Application FILE NUMBER:
RLE W- /gg�z
DATE RECD/PEE P ID
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TOWN OF QUEENSBURY
531 Bay Road, Queensbury, NY 12804 c
DEPARTMENT OF COMMUNITY DEVELOPMENT -TJ
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I . PROJECT APPLICANT: �, U .+ De .k GOpNIGK- C)
ADDRESS : RR f
I /-A
L4�kE � N IZ T
PHONE # : Home: -7(0( - 41q1 D��2
PHONE # : Work: �2 i7 ,�- �GYYj 7 -7 -
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APPLICANT'S AGENT: / 15TEP rI w
ADDRESS: f0 GFIEI� �P D� Z
i%N l( U7 C-T (JCOP.Z
PHONE # : Home: Zp5, _ -1(,7, , Ip/�
PHONE # : Work: _ 619145- I- g
PROPERTY OWNER: 4i
ADDRESS :
PHONE # : Home : __ �—
PHONE # : Work:
DESCRIPTION OF PROJECT- Ir.0 :31M,-(Lt
DIRECTIONS TO THE PROJECT: Please make as clear as possible,
so Board members & Staff can find your project:
SKETCH OR PHOTOCOPY OF OFFICE USE ONLY
ROAD MAP: Tax Map No.
Zoning:
Variance : A U S No
Site Plan : _Yes No
Subdiv. : Yes No
CEA: _Yes_ _No
SEQRA: I, II , Unlisted
Warren Co. : _Yes No
APA: Yes No
Wetlands : Yes No
II . SITE DEVELOPMENT DATA
Tax Map Number: Section '�j Block Lot (o
Zone Classification: gt I( 1At�
Area of Parcel , 44- acres = �. �(p(,_ sq . ft.
. Maximum Size Building Allowed M/A sq. ft .
Disposition of Parcel :
Existing --uT � REwl ✓) A
Building Area sq. ft . % of parcel
Paved.Area sq. ft . % of parcel
( including walks)
Green Area sq. ft. % of parcel
• Proposed
P l OrOF D94-r- 4 GixRAO-)
Building Area 31152� sq. ft . % of parcel
Paved Area 2g7fa— sq. ft . j3.0 % of parcel
(including walks)
Green Area 155i3 sq. ft . _10.5 % of parcel
Building Setbacks
Existing Proposed Required
Front Yard 20 2O�
Front ( if corner)
Side Yard ( 1 ) 26
Side Yard ( 2) 5 T
Rear Yard
Rear Yard (2)
• Shoreline
Width 130' 4-
Depth
— 115, t M-ExIetIN1G
Access (check where applicable)
/ Town Highway County State
Length of Frontage __
Number of Parking spaces : Exi ting Proposed
Town Water: Yes No
Town Sewer: Yes �7 No
Any previous Planning or Zoning Board determination regarding
this property? Q/,-,I
Present Use of Property: �� �G1AjL.Y btOEJa JKV
Proposed Use of Property:
A COMPLETE APPLICATION IS NECESSARY FOR PLACEMENT ON THE PLANNING
BOARD AND ZONING BOARD OF APPEALS AGENDAS - APPLICANT PLEASE READ
The Planning and Zoning Office requires 10 copies of your site
plan or variance application and maps, one original and 9 copies,
along with supporting documentation .
O
In addition to the $25 . 00 fee for site plan applications and m
the $50 . 00 -fee for variance applications, the applicant is required n
to pay for the costs related to engineering review. Applications ~
may be referred to the Town Consulting Engineer for review of 2
septic design, storm drainage, etc . The hourly rate charge for the p
engineer review will be charged directly to the applicant. Fees
for engineering review will not exceed $1, 000 . 00 without n
notification to the applicant. _y
• O
Other permits may be required for construction or alteration Z
subsequent to approval by the Planning Board or Zoning Board of
Appeals. It is the applicant' s responsibility to obtain these.
I, the undersigned, have thoroughly read and understand the
instructions for submission, agree to the submission requirements
and completed the checklist. Furthermore, it is the practice of
the Department of Community Development to have a designated
stenographer tape record the proceedings of meetings resulting from
applications, and that minutes transcribed from those tapes
constitute the official record of all proceedings . If there is a
discrepancy between such record and the handwritten minutes taken
by the designated stenographer, the handwritten minutes shall be
deemed the official record.
• I HAVE READ AND AGREE TO THE ABOVE STATEMENT
Applicant' s Signaturex - Date //ISOI9y
Applicant' s Agent Signature Date
PROJ�IDOER 617.21 SEAR
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART 1—PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
I. APPLICANT l9P6Nv6n 2. PROJECT NAME
. G F F) EY t F)FP59A l>OPu I �DbiJ I RESI( lJG�
3. PROJECT LOCATION:
Municipality T0,JN mr G> U>" �', IR. " County
4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map)
IITIRa HAkDeT 6F c sloeR cZc;-pup_Ax _ l
�UTNt 51 GE OV 6-1.e7!fJ Ll� P40V
5. IS PROPOSED ACTION:
-g
l�New ❑Expansion ❑Modllicationlalteralion
6, DESCRIBE PROJECT BRIEFLY:
NEW + y 2 yPP2�( fAl/ u)a WLIT DIW-r
• �AG�-tb'I� C— �E
7. AMOUNT OF LAND AFFECTED: Ypy
Initially ' 44 acres Ultimately • 44 acres i PaA �
6. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR ' 4
OTHER EXISTING I AND VSF RESTRICTIONS?
El Yes %No If No,describe briefly riOC♦ t l w � -1r5 F-r (AK-L
&,rr WiLt� IMPR.()UC 15XLSTIn)g- S57_P2A64f'_ elm-l-,
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
L'I Residential ❑Industrial ❑Commercial ❑Agriculture ❑ParWForestlOpen space ❑Otne-
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL.
STATE OR LOCAL)??
• ❑Yes L7 No If yes, list agency(s)and permitrapprovals
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
❑Yes & No It yes, list agency name and pennitlapproval
12. AS A RESULT cO-FyPROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION?
❑Yes L"J No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant/sponsor nam Date:
Signature:
If the action is In the Coastal Area, and you are a state agency, complete the'
Coastal Assessment Form before proceeding with this assessment
OVER
1
QUEENSBURY APPLICATION COMPLETENESS CHECKLIST
Application fee for each application .
Original plus 9 copies
Required Signatures
Location Map
Adequate Plot Plan.
Other
• The Plot Plan: Draw to scale (preferably 1 inch = 40 feet or
less) a detailed description of the proposed site . Failure to
include all the required information on your site plan will result
in a determination of incompleteness and a delay in the processing
of your application.
* Items A through M must be included on the Plot Plan for the
site plan review application and all variance applications .
* Items N through Z shall be included on the Plot Plan if
applicable .
P N/A
A. Title of drawing, including name and address of
applicant and persons responsible for preparation of
• such drawing.
B. North arrow, scale and date.
_ C. Boundaries of the property with dimensions in
feet, including zoning boundary delineations .
D. Location of all existing principal and accessory
structures and their uses with exterior dimensions
and lot-line and waterfront setbacks .
P - Provided
N/A - Not Applicable
P N/A
E. Location of all proposed principal and accessory
uses and structures with exterior dimensions and
setbacks.
F. Location of any existing or proposed easements,
driveways, outdoor storage and refuse containment
areas, including setbacks and dimensions of the
structures .
G. Location of existing and proposed sewage
disposal facilities including lot line, waterfront
and well setbacks . For proposed system or if
expanding use, include design details, construction
materials, flow rates or number of bedrooms served
• and percolation test results . Also, location of
existing sewage and water systems on adjoining lots .
H. Location and description of existing public or
private water supply.
I . Description of the method of securing public or
private water and location, design and construction
materials of such facilities .;,
J. Total number of existing parking spaces,
including the number of those to remain or to be
removed, those to be paved, those to be graveled,
and total number of proposed new paved spaces and
proposed graveled spaces, including basis for
determining parking adequacy.
• �_ K. Location and design of all existing and proposed
outdoor lighting facilities .
L. Percent of lot which is presently permeable,
including composition of ground cover (grass,
shrubs , gravel, etc . ) J ' : - �Aczkil✓(r
M. Percent of lot which is proposed to be
permeable, including composition of ground cover.
�tiT� zf-, ;,, _,
N. Existing watercourses , wetlands, and other
waterbodies .
O. Proposed maximum daily water usage in gallons
per day.
P - Provided
N/A - Not Applicable
P N/A
P. Location and design of all existing and proposed
parking and loading areas, showing driveways,
ingress, egress, handicapped parking and curbing.
For proposed parking and loading areas, include
design details, construction materials and
dimensions .
Q. Provision for pedestrian and handicapped access .
R. Location, design and construction materials of
all existing or proposed site improvements including
drains, culverts, retaining walls, and fences .
S . Location of fire and other emergency zones ,
• including the location of fire hydrants .
T. Location of all existing and proposed energy
distribution facilities and other utilities,
including electrical, gas, solar energy, telephone,
etc . For proposed facilities, include design
details and construction materials .
U. Location, setbacks, and size of all existing and
proposed signs, including design and construction
details of proposed signs .
V. Location and proposed development of all buffer
areas, including existing vegetative cover and
screening of storage or refuse areas .
W. Identification of the location and amount of
building areas proposed for office, manufacturing,
. retail sales or other commercial activity.
X. General landscaping plan and planting schedule,
including existing trees over 3 inches in diameter.
Y . Grading and stormwater management plan, showing
existing and proposed contours and including
drainage calculations .
Z . Other elements integral to the proposed
development or considered necessary by the Boards
and staff .
Z2 . SEQRA Determination.
P - Provided
N/A - Not Applicable
AUTHORIZATION TO ACT AS AGENT
if the A PPL I CA N T is unable to attend the meeting, or wishes to be
respresented by another party, the applicant's signature is needed on the
authorization form below, designating an agent.
APPLICANT'S AGENT FORM
I, � G4pN !cam hereby designate �7Pl�eu yC� FSIrE
as my agent regarding a [SaVarian ce, ❑ Site Plan, ❑ Subdivision
application for Tax Map Number: Section[ 38 Block 4 Lot (o
SIGNED: - 4✓ DATE: t l - zq -9q
If the OWNER of the property is not the same as the applicant, the owner's
signature is needed on the authorization form below, designating the applicant as
agent.
OWNER'S AGENT FORM
• I, owner of premises located at Tax Map
Number: Section Block Lot hereby designate
as my agent regarding an application for a
❑ Variance, ❑ Site Plan, ❑ Subdivision
at the above premises.
SIGNED: _ DATE:
Deed Reference: Book Page Date
AREA VARIANCE APPLICATION
(Must be accompanied by site information pages.)
TOWN OF QUEENSBURY
531 Bay Road
Queensbury, New York 12804
Applicant: -h DMFA GODNIUk Parcel No. �O
IN ORDER TO COMPLETE THIS APPLICATION, YOU WILL FIRST NEED:
1 . A map of your property, to scale, showing the location of any existing
buildings, septic systems, and wells. (Remember to indicate North
and the scale.)
• 2. A definite idea of where, and what size, you would like your house,
addition, pool, etc., to be.
3. The setback requirements for the zone (available from the Zoning
Department: 745-4436.)
COMPLIANCE WITH ZONING ORDINANCE: WrL-1A
Section(s) I'I q --I I lq - I(o 4
Require(s) E!fl setbacks lot width 0 buffer zone
En other LAg-ld,i;-� IN(,Izemp- t7rW
that cannot be met by the project as proposed.
Specific setback requirements should be provided on Page 2 of the Project Information
• pages. m
a
USING THE MAP OF THE PROPERTY, SHOW:
1. All proposed new buildings, etc., in relation to existing. Show dimensions 1n
clearly.
2. All setbacks affected by the project, existing and proposed. A
Z
3. Distances to adjacent owner's septic and well, if application involves n
installation or modification to septic or well, or if it could affect adjacent "'
systems.
4. Other items appearing on checklist with Project Information pages, as
appropriate. (If in doubt, inquire.)
ELEVATIONS:
Some projects are understood better if a drawing of what the project
will look like is provided, in addition to the map/plan.
Page 2
THE FOLLOWING QUESTIONS REFLECT THE CRITERIA FOR GRANTING THIS TYPE OF
VARIANCE. PLEASE COMPLETE THEM, USING ADDITIONAL SHEETS IF NEEDED.
1. How would you benefit from the granting of this Area Variance? I': wi('(' AWAA.)
115 Yb NA/>t/� tD Jk I AL?lhaZ. l huns� I,d rti. ,r I1/tA l� rD J �o /� tJ O t tl t,
• 2. What effect would this variance have on the character of the neighborhood and the health,
safety, and welfare of the community? kio i;✓
3. Are there feasible alternatives to this variance? W(>
4. Is the amount of relief substantial relative to the Ordinance? Nay--Wf_ C✓/uw 1c-5. Will the variance have an adverse effect or impact on the physical or environmental
conditions in the neighborhood or district? !{Ly
• m
a
IIZZ
I HAVE READ AND COMPLETED ALL APPLICABLE PORTIONS OF THE PROJECT
INFORMATION SHEETS, AS WELL AS THIS SIGN VARIANCE. TO THE BEST OF MY
KNOWLEDGE, ALL INFORMATION PROVIDED IS TRUE AND ACCURATE.
q 1� r Z
Applicant:u t pp �_ Date: It `lq n
T
Agent: Date: