Site Plan Application TOWN OF QUEENSBURY
r Site, Plan Review Application
EReyiew Process:
1, Required Pre-submission meeting with staff to determine geuncral completeness to be held no later than P.
week prior to deadline day. Call (51 8) 761-8265 or ( l ) 761-8 0 for an appointment.
20 Submittal of c rn. lete,application. l original. and lel copies of the application package by monthly deadline.
I Deterunnination of application completeness. All necessary information must be provided and appropriate
fee :s paid for consideration for pl,a,cernemnt on an agenda for that month.
Inconi °mete au licationsF wil.1 not be considered for lmmceorrnent on any a enJa until all missing
information hns been s,ulumwmitted.
Submittal to Warren County Planning,, if applicable.
6. Planning acrd meeting,, , eunerally the third, & l'OUrth Tuesday of each month. You will be advised in
writing as to which nnrnectin ,to attend.,
7, Following the meeting; you will be provided with mm copy o tine resolution stating the Board's decis,io n on
your application. Ifyour ,application was approved, the new likely step is a Building Permit. Final
drawing's rnu5t be provided for the next phase of review. if your application wvas denied, your project cannot
pr oceed as submitted.
DOCUMENTATION REQUIREMENTS (hard col2V & electronic),-,
Ple; se sn:ubmmni P original & 14,coUigs of-the completed application package to include:
omrn meted licnmti umn put ues - ", sigun d dated
a Pr"ubmis ion Meeting Notes: signed by staff
0 Copy of Deed
0 Checklist& Plot Plan
a Environmental nment;al s es mnnemnt Form for any non-residential project
0Fee: 100 (0 — 10,00 sq,. ft,.;) 50 (10,001 — 30,000 sq. ft. ; S 5 (30,001 -100,000 sq. ft.) 1,000
1010,01010+ sq. ft.
Staff Contact Information-
Craig Brown, Zoning.Administratar craigbkgueeusbury,mmek
Laura Moore, Land Use Planner lmnoore(ar t ueensbury.mnet
uunny Sweet, Office Specialist— Planning sunn suecum,sbnu ,uet1(518) '761-8220
''visit our website at nww , uueensbu .mmet for further ini'onnationa and forms
Site Plain Revirew application—Revised October 2016
'T'own ofQueensbury Plana,.in Office-742 Bad Road.,Quefnsb ury,NY 12804
General Information
I"ax Parcel IDNumber: 302,05-1-97
Zoning ]district: ES
Lot size 2-0.acres
Detained Description of.Project [includes current&props sedl Use]:
jb .ap "jWjf . mpe5ljj[&:a `Sj le Plan M:MaficaRaa^n"to ffif�xi��u„!��`. ��, h„ ' ,�. w„ �,�. � , �. �. is currently and
will confi ue to be naeerrpled by a 5,40 01- S Bro Dinen The app 11icant proposes to modify the existing parking and drive a;y a long the
easterly boundary to facilitate connection, rnt IW Msu�e :rivcww°ay proposed by offiers under separate application,
Location of project:
51'8 Aviation Road near the N ortlibound exit mrannp for 1-97.
Applicant Name: Queensbury Diner, LLC address. 5 18 Aviation Road,C u,ueensbunry '
I rruue Phone Anastasia Pilatinas cell:
Work Pl>Ionye 518-636-5486 Fa
E-Mail:
Agent's Nam e: �"uddre s,:
• 17 Corn, �uuer Drive West,�,llaaun: td's
ldraluler nu�lunee;rnrrr ha9�,l�l.N : �° b �°^
Home Phone ell„ 5 1€4-573-477 .
`wu�rk _ Prue.
1'8-43'8- 9lltu
E-mail
.jacoi.iaouu( 6 lvle,reng.,c,armz
Owner's Name Address 5l� Aviation Road, ueeuualruau�°,l�'
u mAm m nsbury Diner, LL
Horne Phone _ Cell
A nasrasia Pilarinos
Work Phone Fax
E-Mail
Site Plan Review applimsation—Revised October 2016,
Town of Queen,,ftryPlarnaninng ffice-7142 Bay Road, ueen"nsbury',NY 12804
Site DeyLlopnvnt Data
,Area/Type �,• . Existing ft. Proposed, Total sq.
ft.. .
Addition 5g. ft,
A. Building footprint 5,401 01 5,4001
B. Detached Garage 0 O 0
C. Accessory trurctuure(s) � tl 0
D. Paved, gravel or ether hard surfaced area 610,345 01 60,380
E. Porches/Checks 0 0 �
F, Other 0 0
-5—Ttal on-Permeable [Add -;F'] 65;,745 tt 65,780,
H.. Parcel area [43,560 sq. ft. /acre] 87,120 0 87,,1 20
p. 'euceuutag,e of Impermeable ,area of Site [1—GII-i]I 0.75 0,25 0.76
Setback guir r ent
Area, Required i ting Proposed
Front [I I 4(Y 9W N a Change
Front [ ]
Shoreline
Side Yard [9] 30' 75" NO Change
Side Yard [ ] 36' 78.111, No Change
Rear Yard �[11 301 273.85' No Change
Rear Yard [ ] a
Travel Corridor 40' 90, No Change.
Height ht [q'aa ] 70" 0'when closer than 100 7v 1 No C hara e
Perrrpea uii�y 0% 24% No Change
No.of parking spares see patrking-:hart See parking chart No change
i
3
Site Plan Review application m Revised Octobler 201,6
Tovoi of QL,ieevsburry'horningOffice-742 Bay Road,Queensbury,NY 12804
Additional Pro' t; Information
I Will the proposal require a Septic Variance from the"I"own Board of Health? No
2. If tile parcel has previous approvals,, list application number(s): NIJ
........................
I. Does this project require coverage under the New York. State: Pollutant Discharge Elimination System
(SPD.ES) Pennit Program ,? no
4. Estimated project,duration: Start Date July 2017 End Date May 2018
51. Estimated total cost of project: 75,000
6. Total area, of land disturbance for project: sf(0.13 ae),
Floor Area Ratio Worlobeet
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 Flo�or Area Ratio, [FAR]
'Waterfront Residential WR 0.22
Commercial Moderate/ Intensive CM/ C1 0.3
A. The combined area of all square footage, as ineasure 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 euMing over water and one storage shed of one hundred twenty (120) square fOet or less.,
Any addiltilorial 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, wall$ 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
B. Existing Floor-, rea si ., fl. [see above deffi]j!j2qJ
...............
C. Propost�q.,Add itiona I Eloqr.Ar�ea fl.
d
D. ProposcA Total Floor Area sq. ffw
E. Total AflowableFloor,area (area see above tablel
"If D is larger than E. a variance or revisions to your plan mem be needed. Co�nsult with Staff,
Site Plan Review applicadon—Revised October 2016
Town of Queeiiisbury PlanAng Office-742 day Road,Queensbury,NY 12804
179-9-080, Reguiremant s, for Site Plan Appraili
`1'.he Planning Board shall not approve a Sit! Plan unless i't first determines that such site .plant P
� Iameets the
following Standards. Please prepare responses,to each of the following topics:
STANDARDS
A. llie propas;ied project Furthers or is consistont willi the Policies of thell"o%va's Comprehensive Plan ycs
13, Alie proposed pnlicTi,complics with all onier Wqjimments of this Chapter,including.the si,l4 piton Fcvicw standards as set forth in
F of thiqsectiorl,flic dimensional,bulk and density regulations of the zoning district in,iiiiii it is proposed to be Ideated(Article 3 and
Table 1),the applicable requirements of a]I offier Artit.10.9 I hot apply,, yes
a a
C. the silo Plan encourages pedestrian activity internally and, if"practicable,to and from the site with pedestrian paths or sidewalk.5connected
to adjj-acent arem yes
am
D. The:site plan must conform to dippitcr 136 Sewage and.Sewage Disposol,Chapter 147 Storrawater Managenrient Local Law,and other
'porI ic:jc Im,
apol icame local laws.YC,9
E. Thc proposed wase Sir all be in liarmony Vdth tile general purpose oar r intent ofthis Chapter,specifically taking into account tile location,
charaotc,r and size of the proposed mase.and the description and purpose ofthe district In which such use is piropiosed:,the nature and intensity
ofthe activities to bc involved in or conducted in connection with the proposed use and the nature and raic of any increase in the bunim on
supporting pub I ic$cry iccs and facilities which M I I follow the approval of the proposed orae, Yes
...........
The establishment,maintenance and operation of the proposed use� yj I I not create pubiflc�hazards(roan tri trallic,congestio In air the
parking of vcli ic les and/or equipment or be otherwise clegrimentaa to the heaItb,safety or general welfare ofpersons residing or working in
the neighborhood ortothe generalvvclfarco�filictoNmi. "fraffic access and circullation,road intersections,road and driveway wkiths and
traffic oontro,ls will be adequate. Yes
G. OfPstrect parking and l9oa4ing facilific-swill,be appropriately locatcdand arranged and sufficient to sleet traMoonti6patedtoi begenerated
b'y the new use. The establisirntent ol-vehicic links between parking areas ofadjaperis propicinics arc provided where feasible. Th is furthers
the Town's goal of reducing curb cots and reducing CGI1gCSti0f11r A titiventy-foot wide Connection is required,. If adjacent properties are either
undeveloped or previously developed lvithoW having cnida provision for future fink4ge,then a Future connevion must be identiFied and
provided for in the site plan undcr rciview for such future linkage when tile time arises, Tlie Planning Boardjilay requilru pirociftlial the
applicant has madc contact wi th acljoeenq property owners far purposes of coord inat ing linkqges with adjacent properties- Yes
H. 17hic project shall not have art unduc adverse impact upon tire naloral,scenic,aesthetic,ecological,wildli�rb,historic,t"MaNiGnal oropeir
Space ri of the town or the Ad4vindrick Park or upon the adequate prow is ion of Srupporting facilities ifles and services made riecc ssary by
the project,taking Wo account the cionertencial,industrial,residential,recreational of other benefits that might be:derivedfrom the project.
In making the determi not ion hereunder,the Planning 1I shall consider fluase fhoors pertinent to,the projicictcontained in the
development corsiAcrations,set forth herein under§ 179-9-080 of fli is(71tapler,and in so doing the Plan aing Board shall make a net overall
evalunficin of the project in relation to the dicyclopment objectiveq an(!goncral guidelines set farth in 9 1719-9-080 of-Itbis Article. yes
............
"Th-a provision for and arrangement of pedestrian traffic access and icir(4i I walkway structures,control of intersecOons with vehicular
traffic.and overall pedestrian icanvenieii,cc Aall be safe and adequate 1br pedlestriari roovemant. Pedestrian ocinnectiolls between adjacent
sitessho I I be provided to encouraV pledestrian usc.Yes
J. Stormwater drainage fficillities will prevent an increase of post development drainage flows as cornpared to pre-developmCnIt:drainage flows.
Drainage ofthe site shall recharge ground water to the extent practical. Surtace waters flovdng off-site shall trotdegradie ally Streams or
adversely at Met drainage on adjacent properties or public roads,. Facilities shot I be:in conformance with the:drain age standards o F Chapter
147 of MeTown Code and the Town of Queensbttry Subdiv�islon Regulations:where appl ioable.Yes
K The water supply and 9-ni disposal facilities will be adequate and will mccl all applicable and current requiremori set forth by
Department of Health regulations and Chapter 116 of t[I Town Code, ycs
L The adequacy,type and arrange mcm of trees,Shrubs and otttervr suitable plantings,landscaping and—sereening shall affelutivicly prov—idea
visual andlor noise buffir between the applicants and adjoining Lands,ii1oluding ft maximurn retention oflexisfing vegetation;and
mai ntcnancc, including.repla"Mient of dead or deceased plants.. yes
M. Fire lanes,emergency zones and fire:hydrants will be adequate and ritect the needs,and requiremi of ernurgicncy service provider;- Yes
N. fhe C51[gri,ofstructures,roadways and landscaping in areas susceptible to portiling, Flooding andlor erosion.wi I I ni inim�?,e or avoid such
impacts to the maximurn extent practicable, yog
"rho:site plan ron rorms to,the design standards,,larldsc*ng standards and,performance standards of th is c4nptcr., y1L
s
5
Site Plan Review application—Revised October 2016
Ti Of QUeCillsbury Planning Office-742 Bay Road,QueensbUry,NY 128,04
179-9-050 Ch l:ist-Appli -i#ut;yn for Site Plan Review.
Application materials and site plain shall include sufficient information for the, Board to review and provide a
der,isilon. I'tte applicant is to provide a site plan drawing and all attachments that address, items .A- , 'T The
applicant inay request a waiver f'rc;tn AN and is to,provi&ureasons,forwaiver(s) requested. Please label
information to be submitted.
REQUIREMENTS T Sheet#
A., A vicinity map drawn at the scale that shows the relationship of tlac proposal to existingcommunity &Jlhics wu�alch al's t
or srvc it,such as roads,shopping areas,;chrar;ul�s,civ. The map shall al �show all properties,identify owners, ��
subdivisions,streets and easements within 54110feet oFthe property. Such a sketch may be superimposed on a United States
ewey araap of the area.
B. The site,plan shall be drawn mut a scala:tai"foaly feet to the inch(II" :=40 feet),or such odder scale as the Plannin Board may
deem appropriate,nen standard: "x 3 "'spae�ets,�'vx'ith cauntinuaation on 8 II `'x t I"sheets as necessaryfor written , #7,
inf-ormolion. "Ihc information Listed bellow shall be s1aowwn trent the site,pion and conflnuiimaaion slucets,.
C. Name of die project,boundaaios,wlaate,north arrow,and scale of the plan..
D. per,and,seal of the engineer,���the
or lands pe a�7hiteca� If the
alu Name
not the.erecord owner,arletto r of auntho a owv�near.. � tdn
���P p� proposed structures within
pp :ti...
" `Flue lecati�raum a.nd use of exasti and r�dmd crty,includiinp all dimensions ofhciglrt.and.
_floor area,all exterior entra nc",and all antici ated faataure addita,aaas andel alteration,,;.
F, The locatien of all present aan,d proposed public and pTivaatc ways„off-street parking areas,driv^emays,outdoor sicca ea areas,
sidewalks,ranilvs,curbs,paths, landscaping,walls and fences. Location,type mann screening details for all waste dispersal Survey
containers shamll also be shown,
�urruireaatuiurn atwaunaaethruds q cl'mmmduwath lace rmumtea
m intensity typeiunrru incandescent.ctc)of all external lighting,fixtures.. 'fhe�directiaan of �
T " aam2t ,mm 79-h-0201,
ad aranard," ertues�wa5t also Yrae shown in cer¢u liau:ncc waxith L.�
H. The Iar a sun,height,size,gnat �i �mid �tu�fall proposed signs., 'NIS.
The ltrw;ratib,n ofalll present and proposed uutipityr systuras inclutling.; N/A
1, sewage or septic systean;
2. ? anter suapply systcmn;,
3. Telephone,cable"amend elu etrical,systems;.and
4„ watarrmm drainage systema inrcludding a xisti ng arid proposed drauin lines,culverts,catch basins,headwvaalis,endwwadlls„
hydraaltas,man lyoIcsand drainage savapese
Plarns to prevent the pollution rwf'suarfaae w"ur groundwater,crosiru:n of smil both during and after construcAion,excessive rvnawlt'
jarid,flooding eaf other properties,as applicable. A Slturmnwwaatcr Pollluudon Preventaern Plan(SWPIIP))for all land dewelopntemt j NIA
aaeta'writies(enchudian,g,agricultr:rra:l activf le ,)on rite site that results in lanrl(listurbaucc ofo,nc acre or amore. :A Ill']"shall
cernply with tpae requirements of the DEC Sp.DES MS-gyp General perrruit.,and Chapter 147 of the Town ofQuucensfaumy
Code. It shall be at the di,, rctiwan,of the lalani Board as to whether a 'i, PPP or cart eraasian and control)plan shall be
required for site;plan,review puroject land d"usturlaaance of less than one acre,
K., Ex isting and
allow', All elev^aationsshall refer to thu,nearest United Stoics Coastal and eo�detic Bench Mark. Hany portion r,t the Ira ll Survey��
topographyat trw"ren contour intervals,or such oder contour interval as the Planning nin 13=(I spin
m ravel
is within the I Flt)-ycaur floodplain,the area will he.sbowwn OW base flood clevations given. Areas shall be Indicated wwithian
the proposed situ:and within 50 feet of the proposed site where wail Te ov oI or filling is Tequircd„showing the ap!proximatc:
woIurne is iambic yards,
utcrr landscape
of trees,sin p�e trees eight ormoreinches res than dna influence
ver and water sourcesand all pmnpam eda oc�: Survey sand
land y g "proposed
p � in mpiaunmctcr,fasces7
changes t*these fcatures, including sizes and types of plants, trr",atcr bourecs include ponds„ takes,wetlands and
watercourses,aquifers, llmrudplaa'ins and drainage retention areas-
M, Land Use District boundaries within 500 feet of the s'ite's periaanenter shall be drawn and idea iheti Oni the saitc pan, , well
as any Overlay districts that apply to the praspmy. 93
6
Site Plan Review application--Revised Walter 2016
1"Ow t tmt`Queen sbtdry t°[an ning Office-742 Bray Road,Quee asbuty,NY 12804
RE QUIREMENTS (CONTINUED) Sheet#
'fraffic flow p �rn,-%Ohm-the si1c,cntrqnces and exits.at, loading and unloading a.Teas,as we I I as curb cuts on the she anTd
within 100 feel of the sile� The Plimning Board niay, irequirets disciedan,require a.detailed tmffl[c study For large dmTl1DpMCDtS 01' #7
for those in heavy traffic areas, wfiich:shaH iflvludc:�
I The projected number of notor vehiOc tripes to imlcr or]cave the she,estimated for weekly and
winwl peak hour Iraffir levels,
.2 'HIC:projected.trat'ric flow pattern including vehicular movements at ally m0ior inttrscctions likely
to be afrected by the proix s"I use.ofthc site;
3 1'hc impact of Ilds traffic on levels of Scrvicc on abutfing.public:streets and at atTeeted
hitersectiom ExiSting and proposed mZy and aonuat peak hour traffic levels and road Capacity
levels shall also be given,.
For new ounstruction or alterations:to any sn-uCture,a table containing the following InIbrmallio-n shall be included; N/A
I. Esd maled area()f gtrucitorc to be usedfor particular purposes such as retain up'Cralion,Office,
Storage„etc,.,
2. Estimated maximuni n amber o1-vrnp1uyccs-,
3. Maximum seating capacity,where app4tab4e:,and
4, Number of parking spaces existing and required for the interided use,.
p. 77-moormans,
2. Elevations At u sule of onc-quarter inch equals one fool(1/4 1 foot)for all exterior facades of the proposed structure($)
an&or alterations to or expansions of existing facades,showm8 design features and indicating the type and Color ofr materials
to be used..
Q. Soil,logs,wMersupply well and percolation,test results,,and storm water runoff Calculations as needed to,deter triune and
mitisale projeelt irnpavts, NIA
R. Pi;;-%for-disposal of Construction and jenlolition waste,cithcr on-sitc Or at an approved disposal Jh6lity. MA
Plans lbr Snow removal;, inc I Uding location(s)ofion-Oe snow storage, NIA
T. An Environmental.Assessment Form("EAF'�as required by am SEQRA re8olutions, nth Pan I cuiripleted by the Applicant Long
shall be submitted as part of(he application. If the proposed project mquires a Special use permit and an EAF has been,
subm[Ucd in conjunction with a stvcio I use permit application,a duplicate F-Af,"is not wired 94r the site plan up�pljcaflun. Fonn
EA F
U. If anapplication is,fora.pamel or parccls on,which more than one use is proposed,the applicant may submit a single
applicolion for all such uses,provided the PRnposcid m�os arc accuratety delineated on a site plan drawn purmian't U)the
NIA
The Hanning Board my grana the application with respect to some prapowd uses and not
others. For purp<yscs of reviewing an appflealion(and ror'SFQRA Compliance)all proposed uses on a single parcel or(1,11
contiguous parcels shati be Oonsidercd together,,
V, A brief narrative statement on how thio project proposed for reAe%v flurthers or is consistent with the vision,,,goals and pD[ilcies
in the'Fown's Comprehensive Plan. Narrative
7
Site Phi Review application., Revised October 2,016
Town ofQueensbury PlanningOffice-742 Bay Road,Queensbury,NY 12804
Town of Queensbury, Site Plan Pre-SubmissionConference Poria Section 179-9-040
1. Applicant Narae: Queensbury Diner,L,LC
2. Tax Mal) ID 302.,05.1-97 Location: 518 Aviation Road
3. Zoning Cfassirication ESC
4. Re2son for Review- Propused parking/driveway revisions
5. Zoning seetion 0::
6. )l re- Wetirng Notes: Provided Outstanding; Please provide by
Deed
General Information coniplete
SJW Development Data Cbrnplew
Setback Requirements Complete
Additional Projett Info n-nation Complete
FAR addressed
Requirements fog r Site Plari-Standards
Checklist items addmssed
Environmental Form completed
Signature Page completed
..........
Staff Reprntati ve:
Applicant/ Agent-, Date:
Site Plan Review app]ication—Revised October 201,6
Town ofQtjeensbury PlanningOffikc-74.2 Bay Road,Queensbury,NY 12804
Signature Page
This page includes,the L) Authorimlion to Act as Agent Form: 2.) Engineerilig Fee Disclosure,„3.) Authorization fbr Site Visits; 4,)
Other Perm,it:Responsibilities; 5.)Official Meeting Disclosure and C),Agreement to provide docurnertlation required.
OWN ER'S AG ENT FORM-
Complete the foltowing if the OWNE,R of the properly is notthe carne as the applicant
Owner: Queensbury Diner,1,LC
Designates: Aviation Hospitality,LLC
As,agent regarding,, Variance Site Plan Subdivision
_F__Bl�ock _97—Lot
For Tax Map No.. Section
Deed Reference: Book —Page Date
OWNER SIGNATUREDATE-
............
APPLICANT"S AGENTFORM:
Complete the fbIlowin'&if the APPLICANT is unable to attend the meeting or wishes to be represented by another party,
owner: Queensbury Diner, LLC
Designates: Bohler Engineering MA,LLC
As agent regarding,: Variance X Site Plan Subdivision
FOT Tax Map No.: Scction Block L'ot
Deed Reference: Book Page Date
OWNER SIGNATURE: DATE,
2.) try_N�C.1NFEEHJ=-EE DJSCL0S(J1W- Applicafionsmay bic rcfcrrcd lo the Tuwn consulting engineer for revit%v of septic.design, stonn
drainage,etc:- as determined by the Zoning or.planning,DepaArnent.. Fees far enginccring,;c vi[,cw hcrvices will be charged directly to,the applicant.
Fccs for cn.gincefing review ivi 11 not emceed'$ 1,000 without notification to the applicant..
3.) A1TT11QR1ZAT
JDNF(),It,SH'EVJS1TS. By,skgaingthis pogcillnd submiving the application materials attached herein,the Owner. Applicant,
and, histher/their agern(s) hereby authorize the Zoning Board or Planning Board and Town Staff to enter the subject properties rar the purpose of
reviewing ilia appficationsubmillod,
4.) its HER PERNIJT It
ESPONSIBIIXFIESthen ptrrnils may be requirod forconstruction or alteration activity suNquent to approvall'by the
ZQrli4 Board OTPlartning Board. It is[lie applicam's responsibility to obtain any additional permits.
5. OFFICIAL MEETINi.: KIN-11TESDISCLOSURE: It: is the practice: oflhe Community Dc,vc1oprncnt Dcparlmient to have a designated
stcnographer tape record the pracee4iilg� of mcctings,resulting rrom application„ and minutes traoscribe-4 From those tapes,constitutes the oft-1601
record of a I I proccedings.
6.) A('.REEMENTTQ PLROVIDE DOICUNM"N'J'ATIONRr
_11EQLI
1), 'I,the undersigned,have thoroughly read and understand the instructions
for submission and agree to the submission mquirenients, I acinic wledge no eowu4ruetion Activities shall be cornet need prior to issuance ofa vallid
pennh. I certify that ft application,plans and supporting inaterials are a true and Complete statcmcnt/de-scription ofthe existing conditions,and the
wurk proposed, and that all work will 11C PeTFOTMcd in accordlance with the approved plans and jo conformance with local zoning regulations- I
,4c!kn(i%vlcdgc that PT[Or to OCCUPying the facilities proposcd,,lor my agents,will obtain a certificate of accupancy as nen a s5auy I also undlemand that
lAw may be mquirod to prorvide anns-built sairvey, by,a liccnscd land surveyorof all'i newly constructed faCirfities prior to imartce sofa certificate of
occupancy
I have,read and agree to,the above.
Signature: [Applicant] Print Name [Aplicant] Date signed
Joshua D.O'Connor May 23,2017
Signature 1"Agent) Print Narne�[Age�nt] Date signed
9
Site Plan Review app heati on—Revised October 20 16
Town of Queensbury Planning Office-742 Bay Road,, Queensbury,NY 128104