Site Plan Application General Information
Tax Parcel ID: 30(1 , 1c—1 -3-7
a
Zoning District: \ot. t SAIre� � �
Lot size: § c C S f F
Current Use: '\/ct ca" -�--
Proposed Use: 10, ) 3 0 7 S-E R 0- o -4- Co - i /t /
Project Location: c—/ Y ch 1v\ S•V
Applicant Name Pc c4-G rrty,"c) 81St Address: to 15, tick""410-v‘ S)-
Home Phone 1 Cell:
Work Phone Fax
E-Mail: S'E4..Tee- `t@i (G 1
Agent's Name: Address:
Home Phone Cell:
Work Phone Fax
E-mail
Owner's Name: cAddress
oki"wc,.e_ '5 Ck�o v�
Home Phone Cell
Work Phone Fax
E-mail
Site Plan Review Revised March 2014 2
Town of Queensbury Planning Office.742 Bay Road• Queensbury, NY 12804• 518-761-8220
iw.
1
,,
Sith Development Data
Nov 1 8 2 ppea 1 Typp Existing sq.ft, Proposed total Sq.ift.
Addition sq.tt.
A. Building footprint
N//4 9 4 41
B. Eletached'Garege
iv/11 —
C. Accessory Structure(s) _
,v/4
D. Paved,gravel or other hard surfaced area
9. •55- 5--6-
E Porches]Decks
N/4
F. Other(i.e.boathouse, sundeck, etc.)
44 _ .....
G.Teta' NOn-Penneable [Add A-9
?4,55 94.3' /9, 503
H. Parcel Atea [43,560 sq.ft.!acre] .e,i. , 314
43, 3/4
_
...
L Percentage:of Imperrneable.Aree of Site [1G/1-11 2z%
____
Setback Requirements
Area. Required Existing Proposed
Front[1]
404 7.0 4- oc moitho sr..
Front[ J -2)
__
.
Shoreline
--
Side Yard I-I)
__
494D4. it I - - /2.. 5" muilmum -
Side Yard[21
,I
— — 4- 01,tiimum
Rear Yard 11.1:
/0 ' — &05c 1/2 'V i' '-
Rear Yard[21. .
— .--
TfaVel.Corridor -
..._
Height[max] _
40' — / S70/2
Perffeability 5X 7ä"A 56 x
NO.:Of p.arkitig spacet
11 rbo grAu.)
-
Site.1316n Review ReVised.Marqh 2014
Oti3
TowitoMpeprKtury piannirt Offjcp,74 By:13P -cl:' P6r.ist!ory,NY i80,1,51 77- 5:146220.
Additional Project Information
1. Will the proposal require a Septic Variance from the Town Board of Health? 0
2. If the parcel has previous approvals, list application number(s): t3 P 0 0 3 ~1 \ 0
3. Does this project require coverage under the NYS DEC Stormwater Pollution Prevention Program?
4. Estimated project duration: Start Date f ve�"k aot(0 End Date c-kcAd**-aG!
5. Estimated total cost of project: v4,.\\k a`°\
6. Total area of land disturbance for project: '103C00 St e,t+-
Floor Area Ratio Worksheet
FLOOR AREA RATIO (FAR) -- The relationship of building size to lot size, derived by dividing the total building
floor area by the lot size in square feet, yielding a percentage.
Zoning District Symbol Floor Area Ratio [FAR]
l c A.n
Waterfront Residential WR 0.22
Commercial Moderate/Commercial Intensive CM /CI 0.3
Main Street MS 0.3
A. The combined area of all square footage, as measure from exterior walls of all structures on the property, including all
floors of the structures, garages, basements and attics with more than five (5) feet of ceiling height and covered
porches. Building square footage does not include: Open deck, docks and that portion of covered docks extending
over water and one storage shed of one hundred twenty (120) square feet or less. Any additional sheds will be
included. (See"FLOOR AREA RATIO").
B. Commercial or industrial: the total area in square feet as measured from the exterior of the outside walls of a building
or structure, and when applicable,the sum total of all floor areas of the principal and accessory buildings or structures
on the project site.
A. Parcel Area Lk 3 G 0 sq. ft.
B. Existing Floor Area sq. ft. [see above definition]
C. Proposed Additional Floor Area sq. ft.
D. Proposed Total Floor Area O 6 7 0 sq. ft.
E. Total Allowable Floor Area (Area x ) [see above table]
*if D is larger than E, a variance or revisions to your plan may be needed. Please consult
w/Staff.
Site Plan Review Revised March 2014 4
Town of Queensbury Planning Office-742 Bay Road• Queensbury, NY 12804• 518-761-8220
§ 179-9-050 Application for Site Plan Review
Absent any waiver or waivers, an application for Site Plan Review shall include the following:
REQUIREMENTS Sheet#
A A vicinity map drawn at the scale that shows the relationship of the proposal to existing community facilities which affect or serve it,
such as roads, shopping areas, schools, etc. The map shall also show all properties, identify owners, subdivisions, streets, and
easements within 500 feet of the property. Such a sketch may be superimposed on a United States Geological Survey map of the
area.
B The site plan shall be drawn at a scale of forty feet to the inch (1"=40 feet) or such other scale as the Planning Board may deem
appropriate,on standard 24"x 36"sheets,with continuation on 8'/z"x 11"sheets as necessary for written information. The information
listed below shall be shown on the site plan and continuation sheets.
C Name of the project,boundaries,date,north arrow,and scale of the plan.
D Name and address of the owner of record,developer,and seal of the engineer,architect,or landscape architect. If the applicant is not
the record owner,a letter of authorization shall be required from the owner
E The location and use of all existing and proposed structures within the property, including all dimensions of height and floor area,all I
exterior entrances,and all anticipated future additions and alterations.
F The location of all present and proposed public and private ways, off-street parking areas, driveways, outdoor storage areas,
sidewalks,ramps,curbs,paths,landscaping,walls,and fences. Location,type,and screening details for all waste disposal containers
shall also be shown.
G The location,height, intensity,and bulb type(sodium, incandescent,etc.)of all external lighting fixtures. The direction of illumination
and methods to eliminate glare onto adjoining properties must also be shown in compliance with§179-6-020.
H The location,height,size,materials,and design of all proposed signs.
I The location of all present and proposed utility systems including:
1. Sewage or septic system;
2. Water supply system;
3. Telephone,cable,and electrical systems; and
4. Storm drainage system including existing and proposed drain lines, culverts,catch basins, headwalls, endwalls, hydrants,
manholes,and drainage swales. 3
Plans to prevent the pollution of surface or groundwater, erosion of soil both during and after construction, excessive runoff, and
flooding of other properties, as applicable. A Stormwater Pollution Prevention Plan (SWPPP) for all land development activities
(excluding agricultural activities) on the site that results in land disturbance of 1-acre or more. A SWPPP shall comply with the
requirements of the DEC SPDES MS-4 General Permit and Chapter 147 of the Town of Queensbury Code. It shall be at the
discretion of the Planning Board as to whether a SWPPP or an erosion and control plan shall be required for a site plan review project
land disturbance of less than 1-acre.
K Existing and proposed topography at two-foot contour intervals, or such other contour interval as the Planning Board shall allow. All
elevations shall refer to the nearest United States Coastal and Geodetic Bench Mark. If any portion of the parcel is within the 100-
year floodplain,the area will be shown,and base flood elevations given. Areas shall be indicated within the proposed site and within
50 feet of the proposed site where soil removal or filling is required,showing the approximate volume in cubic yards.
L A landscape plan showing all existing natural land features that may influence the design of the proposed use such as rock outcrops,
stands of trees, single trees eight or more inches in diameter,forest cover, and water sources, and all proposed changes to these
features including sizes and types of plants. Water sources include ponds, lakes,wetlands and watercourses,aquifers,floodplains,
and drainage retention areas.
M Land Use District boundaries within 500 feet of the site's perimeter shall be drawn and identified on the site plan, as well as any
Overlay Districts that apply to the property.
Site Plan Review Revised March 2014 6
Town of Queensbury Planning Office.742 Bay Road • Queensbury, NY 12804• 518-761-8220
REQUIREMENTS CONTINUED Sheet#
N Traffic flow patterns within the site,entrances and exits,and loading and unloading areas,as well as curb cuts on the site and within
100 feet of the site. The Planning Board may, at its discretion, require a detailed traffic study for large developments or for those in
heavy traffic areas,which shall include:
1. The projected number of motor vehicle trips to enter or leave the site, estimated for weekly and annual peak hour traffic
levels;
2. The projected traffic flow pattern including vehicular movements at all major intersections likely to be affected by the
proposed use of the site;
3. The impact of this traffic on levels of service on abutting public streets and at affected intersections. Existing and proposed
weekly and annual peak hour traffic levels and road capacity levels shall also be given.
O For new construction or alterations to any structure,a table containing the following information shall be included:
1. Estimated area of structure to be used for particular purposes such as retail operation,office,storage,etc.;
2. Estimated maximum number of employees;
3. Maximum seating capacity,where applicable;and
4. Number of parking spaces existing and required for the intended use.
P 1. Floor Plans.
2. Elevations at a scale of one-quarter inch equals one foot(1/4"=1 foot)for all exterior facades of the proposed structure(s)and/or '1
alterations to or expansions of existing facades,showing design features and indicating the type and color of materials to be used. �!
Q Soil logs, water supply well and percolation test results, and storm runoff calculations, as needed to determine and mitigate project
impacts.
R Plans for disposal of construction and demolition waste,either on-site or at an approved disposal facility. r /f-
S Plans for snow removal,including location(s)of on-site snow storage.
T An Environmental Assessment Form("EAF'),as required by the SEQRA regulations,with Part 1 completed by the Applicant shall bep f,o �
submitted as part of the application. If the proposed project requires a special use permit and an EAF has been submitted in
conjunction with a special use permit application,a duplicate EAF is not required for the site plan application..
U If an application is for a parcel or parcels on which more than one use is proposed,the applicant may submit a single application for
all such uses provided the proposed uses are accurately delineated on a site plan drawn pursuant to the requirements set forth
above. The Planning Board may grant the application with respect to some proposed uses and not others. For purposes of reviewing 11/4._
an application (and for SEQRA compliance) all proposed uses on a single parcel or on contiguous parcels shall be considered
together.
✓ A brief narrative statement on how the project proposed for review furthers or is consistent with the vision, goals and policies in the -rti.C[,.,!
Town's Comprehensive Plan.
Site Plan Review Revised March 2014 7
Town of Queensbury Planning Office.742 Bay Road• Queensbury, NY 12804• 518-761-8220
Pre-Submission Conference Form [179-4-040]
1. Tax Map ID 0 9 ,
2. Zoning Classification h1"\ vt r. ‘
T-
3. Table of Allowed Uses is subject to Site Plan Review
4. Ordinance Section#
5. Pre-Submission Meeting Notes; Outstanding Items To Be Addressed Include:
Deed Yes No
General Information complete Yes No
Site Development Data Complete Yes No
Setback Requirements Complete Yes No
Additional Project Information Complete Yes No
*Coverage under DEC SWPPP Program Yes No
FAR Worksheet complete Yes No
Standards addressed Yes No
Checklist items addressed Yes No
Environmental Form completed Yes No
Signature Page completed Yes No
*Applicant must provide office with Notice of Intent (NOI): SWPPP Acceptance Form, DEC letter issuing permit number;
Notice of Termination (NOT)
Staff Representative:
Applicant/Agent:
Date:
Site Plan Review Revised March 2014 8
Town of Queensbury Planning Office. 742 Bay Road • Queensbury, NY 12804 518-761-8220
Signature Page
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: N'rwl rv..MS A-Se 14s SA-> •}s 510
Designates:
As agent regarding: Variance Site Plan Subdivision
For Tax Map No.: Section Block Lot
Deed Reference: p B k �\
W LPage tt Date I I
OWNER SIGNATURE: Vr(., DATE: 1 `a R l�
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: Variance Site Plan Subdivision
For Tax Map No.: Section Block Lot
Deed Reference: Book Page Date
APPLICANT 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 -haavee read and agree to the above.
' '!` 1Nne gym,tit' Sieb\t" VIAQ K" I (C. i S
Signature [Applicant] Print Name[Applicant] Date signed
Signature [Agent] Print Name[Agent] Date signed
Site Plan Review Revised March 2014 9
Town of Queensbury Planning Office-742 Bay Road• Queensbury, NY 12804• 518-761-8220
617.20
Appendix B
Short Environmental Assessment Form
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:
cn YY\ sr 4)14lc
ProjectojLocation(describe,and attach a location map):
c6 ih %rev_
Brief Description of Proposed Action: � Y-'"1Sti PtC� �
SF �V)3O4 0 f (l`e- 1t "." s•Kv,ct 1
Name of Applicant or Sponsor: Telephone: SclQ"^4 (p — i c,a
Pe e cr 4"-•t 4S 5 11-ist r t, LL-C- E-Mail: S h y y � .1 C ca(� wrl;cc
Address: C
1�-Cls " Aai vir 1 S C� J
City/PO: State: Zip Code:
sqVol.A Gsct Sio,r s 1 a4 4 0-C ‘'
1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES
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.
2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES
If Yes,list agency(s)name and permit or approval:
3.a.Total acreage of the site of the proposed action? (l 14 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 1 d uses that occur on,adjoining and near the proposed action.
rban 0 Rural(non-agriculture) 0 Industrial 0 Commercial 0 Residential(suburban)
o Forest 0 Agriculture 0 Aquatic 0 Other(specify):
❑Parkland
Page 1 of 4
18.Does the proposed action include construction or other activities that result in the impoundment of NO YES
water or other liquids(e.g.retention pond,waste lagoon,dam)?
If Yes,explain purpose and size:
19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES
solid waste management facility?
If Yes,describe: ,(
20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES
completed)for hazardous waste?
If Yes,describe:
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE
Applicant/spon en 4')`1"'"(1- wm44 A €% sceAsw, Date: ( lid f r.
Signature: V` t vr.11t✓
Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. 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 Moderate
small to large
impact impact
may may
occur 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)? V
5. Will the proposed action result in an adverse change in the existing level of traffic or /r
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)?
Page 3 of 4