Site Plan Application General Imformation
Tux Parcel ID Number: 303.15-1-25.1
Zoning District:trice: 1
Lot sl 33.27 acres
etailed Description of leo gjer1 [Includes cuurrerit&proposed use]
paintin Exterior ofexisliu•ug`'w"al,m rt store
Location ofprrugje t:
24 u rakiu r Ridg Rid131 c1,.
licant Name rrrruuu,rrl Rei Esus Address- l � 1 � � , l:r��t
Applicant
Business Trust petit twill a AR,72712
H 1 iuu muu Cell:
Work Phone Fa
479.273,401010 x
E-Mail;
Agent's Name: Laura 1'.� �11�'.uu, Address: 1��'�h��au uruarua�� unite lel,
pb2 architecture 4- etigineering 72758
Home Phone Cell:
Work Phone
4791.633,11951.
-
lainrra.lew llen@ pb ae orn
f
Owis Name Walmart Real Estate Address t Street
Bumsiness'rru:msL Bentonville, AR.727 1
Home Phone 11
Work Phone Fax
479.2:73.40,00
E-mail
2
ite Plan Review application—Revised Oictober 20 V
Town of Queenshury Manniui,,g ffice442 Bay Road, Queensbury,NY 12804
Site _Development Data
area/ the Existing sq. ft., Proposed Total sq. ft.
Addition ft.
footprint
B. Detached Garagemm
156,5.50 / 156,', 50
WA NIA
AZµ s .... mm.
eerur, ,tru�et��re(s
/ . NIA '/ .
�...,.,—r Existing te+'F:err�arru Nj /
��. F�ar�ed, �ra�e'll rrr rut��r hard �u�rff�e�ed���'�
A NIA
E. Porches,/Deeks /
NIA NIA
F. Other _ NSA I N/A
„
. Total Non-Permeable [,add -F) 156,550 NIA 15,6,5,50
1 , _... 1,449.241,20 1 1,449,2,41.20
Z��r�ce� Area ��1 ,5 � q� :J ere
T Percentage of Impermeable Area ot�ite [1=10'/Hj '1018 NIA 1018
Sntback Requirements
Area Required Ex'ist'ing Proposed
Front[I1 —275' Existin
to Rem,aarp
i:"rordt[2] „
SIA NI.A NIA
Shoreline
NIA NIA NIS,
Side Yard [1]
Existing to Remain
Side Yard [2]
/A NIA Existing to Remain
F ear Yard [1,1 25 —75' Existing to,remain
Rear Yard(2) / N/A NI
Travel Corridor /A NIA
Height [erua�x]
6.6" 264" Ex stiru to Remain
No., of parking spaces 7'7 775
BxisfiDg to Remain
3
Re Marr Rev iew application—Revised October 2016
"lbwnofQueensbury Planning Office,742 Bay Road,Queensbury,i''+Y 12804
Additional Project Information
I Will the proposal require, a Septic Variance fi.,orn the Town Board of Health? N
2. If the parcel has previous approvals, list application number(S): NIA
3. DoQs,this project require coverage under the New York State Pollutant Discharge Elimination Systei.,n
('SPICE'S), Permit Prograrn ? NO
4. Estimated project duration', Start late 09/15/2017 End Date 09/3012017
w5, Estimated total cost of projecu. S'50„.000,00
6. Total area of land disturbance for prqjea: N/A
Floor Area Rat�io, Worksheet
FLOOR AREA RATIO �FAIZ) -- The relatioliship, of biAding size to lot size, derived by diviiding the total
building floor area by thQ lot size in square feet', yielding a percentage.
zojflng District Floor Area Ratio [FAR]
Waterfront Residential WR 0.22
Cornmercial Moderate/ In,. nsive Cm/Cl 0.3,
A. The combinedarea of all sqUare footage, as measure ftom exterior walls of all structures on the property,
including, all flrborl% Of the strud=s, garages, basemQnts and attics with more than five (51) feet oaf eeiling
height and rovered 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 (l 0) 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 J-neasUJ-Qd from the exterior of the,outside: walls of a
building or structure, and when applicable, the surn, total of all floor areas, of the principal and aocessoy
bu i I d i jigs or structures on the project site.
A. Parcel Area 49,241.20 sd fl.
B. Existing Floor Area 156,550 fJsee abo,ve definition]
_t. Pro Rneed Additional Ptoor Area sq. ft.
D. Proposed Tota] Floor Area ft.
E. Total Allow abler Floor Area utr8 Area, Y, fseq above table
*If D is larger than E. a variance or revisions to your plan rnay be needed. Consult with Staff.
4
Site Plan eview applicafloji—Revised Oclober 20116
ToNyn of Queensbury Plaaniq Office-742 Bay Road,Queensbury',NY 12804
§ 179-9-0i O Regidreamen ts for Site PEW11 A roval.
DR_,
T'he P'lanning Board shall riot approve a Site, Plan, unless, it 'first determines that such site plan 111e is tJJe
following Standards., Please prepare responses,to each of the following topics.
See attaclied
-§T—A—NDARDS
A, The propusicd.project furthers or is consistent with the policies of the Town's Comprehensive NMI.
The proposed�project complies with all other reqni rernents of this Chapter,,hicluding the site plan review standards as set forth. in Paragraph
11 of[his,section,die dimer sionia],bulk and density regulations of the:zoning district;in which it is proposed lobe located(Artir-le 3 arm,
Table I),the applicable requirements of all other Ari that apply
C, The site plan encourase-9 pedestrian act iv iLy intiennal lyand,i f practicable,to,and,f1rom the site with pedestrian paths or sidewal ks connected
to,A,Oceri'l areas
D�. The site plan must conform to Chapter 1316 Sevmgeand SewqA Disposal,Chapiter 147 Stormwater Management Local Law,and other
applicable:local laws.
T 'Che use shall be in harmony with Ifiegeneral purpose or intent of this Chapter,spiccii ffeal ly taking Tinto account the location,
.7 character and size of the proposed use and the description and purposcof the district in which,sudi use is proposed,the nature and intensity
of the activitics to,be involved in or conducted iii,connection with,the proposed use and the nature and rate airany itterease in*,m burden on
supporting public servim and Mci 11tics which vw 11 follow ffie approval of die proposed Use.
F, The cstablishment,maintenance and operation of the proposed use%vill ri(Acreate public lizzards ftom tra Me,traffic congestion or the
parking or vehicles and/or equipment or be officruisc detrimental to the:health,safety or general u-015ft of Persons residing or working in
the neighborhood or 101be general welfare o t die town. Traffic access and circu lakion,road intersections,road and driveway widths and
traffi r controls voi I I be adequate.
Off-street park�ing.and,19004ini facilities will beappmpriately located ari arranged and w Ideottomeettra izan(Qipare to bel;cneralic
'by the new use. The establishment ofvchicic links between parking areas ofadjacent properties arc provided where feasible. This furthers
the Town's goal of reducing r uT'b cuts and reducing tongesdom.. A twenty-foot wide connicri(ion is required- If adjacent propetqies at,a either
undeveloped or previously developed without having made provision for future,[Jokagie,,than a future connection must be identified and
provided for in die site plan under review fear such Fulum linkage when the dine arises. The Planning Board may require prou r dint the
applicant has,made coillact widi adjacent property owners for,purposes of coordinating linkages with adjacent properties.
The project shall rLot have an unidue adverse impact upon the natural,scenic,aesthetic,ecology ical,wild]if;historic,rc eantitirial or open.
space:FeSoUrCeS of ffie.town Or the Adirondack Park or upon the adcqwde Provision of supporting faci I iiiies and services made necessary,by
die proj�ccl,taking into acc;o1unit the Ommi iogduslrial,residendal,recreational UT other benefits that inight be:derived Rom the projject.
fin rnWng,14e:deterinjination hereunder,the Planning Bowel shall consider those,ractors pertinent to flic project contained in die
dew etopment considerations,set forth herein under§ 1,79-9-NO of this Chapter,and in so doing,the Planning Board.shat 1)make a suet overall
evaluation of the project,in relaliou to the development objectives and general guidelines set forth In§ 179-9-080 of Article,
The on Jim an.d.arrangement of pedestrian traffic access and circulation,walkway structures„control of intemictions with vehicular
trafrpe and overall pedestrian convenience s,hall be safe anal adequate fur pedestrian movcmcjl:t,. Piedtstriwi connections between adjacent
sires shard be pTovfdcd to encourage pe4estriu use.
Storrawater drainage facilities will prevent an increase o'rpost development drainage flows as compared to pre-devc1opment drainage flows.
Drainage orthiesile sball recharge gmund water to the extent practical. Surface waters flowing off-site shall,not degrade any 51rcams or
adversely affect drainage on adjacent.properties,OT public road&, racilities shall be,in conformance with the drainage standards ofChapter
147 of the"'rown Code and the'Town of Quetinsbuiry Subdivision Regulations where appl ieoblie,
mm
K� Tlic water supply and sewagedisposal raciles;wi I I bc:adequate and will raecl all applicable and rurrcnt rerjuirenients set 1�rth by
Deparunent ol"Health,regulations,and Chapter 136 of the Town Cei
The adequacy,type and arrangement ofurees,sturubs and Wier suitable plantings,landscaping and screeniti.g shall cfrectively provide a
visual andlor noise bufter betvoeen,the applicants and adjoining:lands,including the maximum retention of existing veaclotloo and
main tenailce,including replacement ofd,ead or deccaisod plants,
M. Fim lanes,wnerge�i cy zones and fire In will be:adequate and meet t;;F7—n—e s ani requirements of emergoncyservice providers-
N, 'vie design ofstructnrcs,roadways and hindwoping in areas susceptible:to ponding,fliooding andlor erosion NAll,minimize or avoid suds
impacts to the maxi murn extent practicable.
0, The siteplan confionns to the design standards,,landscaping stand ar&and perform,ance standards of'this cha.[ACT.
I
5
Site I'llan Review application— Revised 011(),16
Town ofQueensburyFla nnine g Of Bay Road,Queensbury,NY 12804
STANDARDS
A.The:proposed project furthers or is consistent with the policies of the Town's Comprehensive
Plan.
The proposed repainting of the store is consistent with the policies of the Town"s Comprehensive
Man,
B. The proposed project complies mith all other requirements Of this Chapter, including the site
plan review standards as set forth in Paragraph F of this.section,,,the dimensional,bulk and density
regulations of the zoning,district inwhieh It is proposed to be located (Article 3 and Table 1),the
applicable requirements of all other Articles that apply.
All site plan review standards are existing to remain. Dimensional,bulk and density regulations
will not be affeoted, by the repaint.
C. The site plan encourages pectestrian activity internally and,if practicable,to and from the:site
with pedestrian paths or sidewalks connected to adjacent areas,.
Exi5ting,pedwrian activity will not,be affected by the repaint of the store,
D. The site plan must conform to Chapter 136 Sewage and Sewage Disposal,Chapter 147
Stormwater Managetnent U,cal Law, and other applicabte local laws.
Sewage and swage disposal will not be affected by the exterior paint change of the building
E. The proposed use shall be in harmony with the general purpose or intent of this Cbapter,
specifically taking,into account the location,character and sizk,of the proposed use and the
description and purpose of the district in which such use is proposed, the nature and intensity
of the activities to be involved in or conducted in connection Nvitb the proposed use and the nature
and rate of any increase in the burden on supporting public services and facilities which will follow
the approval of the proposed use.
The use of the property will not be affeetcd by the exterior paint change.
F.The establish ment,'Maintenance and operation of the proposed use will not create, public hazards
from traffic,traffic congestion or the:parkhag of vehicles Qndtor equipment or be Otherwise
detrimental to the health,safety or geaaerall welfare of persons residing or working in the
'neighborhood,or to the general welfare of the town.Traffic access and circulation, road,
i ntersections, :road and driveway widths,and traffic,controls,will be adequate.
No public haa-wds,additional traffic or vehicles will be associated with the exterior paint change
of the building,
G. Off-street parking and l9oadhig facilities will be appropriately located and arranged and
sufficient to ineet traffic anticipated to be generatedby the new use. The establishment of vehicle
links,between parking areas of adjacent properties ore provided where feasible. This furthers the
Town's goal of reducing curb cuts and reducing congestion.A twenty-foot wide connection is
required. If adjacent properties are either undeveloped or previously developed without having
madeprovision for future linkage, then a future connection inust be identified and provided for in
the site plail under review for such future linkage when the time arises, The Planning board may
require proof that the applicant has made contact with adjacent property owners for purposes of
coordinating linkages with adjacent properties.
Off-street parking and loading will not be affectedby the ctxterior paint chango,
.H. Theproject shall not have an undue adverse impact upon the natural,scenic, aesthetic,
ecological,wildlife,, historic, recreational or open space re$Otirces of the town or the Adirondock
Park or upon the adequate provision of supporting facilities and services made necessary by the
project,taking into account the commercial,industrial,, residential,iTereational,or other benefits
that might be derived from the project. In making the determination hereunder,the Planning
Board,shall consider those factois Pertinent to the project contained in the development
cons idera tions set forth herein under§ 179-5-080 of this Chapter,and in so doing,the Planning
Board shall make a net overall evaluation of the project in relation to the development objectives
and general guidelines set forth in § 179-9-0-80 of thisArticte,
The change in exterior C0107S Of the building will not adversely affect the existing natural,
ecological, historical or Open spaces resources.
1.The provision for and.arrangement of pedestiian traffic:access and circulation,walkway
structures,control of intersections with vehicular traffic and overall pedestrian convenience shall
be safe and adequate for pedestrian,movement.Pedestrian connections between adjacent sites,shall
be provided to encourage pedestrian use,
Existing pedestrian traffic,access or circulation wi I I not be affected by the exterior color cha.rtV
of the building.
J, 8 toren water drainage facilities will prevent an Increase of post development drainage flows as
colm pa]"ed to preA evelopment drainage Rows. Drainage of the site shall recharge ground water to,
the extent practical. Surface waters flowing off-site shall not degrade any streams or adversely
affect drainage ori adjacent properties or public roads.Facilities,shall be in conformance with the
d rain age standards of'Chapter 1.47 of the Town Code and the Townof Queensbu ry Subdivision.
Regulations where applicable.
Existing stormwater drainage:or site:drainage will, not be affected,by the exterior color change,
K. The water supply and sewage disposal facilities will be adequate:and will meet all applicable and
current requirements set forth by Mpartment of Health regulaflons and Chapter 136 of the Town
Code.
The existing water supply and sewage disposal facilides will not be affected by tine exterlor color
change.
L The adequacy,type and arrangement of'trees,shrubsand other suitable plantings, landscaping
and screening shall effectively provide a visual andlor noise buffer between the applicants and
ad joining Ian ds, inel uding the m axi.ni u m retention of existing,vegetation and maintenance,
including replacement of dead or deceased plants.
Existing landscaping;w i I I not be:affected by tine eXteriOr Color change of the buildfi1g.
M. Fire lanes,emergency zones and fire hydrants will be adequate and meet the'Reeds and
requirements of emergency service providers.
Existing,fire lanes,emergency zones and fire hydrants will not'be affected by the updated,exterior
paint colors,
N. The design of structures, roadways and landscaping in,areas susceptible to pending,flooding
and/or erosion will m4rihnize or avoid suth impacts to the:maxinluni extent practicable,
Updating,the exterior paint colors'will, not.impact,drainage:or landscaping design.
0.The site plan conforms to the design standards, landscaping standards and performance
standards of this chapter.
We believe that the new colors proposed for the bui Id ing exterior are in conformance with tho,
Town's design, landscape and performance standards.
§ 1,79-9-050 Checklist-Application for Site Plan Review.
Application materials,and site plan shall include SUMCient infOrMation for thle Board to mview and provide a
decision., The applicatnt is to provide site plan drawing and all attachments that addir—,ss, hems AN. 'The
applicant may request a waiver frorn AN and is to provide reasons for waiver(.$) requested. Please: label
inkri-nation to besubmitted.
REQUIREMENTS Sheet 4
k A vicirthy map drawn at the scale that shoNvs flic relationship ardie prapasall to exisgirkg conimunily l"acilifies Mitch�fi�,t i
Vi n ty
(IF scam it,suchos roods,sliopping areas,scfioals,etc. 11e map shal I also show all properties,,11doifify owners,
subdiv istans,streets and e-am,menu within 500 Foet pf Ilse property, Su ch a sketch niay be sirp,crimposcd on 0,United States Map
Geological Surycy i!nap of the area,
57 ']lie site,plan shal I be dramn at a scala tj f forty feet w flit inch(1 4 -t)Or Such other scale as,dic Planning,Board may
decrin appropriate,on standard 24"x 16"sheets,Nvith continuation on 8 V2"x I F n,hLet%as nect&sary R)r written CLO
bifurina6lom The:infimmilon listed MoNy shall beshow on
C. 'N anteoftrine project,boundaries,date,north arrow,and stale of the plart A2
D,1
Na pi
and address of the owner of recard,developer,and seal orthe engineer,architect or landscapL arciiiiect.. lfai
ayp1jeant is not tht rrd,owner.a 1101M Of M11110(riZOR ion diall be tvquired,from the ulmner. Application
717he location and use of all existing and proposed structures with in the prolmr1y,i ritluding alp dimension%of heislit and Unchanged from
flmw area,all exterior eritrall"s,and"III anticipated futurc additions and alterations, 4XUtLQg
F _ ']lie location o�f all Present and proposed public and private ways,olT-street parking areas,driveways,autdcmir starage a"' 'Unchanged I ro�m
sidewalks,ramps,curbs,pofliq,lujbi� wping,wallis and fences. Location"type and screening details for all~waste disposal
conta i ners shall also be shown. existing
111C locotiop,boigbirnensity and bulb typc(sodiurn,incandesceitt,etcj ofall external lighting fixtures. The direction of Unchanged from
i Huniination and methods to el inlinale "tarn:onta 44joinilig,pfopc.rties must also be shown in 4rimpli ancc with § 179-6-0201.
H. 1110 kicalioi).,height'.sjze,niastrialls and design of all Proposed signs. Uitt cnged Irom
'llie locadon of all present amid proposed utifity sys�irms ind1kading; exl7ing
I Sclvagc or selifle System;
2 IA4er supply systvvri-1 Unchanged
3. Telephone,cable andelectrical systerns.,and existing
4Skirun dfairiagcsystcrn inckWiing cxisfingand proposed drain fines,ctihixts,catch basins,head%valls,,endwalls,
hydrants,manholes and drainage swales,
11hani to,prevent.flue pollution onf sarfiluL or groundiyMer,erosion Ofsoil both during and aficr construction,excessive runoff
and flooding,of oflicr propert Ics,as applicubk. A Stornivvater 11ol ludon 11mvent[on,Plan(SNV PPP)k)r all land development
aWtivjtjcs(exeludirtg on the she that results in land disturbance of one acre or more, ASWITPsfiall Unchanged 'rolln
coniply%with die requirenients ofthe DEC SPUS,MS-4 Gcncral 111cmikand Chaplur '[47 of the Tuvai ofQucensbury existing,
Code. It shall beat the discretion of die Planning Board as to,whekher o,SW PFPoT an erosion and control plan shall bo
rcqu ircd for a site plan review project land disturbance of less than one acre.
K Lx i sting and proposed topography at two-foot ea raour intervals,or Such other wntoiji-intorwo I as the Planin irng BouR�l shatl.
a]low, A]I cicval ions shall refer to the ncam�I United StatLi Coastal and Geodetic Benett MarL I f any portion o f die rcel' Un,changed 'rorn
is withiln the 100-yo urfloodplain,the arca ivill be showii and(base (food elevations given, Areas shall be indicated within
the prop osed.site:and within 50,ket ONIL proTsised sate%V111cre soil removal or filling,isrequircd,slimving the approximate I existing
volujite in cubic;yards.
A landscape plan showing,alp e_xW.';_gna1u:ro1 land features than may influence the dc-sign of the proposed use stich,as rack Unchanged f yam
Outcrops,stands of Imes,single trees eipjil or more inches in diameter,fibmst irover mid watersou=s ond al I proposed existin
cliartges to these features,including sizes and types of plants, Water sourees include pands,lakes,wedands zaid
watercourses,aqui fenq, floodploins ond drainage rcicni[on oreas.
M. Latind Use District boundaries within 5100 fief ordiesite's pLiri raLter shall be drawra and idtalified on kite situ;plan,as W011 Unchanged 'rom
as only Overlay Disiricis flial ATply to the property.
She Plan Review application—Revised October'20 hS
ToKwn U 17 Quemisbury Plam.fl ng,Office- 4 Bay Road,Qui certsbury,N Y 12804
REQUIREMENTS (C'O�NTINUED) _§_heet
Trafflc llow patterns within the site,entrances and exits,load.ilig and un loading areas,as;well as curb cuts Cm die site mid,
widifil I OqO feet of die site. 'tire Planning Board may,at its,discretion,require a detailed Uaffic study for large&vc1opmcn ts or
for those in,heavy traffic areas,which shal 11 include:
l.. 11e projected intinberof motor vehicle trips to enter or leave the site,estimated for wee.kly and Uncharige I
annual,peak hour traffic levels, from
2. 711e projected tragrw flow pattern including vchiculaT movements at all major Intemetions likely existing
to beaMcted by I he proposed use of the tante;
3. The impact of this traffic on levels of service an abutting public streets and at affected
interseeflons. Existing and proposed wcrkly and,annual picakhour traffic leve s androad capacity
levels shall also be given.
0. For new construction OT alterations to any structure,a table woloining,tbic following infurmation shall be imbidod,
I. Estimated area of structure to be used For particular purposes such as retain operation,office, Unchartge A
Storage,etc,,
.2, Estimated maximurn number of cmployccs, from
exisfin
3, MoximUrnscatinw
g capacity, here applicableapplicable;and.
g
4. Number of parking spa=existing and required for the intended use.
pr!"'Mans.
Z Elevations at a scdc of one-quarter hich,equais one fbol(1W1-I foa),for all extenor Pa"dies of proposed Unchange
aodfor alter ions W or expansions of existing facades,showing design features and iftdicofing the type;and color of materiaEs frorn
to be used. existing
Soi I logs,wairr supply well and percolaMon test resu its,and storm water runo iT ca lcu lations as needed to detenn irte:and Unchanged freer
mitigate p�roject impacts. existing
R4 P tans for disposal of tonstruction",4 demolition waste,either on-site oi.,at an approved disposal facility
S. Plans for snow removal,including locaflon(s)of on-site snow sloroge, d ftom
An Envi ronnientail Assessment Form('T,AF')as rcquirod,by the SEQRA regulations,with Part I compilcied by the Applicant je-ll"Xisti fig
shall be submitted as part of the application- Et tine proposed project,requires a special use permit and on C-Al'hos bean. tAF
subrnitled io conjunclim vdth a special use permitapplicadon,aduplicale JEAF is nat required for the site plan application Attached
If an application is for a parcell or Parcels on which more than one use is proposed,the app]icant ma:y submit a single
app]i1cation,for all such uses,provided the proposed ruses are OCCUratClyr delineated on a site plan drown pursuant to the
requirements set 1-ortb,above, The Planning Board may grant theapplication-willi respect to mirie pr"osed uses and not
others. FQr purposes of reviewing a7i application(and for SEQ,RA compliance)all propomd uses on a single parcel or on N/A
conOguous poTeols shall be considered tGgpther.
V. p A Lvrief narrative statement on'T�wo proicci proposed for review furthers or is consistent with the vision,tl,goals and policies, Narrative
in the Tbwm"s Comprehensive Plan., attached
7
Site Plan Review application—Revised October 20,16
Town o f Queensbury P[an ni ng Office-742 Bay Road,Queensbury,NY 12804
Town of Queensbury, Site Plan Pre-,Submission Conference Form / Section 179-9-040
1. Applicant Name- WaIrnart Real Estate Business Trust
2. Tax Map ID 3013,15-1-25,1 Location: 24 Quaker jAge BIvA,
3. Zoning Classification CIL
4, Reason for Review: .evise exterior paint col()rs for Walmart #44:03
5. zoning stction#: 1,79-7-050,
G. Pr"ubmission Meefing,Notes- Provided Outstanding; Please provide by
Deed
Gener-al Information complete
Site Development Data Complete
Setback Requirements,Coinplete
Additional Project Information Complete
FAR addressed
Requirements for Site Plan-Standards
Checklist items addressed
Env iron in ental Form.completed
Signature Nige conipleted
to Representative:
Applic,ant/Agent: Date-
Ske Plan Review applicaflion—Revised October 2016
Town of'Quetnsbury Plann,h%Office-742 Bay Road,Qutensbury,NY 12804
Signature Page
This page; inic.Wdes Oise; 1.) Aulhorization lo Act as Agent Form; 2.) Enginecriflg Fee Disclosure3.) Auth0fization For Sil.Ae Visits;4.)
Olher Pieraljtft.espoli'sibffifies;5.)Official Mecting Diszlositire and 6.)Agreernient laI)mvide documonlaflon required.
OWN tACS AG ENT POIRM,
Compi ete'the fool owing if the OW N ER ofthe properry is not the same as lilt appli'vali'l,
Ow.ner. Walmart Iteat Estate Busincss'Trusit
Designates: pb2 architOCILIM+engincering
As agei regarding-. -X 1,11.1.Varianco Site Plan SL]Wvision
For Tax Map No.:� Section Block Lot
Deed Reference. B00,k -7—Page -IMT i)ate
OWNE?ft SIGNATURE., DATE:
-'uP'-P1ACANT"`S AGENT FORNv
C'0111pletc tic following,if the APPLICANT as Unable,to,astand the meeling or wlshesi to be represented by another party,
Owner, Walmad Reat Emile Busillass'l-irwt
Designates- Jim Gallagher,pb2 architecture+eugineled
............ ------
As agent regard Ing: ................I Variance: site P1111 ....... Subdivision
For Tax Map No.: eclion Block LaOt
Deed Reference- '4WT-Book Page -3M7'r7aj,e
,0 WN,E It S IGNATU RE. DATE
.-
11 ENGINE3-JUNG 1-ji,F, Ot�, (J,i ofr
j1_11JIK: Applications inay be reFcnui to the Town ofinsWung engin for ix�view septic design, storm
drainage,&c.,as dewmincd by fli c Zonin L7,of 11 lanning C)cpartmcni.
14'ecs for engi ncvring rp.%,icw will not excwd S 1, 000 without noki ricution to flit:applicant.
3.1 A jrj)'j(�Sjj'$."V[$j B 51 gning rltk pkiigic and submitfing
Y 11flamrials atjoichrd hcrpini,the Owncr,Appliorri.,
gild bisi'lledtheir agerrifsf hct%eby auffiorize the Zoning Board or Planniq; Doord and Town Staff to enw-r the SUbjccl pi-operfir,; for the purpose of
rev 11i Ille application su billitled-
(YI'l IEE P FIRM IT R INTIONR W1 JTTES-, Offier permits iii ay be mquirud,for c4in-4rurtion or afteration actj Y ity subscquvit to approval by Oki.,
Z(i,11ing inward ulr Planning BimrT3. It is 9he applicara's respcnNsibility to obtain,any addhionat PlUrnii5.
I ILIUM(:
O—CIAL MEETING MINIJI-Ii.9 InscTOMME" 11 is the pl°actice or flue Comiiiiurii:ty Devellopanent Department to lhavir, :a desIgnawd
sLcnA,gr'aph,cr Ippc mord Cho prottedings;of inetfingq resulting ftoni application,and minum,5 aMZISCT:ibcd firain those tapes coail.aIutes the official
record;waft all pro=ding,%.
i At;RE EAll LNTIO PROVI III,',Dof'I W I"i ON 14 HQUI Ik LO L t1ve undiewsignO.liavc fliorougWy re and understand the instruel lons
61 submission and Arc:to the svitimission Fequirem�nft., I uckhowledg�e no construction activities 01jill,be enimAnencied peiorto issuance of valid
perrtth,. I certily that(lie applicaflicin,plans nRd supporting matoriibN are a true and carnpiete siawmeta/descr[ptio orithe existing conditiolis and the
work proposed, and 14al all vmT-k will he pci-rornilud in awwdaiive with the approved 111'alls and, in ConformaTilor with local,zoftilig reguliutioils,- I
aCk-1No%%1LdgC ural pr[riv lo,occupying.the fitriliflies proposed,I or rily ageriLq�,will,obtahi,2 W-Ljf`tCaqC GfoCCUPg11'V'Y Hs3iiCC'eS$2J'Y- I al undeTstand dial
V%vie,.may be lOqUired to provide as as-bulft by a liccnscd taind sun?cytir ufall aiewly conskructied fbicilikim pri,13T tO is.suguice ol-a ceftjfj'Cj3LC of
nocupancy
I have read and.agree 1,io tie:Ebovc.
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S' mat arty` I"M a t] Print nt zuiiiv [A p P I i can I ale s igned
P n
atlfaa
C Print Name[Agent) Date signed
Sita~ Pian Review opp I ication—Revised GeLober 201 Ca
Town,o 1,Queensbuiry P anji ing Officc,7 42 Bay Road,Quimnsbiury,'N Y' 1804
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