________________
_____________________________
(print or type name) (signature)
Address _____________________________________________________________________
Owner 3
______________________________
_____________________________
(print or type name) (signature)
Address
_____________________________________________________________________
COMMONWEALTH OF MASSACHUSETTS
Hampshire, ss _____________________ , 20 _____
Then personally appeared ___________________________________ , the owner, and acknowledged the foregoing instrument to be the free act and deed of said party(ies) before me.
_________________________________________
Notary Public
My commission expires ______________________
COMMONWEALTH OF MASSACHUSETTS
Hampshire, ss _____________________ , 20 _____
Then personally appeared ___________________________________ , the applicant, and acknowledged the foregoing instrument to be the free act and deed of said party(ies) before me.
_________________________________________
Notary Public
My
commission expires ______________________
Town Clerk:
Date
of submission: _____________________________
Amount submitted _________________ Signature ______________________________________