ApplicationSign Variance [ZBA approved September 21 2016]
General Information
Tax Parcel ID Number: ____________________
Zoning District: ____________________
Detailed Description of Project [include current & proposed use]:
Current Use: _________________________________________________________________
Proposed Use: ____________________________________________________________
Location of Project: _______________________________________________________________
Applicant Name: Mailing Address
Home Phone City, State, Zip
Work Phone Cell Phone
E-Mail: FAX No.
Agent’s Name: Mailing Address
Home Phone City, State, Zip
Work Phone Cell Phone
E-mail FAX No.
Owner’s Name Mailing Address
Home Phone City, State, Zip
Work Phone Cell Phone
E-mail FAX No.
Page 1
Sign Variance [ZBA approved September 21 2016]
Site Development Data
Area / Type Existing sq. ft. Proposed
Addition sq. ft.
Total sq. ft.
A. Building footprint
B. Detached Garage
C. Accessory Structure(s)
D. Paved, gravel or other hard surfaced area
E. Porches / Decks
F. Other
G. Total Non-Permeable [Add A-F]
H. Parcel Area [43,560 sq. ft. / acre]
I. Percentage of Impermeable Area of Site [I=G/H]
Setback Requirements
Area
Required Existing Proposed
Front Yard [1]
Front Yard [2]
Shoreline
Side Yard [1]
Side Yard [2]
Rear Yard [1]
Rear Yard [2]
Travel Corridor
Height [maximum]
Permeability
Number of parking spaces
Page 2
Sign Variance [ZBA approved September 21 2016]
Compliance with Chapter 147 Sign Ordinance
1. A scaled drawing of the entire sign(s) and site plan drawing showing the location is to be included in the
submission packet ie on building and on site. Please note a survey is required unless a waiver is granted.
2. This application is for a change in the (check all that apply):
_______ Number of Signs: from (currently): ____________ to (proposed): _____________
_______ Setback for Sign
_______ Size of Sign
_______ Height of Sign
_______ Other (specify) __________________________________________
3. Sign Dimension(s)
Sign Type Existing
(Check)
Proposed
(Check)
Length
(ft)
Width
(ft)
Total
(Sq Ft)
Height
(ft)
Wall
Wall
Freestanding
Freestanding
Other ie panel
Projecting
Awning
Illuminated Type:
4. Property Line Setbacks Front/ Rear ______________ Side _____________
5. Sign Wording: _______________________________________________________________________
6. Additional information if applicable_________________________________________________________
_________________________________________________________________________________________
Page 3
Sign Variance [ZBA approved September 21 2016]
The following questions reflect the criteria for granting this type of variance. Please complete them; use additional
sheets if needed.
1.Whether an undesirable change will be produced in the character of the neighborhood or a detriment to nearby
property will be created by the granting of this sign variance?
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
2.Whether the benefit sought by the applicant can be achieved by some method, feasible for the applicant to pursue,
other than a sign variance?
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
3.Whether the requested sign variance is substantial?
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
4.Whether the proposed variance will have an adverse effect or impact on the physical or environmental conditions in
the neighborhood or district?
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
5.Whether the alleged difficulty was self-created?
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Additional Project Information
1. If the parcel has previous approvals, list application number(s): _________________________
2.Does this project require coverage under the New York State Pollutant Discharge Elimination System (SPDES) Permit
Program? __ Yes / __ No
3. Estimated project duration: Start Date __________ End Date __________
4. Estimated total cost of project: _______________
Page 4
Sign Variance [ZBA approved September 21 2016]
Section 179-14-030
Application materials and site plan drawing is to include sufficient information for the Board to review and provide a decision. The
applicant is to provide a site plan drawing(s) – a survey showing existing conditions, a proposed conditions map (see page 00 for
specific criteria) and include any other attachments that address A - D as applicable to the proposed project.
A. General Shown on Sheet #
1 Title, Name, Address of applicant & person responsible for preparation of drawing
2 Deed
3 North arrow, Tax Map ID, date prepared and scale [minimum: 1 inch = 40 feet ]
4 Boundaries of the property plotted to scale, zoning boundary
5 Principal structures, accessory structures with exterior dimensions
6 Site improvements incl. outdoor storage areas, driveways, parking areas, etc.: existing &
proposed
7 Setbacks for all structures and improvements: existing & proposed
8 Elevations and floor plans of all proposed and affected structures
B. Water & Sewer Shown on Sheet #
1 Project sewage disposal facilities, design details, construction details, flow rates, and number of
bedrooms proposed
2 Water supply [i.e. well] & septic on adjoining lots with separation distances to existing or
proposed on-site water supply and septic
3 Separation distances for proposed sewage disposal system to well and water bodies
4 Existing public or private water supply [well, lake, etc.]. Method of securing public or private
water, location, design and construction of water supply including daily water usage
5 Percolation test location and results
C. Parking / Permeable Areas Shown on Sheet #
1 Number of spaces required for project including calculations and justification: existing &
proposed
2 No. of existing parking spaces, number to be removed, number to maintain and type of surfacing
material [e.g., gravel, paved]
3 Provision for pedestrian and handicap access and parking: existing & proposed
4 Design details of ingress, egress, loading areas and cutting: existing & proposed
5 Location and character of green areas [existing and proposed], modification to green area, buffer
zone to remain undisturbed
6 Lighting, location and design of all existing and proposed outdoor lighting
D. Additional Site Development and Miscellaneous Shown on Sheet #
1 On-site & adjacent watercourses, streams, rivers, lake and wetlands
2 Utility / energy distribution system [gas, electric, solar, telephone]: existing & proposed
3 Location, design and construction details of all existing and proposed site improvements
including: drains, culverts, retaining walls, fences, fire & emergency zones and hydrants, etc.
4 Square footage of bldg. area proposed for office, manufacturing, retail sales or other commercial
activities: existing & proposed
5 Signage: Location, size, type, design and setback: existing & proposed
6 Waiver Request: provide letter with application requesting any waivers: please reference
specific items
7 Commercial / Industrial Development requires submission of Landscaping, Stormwater
Management, Grading & Lighting Plans
8 Identification of Federal, State or County permits required for the project together with a record
of application for all necessary permits
Page 5
Sign Variance [ZBA approved September 21 2016]
Pre-Submission Conference Form / Section 179-9-040
1. Applicant Name: __________________________________________________
2. Tax Map ID ________________ Location: _______________________
3. Zoning Classification __________
4.Reason for Review: __________________________________________________________
5. Zoning Section #: ________________________
6. Pre-Submission Meeting Notes:Provided Outstanding; Please provide by
Deed ____ _____________
General Information complete ____ _____________
Site Development Data Complete ____ _____________
Setback Requirements Complete ____ _____________
Additional Project Information Complete ____ _____________
FAR addressed ____ _____________
Compliance with Zoning Ordinance ____ _____________
Checklist items addressed ____ _____________
Environmental Form completed ____ _____________
Signature Page completed ____ _____________
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__________________________________________________________________________________________________
Staff Representative: ________________________________
Applicant / Agent: ________________________________ Date: ___________
Page 6
AdirondackTrust Company
309.10-1-48 79 Main Street
MS
New monument sign of 45 Sq ft in the Main Street zoning district-setback
140-setback
x
x
x
x
x
NA
x
x
x
x
Laura Moore via email 02182021
The applicant proposes to install a 45 sq ft free standing monument sign for the Adirondack Trust Bank under
construction at 79 Main Street. The project is subject to a sign variance due to the setback requirements;
proposed is 0.62 ft where a 15 ft setback is required. The Main Street zoning district also requires new signs in
the district require site plan review. The code section requires information on materials, lighting. The sign
does not have any lighting where the code allows for lighting that is downcast. The sign materials are acrylic
and color is green and white and black with a stone base. The materials allowed are to be made of durable
materials, Materials used can be wood, metal, stone, brick or similar materials where resin or composite
materials that give appearance of traditional materials.
Reviewed site plan application, sign variance application, survey, sign details.
Items to update or provide
1)signatures needed for property owner.
Sign Variance [ZBA approved September 21 2016]
This page includes the 1.) Authorization to Act as Agent Form: 2.) Engineering Fee Disclosure; 3.) Authorization for Site Visits; 4.)
Other Permit Responsibilities; 5.) Official Meeting Disclosure and 6.) Agreement to provide documentation required.
OWNER’S AGENT FORM: Complete the following if the OWNER of the property is not the same as the applicant:
Owner: _________________________
Designates: ___________________________ as Agent regarding the following:
Variance ___ Site Plan ___ Subdivision ___
For Tax Map No.:________________ Deed Reference: Book____ Page ____ Date ____
OWNER SIGNATURE: ___________________________________ DATE: _______________
APPLICANT’S AGENT FORM:Complete the following if the APPLICANT is unable to attend the
meeting or wishes to be represented by another party:
Owner: __________________________
Designates: ____________________________________ as Agent regarding the following:
Variance___ Site Plan ___ Subdivision ___
For Tax Map No.:________________ Deed Reference: Book____ Page ____ Date ____
OWNER SIGNATURE: ___________________________________ DATE: _______________
2.) ENGINEERING FEE DISCLOSURE: Applications may be referred to the Town consulting engineer for review of septic design, storm
drainage, etc. as determined by the Zoning or Planning Department. Fees for engineering review services will be charged directly to the applicant.
Fees for engineering review will not exceed $ 1,000 without notification to the applicant.
3.) AUTHORIZATION FOR SITE VISITS: By signing this page and submitting the application materials attached herein, the Owner, Applicant,
and his/her/their agent(s) hereby authorize the Zoning Board or Planning Board and Town Staff to enter the subject properties for the purpose of
reviewing the application submitted.
4.) OTHER PERMIT RESPONSIBILITIES: Other permits may be required for construction or alteration activity subsequent to approval by the
Zoning Board or Planning Board. It is the applicant’s responsibility to obtain any additional permits.
5.) OFFICIAL MEETING MINUTES DISCLOSURE: It is the practice of the Community Development Department to have a designated
stenographer tape record the proceedings of meetings resulting from application, and minutes transcribed from those tapes constitutes the official
record of all proceedings.
6.) AGREEMENT TO PROVIDE DOCUMENTATION REQUIRED: I, the undersigned, have thoroughly read and understand the instructions
for submission and agree to the submission requirements, I acknowledge no construction activities shall be commenced prior to issuance of a valid
permit. I certify that the application, plans and supporting materials are a true and complete statement/description of the existing conditions and the
work proposed, and that all work will be performed in accordance with the approved plans and in conformance with local zoning regulations. I
acknowledge that prior to occupying the facilities proposed, I or my agents, will obtain a certificate of occupancy as necessary. I also understand that
I/we may be required to provide an as-built survey by a licensed land surveyor of all newly constructed facilities prior to issuance of a certificate of
occupancy
I have read and agree to the above.
______________________________ _____________________________ _______________
Signature [Applicant] Print Name [Applicant] Date signed
______________________________ _____________________________ _______________
Signature [Agent] Print Name [Agent] Date signed Page 7
Short Environmental Assessment Form
Part 1 - Project Information
Instructions for Completing
Part 1 - Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses
become part of the application for approval or funding, are subject to public review, and may be subject to further verification.
Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully
respond to any item, please answer as thoroughly as possible based on current information.
Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful
to the lead agency; attach additional pages as necessary to supplement any item.
Part 1 - Project and Sponsor Information
Name of Action or Project:
Project Location (describe, and attach a location map):
Brief Description of Proposed Action:
Name of Applicant or Sponsor: Telephone:
E-Mail:
Address:
City/PO: State: Zip Code:
1. Does the proposed action only involve the legislative adoption of a plan, local law, ordinance,
administrative rule, or regulation?
If Yes, attach a narrative description of the intent of the proposed action and the environmental resources that
may be affected in the municipality and proceed to Part 2. If no, continue to question 2.
NO YES
2. Does the proposed action require a permit, approval or funding from any other governmental Agency?
If Yes, list agency(s) name and permit or approval:
NO YES
3.a. Total acreage of the site of the proposed action? ___________ acres
b. Total acreage to be physically disturbed? ___________ acres
c. Total acreage (project site and any contiguous properties) owned
or controlled by the applicant or project sponsor? ___________acres
4. Check all land uses that occur on, adjoining and near the proposed action.
9 Urban 9 Rural (non-agriculture) 9 Industrial 9 Commercial 9 Residential (suburban)
9 Forest 9 Agriculture 9 Aquatic 9 Other (specify): _________________________
9 Parkland
Page 1 of 3
Page 2 of 3
5. Is the proposed action,
a. A permitted use under the zoning regulations?
b. Consistent with the adopted comprehensive plan?
NO YES N/A
6. Is the proposed action consistent with the predominant character of the existing built or natural
landscape?
NO YES
7. Is the site of the proposed action located in, or does it adjoin, a state listed Critical Environmental Area?
If Yes, identify: __________________________________________________________________________
_______________________________________________________________________________________
NO YES
8. a. Will the proposed action result in a substantial increase in traffic above present levels?
b. Are public transportation service(s) available at or near the site of the proposed action?
c. Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action?
NO YES
9. Does the proposed action meet or exceed the state energy code requirements?
If the proposed action will exceed requirements, describe design features and technologies:
_______________________________________________________________________________________
_______________________________________________________________________________________
NO YES
10. Will the proposed action connect to an existing public/private water supply?
If No, describe method for providing potable water: ______________________________________
_______________________________________________________________________________________
NO YES
11. Will the proposed action connect to existing wastewater utilities?
If No, describe method for providing wastewater treatment: ________________________________
_______________________________________________________________________________________
NO YES
12. a. Does the site contain a structure that is listed on either the State or National Register of Historic
Places?
b. Is the proposed action located in an archeological sensitive area?
NO YES
13. a. Does any portion of the site of the proposed action, or lands adjoining the proposed action, contain
wetlands or other waterbodies regulated by a federal, state or local agency?
b. Would the proposed action physically alter, or encroach into, any existing wetland or waterbody?
If Yes, identify the wetland or waterbody and extent of alterations in square feet or acres: _______________
_______________________________________________________________________________________
_______________________________________________________________________________________
NO YES
14. Identify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply:
Shoreline Forest Agricultural/grasslands Early mid-successional
Wetland Urban Suburban
15. Does the site of the proposed action contain any species of animal, or associated habitats, listed
by the State or Federal government as threatened or endangered?
NO YES
16. Is the project site located in the 100 year flood plain?NO YES
17. Will the proposed action create storm water discharge, either from point or non-point sources?
If Yes,
a. Will storm water discharges flow to adjacent properties? NO YES
b. Will storm water discharges be directed to established conveyance systems (runoff and storm drains)?
If Yes, briefly describe: NO YES
_______________________________________________________________________________________
_______________________________________________________________________________________
NO YES
18. Does the proposed action include construction or other activities that result in the impoundment of
water or other liquids (e.g. retention pond, waste lagoon, dam)?
If Yes, explain purpose and size: ____________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
NO YES
19. Has the site of the proposed action or an adjoining property been the location of an active or closed
solid waste management facility?
If Yes, describe: _________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
NO YES
20. Has the site of the proposed action or an adjoining property been the subject of remediation (ongoing or
completed) for hazardous waste?
If Yes, describe: __________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
NO YES
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE
Applicant/sponsor name: ___________________________________________ Date: ___________________________
Signature: _______________________________________________________
Page 3 of 3
Page 1 of 2
Agency Use Only [If applicable]
Project:
Date:
Short Environmental Assessment Form
Part 2 - Impact Assessment
Part 2 is to be completed by the Lead Agency.
Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by
the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by
the concept “Have my responses been reasonable considering the scale and context of the proposed action?”
No, or
small
impact
may
occur
Moderate
to large
impact
may
occur
1. Will the proposed action create a material conflict with an adopted land use plan or zoning
regulations?
2.Will the proposed action result in a change in the use or intensity of use of land?
3.Will the proposed action impair the character or quality of the existing community?
4.Will the proposed action have an impact on the environmental characteristics that caused the
establishment of a Critical Environmental Area (CEA)?
5.Will the proposed action result in an adverse change in the existing level of traffic or
affect existing infrastructure for mass transit, biking or walkway?
6.Will the proposed action cause an increase in the use of energy and it fails to incorporate
reasonably available energy conservation or renewable energy opportunities?
7.Will the proposed action impact existing:
a. public / private water supplies?
b. public / private wastewater treatment utilities?
8.Will the proposed action impair the character or quality of important historic, archaeological,
architectural or aesthetic resources?
9.Will the proposed action result in an adverse change to natural resources (e.g., wetlands,
waterbodies, groundwater, air quality, flora and fauna)?
10.Will the proposed action result in an increase in the potential for erosion, flooding or drainage
problems?
11.Will the proposed action create a hazard to environmental resources or human health?
Page 2 of 2
For every question in Part 2 that was answered “moderate to large impact may occur”, or if there is a need to explain why a
particular element of the proposed action may or will not result in a significant adverse environmental impact, please
complete Part 3. Part 3 should, in sufficient detail, identify the impact, including any measures or design elements that
have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency
determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting,
probability of occurring, duration, irreversibility, geographic scope and magnitude. Also consider the potential for short-
term, long-term and cumulative impacts.
Check this box if you have determined, based on the information and analysis above, and any supporting documentation,
that the proposed action may result in one or more potentially large or significant adverse impacts and an
environmental impact statement is required.
Check this box if you have determined, based on the information and analysis above, and any supporting documentation,
that the proposed action will not result in any significant adverse environmental impacts.
_________________________________________________ _______________________________________________
Name of Lead Agency Date
_________________________________________________ _______________________________________________
Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer
_________________________________________________ _______________________________________________
Signature of Responsible Officer in Lead Agency Signature of Preparer (if different from Responsible Officer)
Short Environmental Assessment Form
Part 3 Determination of Significance
Agency Use Only [If applicable]
Project:
Date: