Site Plan application iF
�roW'N OF QUEENSBURY
Site Plan Review, Application
Review Process-.
l,. l equrim d Pre-submission meeting with staff to determine general completeness to he held no later than t
week prior to deadline d1t. Call (518) 761-8265 or (518) 761-8220 for an.appointment.,
2. Submittal of complete application I original and 14 copies of the application package by monthly deadline,
3. Determination of.application, completeness. All necessary information must be provided and appropriate
Fee(s) paid for consideration for placement on an agenda for that month,
4. Incompleft, applications will not be considered f' r li!cement on any agenda until all missing
information has been submitted.
. Submittal to 'Warren County Planning, if applicable,.
6. Planning Board, meeting, generally the third &. fourth Tuesday of each n-tooth. You will be advised in
writing,as to which meeting to attend.
7. Following the meeting you will be provided ;i'th a copy of the resolution stating the BoardTM% decision on
your application, if our application was approved, the next likely step is a Building Permit. Final
drawings must he provided for the next phase of irview°. If your application was denied, your project cannot.
proceed as submitted,
DOCUMENTATION (hard copyelectronic):
Please submit,1 original & 14 covies pf the completed application package to inncluade-
• omgle dpplicatitnmm pages 2-9, signed & dated
• P ubMis ion Meeting Notti; signed by staff
• Covy of Deed
• Clieclali t . Plot elan
• E nvi,nro narmmen:talsessment Form for any non-residential project
• Fee: $100 (0 -- 10,000 sq. ft.);
.); $250 (10,001 .. 30,000 sq. ft.);, $.500 (30,001 100,000 sq. R); 11NOO
Staff+ contact Inf rmatio�n:
Craig Brown, Zoning Administrator craigb4a4gueensbuty.net
Laura, Moore, Land Use Planner Imrmoore mm lkensbu .net
Sunny 'Sweet, O' fficep. cialist,.. Planning, sunayskg ucensbu U.net 518) 761-8220
RECYZINII ur website ite ant,vwW.gueen$Liyry&et for further information and norms
t
� � 1 2017 Site Plan Reviewa��pB7cakion �� .evised�f�e '�er'�,�0 16
�, O Fow n of Queensbury Planning Omer:-742 Bay Road,Qucensbury,NY 12804,
y
PLANNIN
General. Information
Tax Pared ID Number: 289,17-1-4
Zoning DislriaWR
0..69 A,crees
Detailed Description of Project [includes current&proposed use]:
1g,Family Rusid
Proposed-Sarne gratia Nem ori D,cck
Loczrtion of project:
113 Birdsall Road
Applicant Name: P+v'Gaauraaa.n Valenti Address: 113 BirdsalI Road
Qucensbury,New York 12804
Hame Phone 518,-798-0073 ell`
Work Phone Fax
E-Mail.
Agent's l"auric: Address: PO Lox 898
irl�ua l J. � raawraer .aliens Falls,New York 128011
Hom Phone cell:
Work Phone Fax 518-7912-6972
E-rug a i l
ar���euaa�uuer� ll �la,�,:c,�1,�a
Owner's Name Address
tio'u'au°as,Applicant
Heinle Mime Cell
Work,Phone Fax
-mail
2
Site Plan ReVio w application- Revised October' V
Town ofu ueensbury Planning Office-742 Bay Road, Queensbury, NY 128,014
Site Development Data
Area Type Existing sq. ft. J.'ropos,ed Total sq. ft,
Addition %9., ft.,
® 1843
B. Detached Garage
Atces 9trrrc4rrr s 7
D. Pae ravbard .. ..
l r°sat�rr r la r U uur a ed rr 73017 7307
E Porches/ Dell
580 4,84 1064
F., Other
G. Tlotal Non-Permeable [Add A.F) 10,270 10,270
6•l. Paroel Area _ 43, 160 sq- ft, J �rrrj 3 O'd 4 5 _ 30845
.ammo.
ElPcrc ent,-co f I nn p e,rrinLeila Area offSiill �l.,,-G/FQ 333% 43.3%
Setback Requirements,
Areas Required Existing Proposed
Front 50, sop 26.9"i
F"r n4[ 1
Shoreline 50' 50," 2,6.9"
Sidle Yard I I
Side Yard [-, ,
' 21,311 4S'
Rear Yard 651" 6,51"
Travel Corridor~ MA
Hicight [max] NIA
Permeability 66.7%, 66l71% 66l7'%
No. of par hig spaces2 2, .
3
Site Plan Review application-Revised Octubler 2016,
TOwn of'Queenrsburry Planning Office-742 flay Road,Quunsburry,NY 1213014
Additional Project Information
I Will the proposal require a Septic Variance from the 'rown Board of 1-1ealtll? NO
2. If the parcel has previous approvals, list application nuniber(s),
3. Does this prqJect require coverage tinder the New York. SlatePollutant Discharge Elimination Sy,stern
(SlIDES) Permit prograrn ? No
4, Estimated prqject duration. Start Date 08/2017 End Date I 1130/20l a
5. Eaiaiated total cost,of'project: S8,0009,00
6, Total area cel"land disturbance for project. 484
Floor Area Ratio Works,beet
FLOOR AREA RATIO (PAR) -- Th,e relationship of building size to lot sim, derived by dividing the total
building,floor area by ft- lot size in square 1'ect, yielding a percentage,
Zoning District Symbol F I oor Area Ratio ILFAR
Waterfront Residential WR 022
Commercial Moder-at�,4 Intensive CM/ Cl O�.3
k The combined area of a]I square footage, as measure from exterior walls of all structures on, the property,
including all floors of the structures, garages, basements and attics, with amore than five (5) let of ceiling
height and covered porches. Building square footage!does, not include. Open deck, dock.9, and that portion of
covered docks extending over, water and one storage shed of one hundred twenty (l fl) square rect or less.
Any additional sheds,will bf,- included. (See "FLOOR AREA RATIO").
B., Commercial or industrial. the total area in quare feet as measured firorn the exterior ed the outside walls of a
building or structure, and when applicable, t�he sum total of all flour amas of the principal and accessory
bu i ld i rigs: or slrUc tures, on the project site,.
A- Parcel Area 311,84 sr
B. .Existing Floor Area 4,235 sq. ft, [see above: defn4i2ll—
ll ruuPosed Additionat Floor,Area - s ,
D. Proposed Total Floor Area 4,235 sq. ft.
E. Total Allowable Floor Area 1 1,.G20.9 Area sou above table I
I H) is larger than E. a variance o�rr revisions to your plan may be needed. Consult with Staff.,
4
Site Plan Review application Revised October 2016
,r'o,wnoi"Q,uLeiisbui��yP,Iaiiniji&Olfrtce-74B,ayRoad, uccii.sbury,NY 12904
§ 179-9-080I Re Agi, ementsforStPlanAroal.
The Planning Board shall not approve a Site Plan unless it firstdetermines that such site plan meets, the
following Stardardq- Pk,-ase prepare msponses to �ach of the following to 9�
—�Thr KF)ARDS
A., The proposed prol furflicrs or is consistent with die policies oftlic Towns CompiGlicitsivc Man.
f3. The proposed prq*t corn lies kll all othicr requirevrientl OFfili.q C,'EMPILE',inll the situ plan reviLw standards as set forth in Paragraph
F 01,111is sccfiou,the dinionsionat,bulk and densily regutalions ol l le�llinl;district in which it is proposed tol be located(Article 3 and
'Fable 11,the applicable requimincrits of all when Artic[cs dim,apply�
C The site plan lencourargas pedestrian activity infernally and,if practicable,to and froar thus site wilkh pedestrian paths or sialckya lks connected
to ad,jucont areas,
We75ic:plan must conform IA)Chapicr i M Sewage and Sewage Disposal,Chapter I dl 7 Storrawatcr Managcnicni t Ucal I aw,:it ild other
applicable bcal laws.
The proposed use shall be in harmony With flic gVICTId Purpose ar inituni o f I li is Cliupkc r,spcici FkAdly laking We acquuni Eh)t;localion,
character and size offfic proposed use and flee dwcfiptill and purpose ofthe district in whicli sucli use is pralpased,,the naluit and intonsity
oRba activities ko lac involved in or coladucked in connection with the proposed use and the n2ftire and rate ofarly increase in the burden on
suprx)lfting puWic sary ivos and facil i k ics v4i ich wil I Fo How the approval,of the proposed use.
F. 'l establishment, maintanance and operation otl proposed me will not create Public hazards fram itafflic,trat'lle Congestion or the
paring o F vehicles andlor equipmenq or be otherwise detri nienta I to die lizalth,safLty or gencrai we I Care of persons residing or%orking i ri
the wighborhouct or to the general il ofthe town. Traffic access and CirCLAlation,road intersections,road and driveway wid-ths and
traffic controls M I I bL adequale.
QJT-,q1mLi parlking una,19oading flicilifics,will,be approprialely located and arranged and sufflicicni to meet traffic amicipatcd to be generated
by the new use. The estaNplishnurumrt ol'vtAiielo links between,pwking areas ofadjacent pzoper1iL!4,4Tc providod%lll ftmsible- `111i:L,lunficrs
Ella"]own's goal orraduting carr cuts ati-d reducing congestion..
undeveloped or previously developed withota having jilade provision [br ILaare linkage,them a firture connection must be identified avid
provided lbr in the qi1e plaji under revilclix lbr.4vich 11num linkage when flic tiritc arises, The Planning Board may require proafthat flic
applicant has made coritack with 4jacC111 PrOPC71y OAMUS liar PLk"SQ$017coordinafing linkaps with ad.jacmit properties.
H. The project shall not have wi unil adverse ifflitad L1,110111 the nutural,scerfic,nesthetilt,ecellogicol, il historic,rLerealionaloranon
spate remur"s ofthe 11own or dru Adirondack Park or upon the adicqUMIG provision ofsupporling facififiles and services made necl by
the pTqjeck,Iaki,ng into account Elie iMv,91riWl-,mq�WuWiad,rccrcagiaanaaN or oflicr bLnQ1n,,5 ghul might be derived froom, the project,
In making the detcrin ination hojeundlar,the Plami ing Board shahI conl�iidjer thos2 llaaars:lielabient to the proJect conlained in 11te
dcvr hiparrat considic rations wl Forth herein under§ 179-94 80 or fli leis Chapter,and i a so do i ng. Like Plan lung Board sha I I make a ruct overall
uvakiakian ofille prqjolct ill rekiflion tol the deMopmelu:objectives,and,general guidclines set [bali in§ 179-9-080 of this Arliele.
'11c provision rot anid arrarigortil till"peda-,ilrian MOM access and,circulation.,widkway structures,conknol ol'iracrsce6om with,vcllicuhar
Iraffilu and over-all pedestrian convenienceshall he salt and adequate fbrpcdeqrnui movenwnt.
;situs shall be prl Wed IG encourage pedestrian.irso.
J.l Storinxil d rainagle faci III ics will provent an incrcasL o f post davelopment drainage llows as clainpared to pw-&velop awnt drainage now,.
Drailingle(Ifthe site MIMI roulitiTge ground water to tic:axwnt practical. Surface waters llowing,off-silL shall not degrade ally stircanis or
adv4,r-ielyail'Leldruiwi4igQons adjacent propertics orpublic,road&
147 orthaTown Coda and the'[Fowij(A'Qijaunsbury Subdivision Regulultions,Whom applicall1c,
KTbe:water%Ipply and%-Wjjl dispo,,ad 11-acilldes will be adeqW.11C and will natet all-applicable and current reqUircincrits set lbrill by
Department of Hea Ith regu I af ions nuid Cbaptcr 136 o f flilc Town C'kyjrz,
The adequacy,typc and arrangenleat onmlcs,shnibs and Ober svitoble plantings, landswipling and scrcartiwig,AW1 of ootively provide as
ASUal and/or noise buffier berllll the:applitants and arts ohling hulds,including,Ora rno\4nvm ratll ol'exisfing V060tafli(lll and
maintenance. including replacesnent of,dead or deemsed p4angs.
Fire faunas,entergenLy zollus and Fire hydrants will be adcquulc and muct Che n",ds and rcquimmelits(4cmergimicy 5rirvicr providers,
, reptibloopauiooding,endcrNTl desigo orsirucluTes,t�oad%yays and Landcapilag in aea%sw6cllor o4iian will nunini,ixc:or avlciid well
inipil to the niaxinium extent practicable.
Ilie site plan Confornis 10 time design sturldarih., landscaping smadards and pri-forunpricc sumdards-lulf t[lis Qfiapgcr,
5
Site Plan Review app lilcation -Revised October-2016,,
Town of Queensbury Pkknnhrg,Office-742 Bay RU'all, Queensbury,NY 128,014
179-9-050 Checkfist-Applicafion for Site Plan Review.
Application materials and site plan shal'i incklide SLIflkient information fb,r the Board, to review and provide a
decision, The applicant, is to, provide a site plan drawing,and all attachments that address items A-V. The
applicantmat y tecluest a waiver fromA-V and is to provide reasons for waiver(s) requie5ted. Please. label
infort-nation to be submitted,
REQUIREMENTS Sheet#
k A vicinity map drawn at ilia,scute illjot shows the rclationship of Ifie proposal to existing carnmuiiky r ilifles;witich affut
or serve it,such as roads,sb(i,pping u7omL� qvljajqj Is,c4c. Th L mrIp,shall also show alll properties,Well d ry owltcffs, Tax Map
p
subdivisions,sucets and cawinents within 500 ll:ul oftho prorwrty, Such,au sketch may be superfill, used on a United Slates
cy map offlic area,.
B. 11c silt plan shall be drawn at a scale of A)rly Feat I*0w inch('1"_40,Nct)or such other scalcas thc Planning Board may
deem appropriate,,ousunchird 24"x 36""Amu,with condritlagiran on a U2"x I l"slizeu as necessary ibe writtert
jow shall be shown,ont
, h c smc p4an and confinual ion ssheets"information, Alfie itilbrination listed be
C, Naine of 010:prujecl,WtuidaTiles,dalc„nDilh arrow,and scale offfic,plart.
D. Name and address o F the owncr ofrceord,.developer,and seal oil'the engineer,arefi itect or landscape arch i tect. IfOIL
au Meant is not the ruxird owrior,a 1,wsur o F axn1wrizAhlio n An I I be rcqfaired frain the owner.
'1110 lkyco�fion wnd use of'all existing and pinposed s1ru,cluras within the property,including all dinwwsiowqofiacighl and
floor ama,all emeriorentrarIcas,canal,all,anticioacd ruturc additions andaltermions.
—Ioaaiion Df all prcscnt and proposed public and private ways,ofl--streLt Parking OMHS,&VOVHYS,OutdOOT sIQT11gQ amreaw,
sidewalks,ramps,curbs,path.s�, hAndscuping,walls and fimccs, Location,type and screening diclails,Vbr all waste disposal SA
coutu i ncirs shall also be shown.
G. The location, aQ
height,intensity bulb —qTd i inuanckscul,etc.)oFall external Highfing fixtures. The direction or
illuni,inaflon and rnethods to clhuiillgej!aru�onto adi(lirting pmporfili%must PiNo howD bu sin conipliancr ividi § 179-6-OX NONE
H The location,heigh 1,si;,xc, inaleria[S find de"sifP1(I F U'll P'Tvflo,wa:d Signs
N/.A
1. Thc location of all present and piroposed Litt I ity systcnis including.' N/A
1. scwagc or Wplic systern;
2. Winu svpp4y sysiem,
3. 1"clephone,cable and LlectriLal syslmms,and
4, Slunn drainage sySIC.111 Including,existing atWpraposed drain busim,hokW%valk,eridwdlk,
hydnaits,rnunlwks and drainago swales..
Plans to PrCVCM 111C pol tuflon of surface or groundwaler,crosionof so 0 bolh during atid aller construction,excess i ve rurtail'
P �IA-�484
and flooding t)fotlu�r r�jpurjjcs,as upplicablic. A Stormwatcr Polluflan Prevention Plan(SWIPP11),fbir all land deVc1opment
,V,es(ex,r .
i i i ludin URdJCLflWtEi aCtivitieS)(ni ft$40 0ml r"uUs in land disturbance ofunc acrc or morc" A SWITPAM11sq
cumply with the requimments afthe DFC SPES MS
D -4 ll P
Genoraertnit and Chapler 147 eftlw Town ofQueewq bury
CodL. 11 Shall beak thA.duc
istion offfic Plannbg Board asto,%vhW
ctlicr aSIT or an crusion and control plan shall be
W
rcq�i i:rcd for asile plan review pirojca ImW(I isturbunix o 17 1C,95 thall one acre,
K Existing uad pRiposed topography at two-root eonlour hucryalls,or such ollier contour intervat as the Planning Board shaH
.allow. All elevations sliall nfl,4 q0 Ole lickircsi Unitcd Slams Cuasta,l and Gwdoic Micli Mark. If any poniula oftlic parcel Reque,sted
is:wilhin,11m F001-year floodplain,dio uraw will be�11a)wq aIljd buw-Owd ckwitions given, ATCZ55171411 13-u:incliVMW%%9*Ihin
the prurKiscd site and within 50 lbet ofthe priarmseed site whate sail removal,or filling is required,showing EhL approxii nate
Vu lu me in cubic yards.
all scapa P,an, low n g aall VX1 Ang nattua.l lan caturcs than may intllu,ence.Life design ortUic proposed Ilse sue I as roc, 'batt as
outcrops,stands of trees,single trees eight or mom inclics in diameter, rorcst covu and water sources aurin all proposed Ufa a�areste+
changes to ffiesc lbaturt2,q,iniJuji'lig sizrti and types of'plants, WaNTSOUTC0i filclude ponds, lakcs.wedands And
%walcro,okinges,aquillbrs,floodplains,and drainage retention AMILs.
M. Lond Usc D,iLtrict boundafics within 500 lbot Of the qfte'S Nrjjjj0jLr q1tall be,drawn and idenfifiLd citi the site p1mi,as well;
as arty Overlay DWT i1C13 that apply to I he property. Waiver Req,
6
Site Plan Review appHeation—Revised October 2016
Town ofQueensbury Planning OffiEce-742 Bay Road,Queensbury,NY 125,04
-7,7,:Q-U,RE,MENTS (CONTINUED) Sh.eet 4
N, 'ITaf'f'1c 110%y W�01'115 Nwithin the site,critratirces and Gxits,Icoding Lind unloading Lveas,as M11&S Qirb culs on ilio wjtu wild
willfirt 100,fw oftlw silv, 'flan Manning 130OTd inay,at itq discretion,require a delailed trallic sludy kir large dev'Lloplylentsol, NI/A
Ebr those in ficavy Ira Me areas, wh i ch shall i ncludi;-
i. The:projwad number ej r r7w toF vChfiC:,je lTipq In,enter or leave the site,est i irtmod RIT wwkly and,
aturual peak hour traffic ICV42 J&,
'[11e projected Iraffic now pattern including vehicular rnowments at all major inwrse-cfions likely
In be a 11'ected by die proposed use o f Ific si te;
1 Thic inipuct ofOiis Irm[Tic on levels ofqLMce on abutting public streets and al,afl'41ed
inlersections. Exisfing and proposed,weekly Lind-annual pcok how ft4LMIC levels;and road,capacity
Jew,Is�shal I a.]so lbe:given.
0, For new construction or alteral ions to any 91 rur twr,itlob 1,;�.c(pran iltiag thL to]towhig intbrmation shall I I bc iwicluded NIA
i. Estimated area 0 f SInICLUFC to be used for parti qu IPT purpwws such as retain operation,offlicc.
Swiragq,cte.-I
2. Estignated knaxitnuni nuniber oremployces,
3. Maximum sealing e,`aP1AQ:jIy,W[TCTe applit.ible,and,
4. Nuniber ol'parking:spaces existing and rcquircd 11or ffiv intondod u.se.
P' 1, TICKIT'Plan$ NIA
2- Elevations 2t a scale of one�quartcr inch cquals one rool(1/4"- I f6w)lbr all exterior fficadeq of flio prop esed structure(s)
andlor alterations to or expansions of uxilstbig F44=10s"showing design features and indicating 1W Type and color Of 111HICTialS
to be uscd.
Oil lop,5,Waiter Supply well and perculatflon tootiosulls,,and morns walor runo,iTcalculadons as nc4dado determine and Waiver Req.
111itigatc project iniparks,
PIRM POF diSFAIISUI Of Wnstruction and dumnafition wasle,cil her on-site or al,an approwd disposal l'ac i fity. MCI[=
Hauler
S Pkins for snow removal,including location(s)oron-site.9nows-4orAge- N/A
T, An FrivironnicnAul Aswrn,�-onn("IFIAF)as requived by the S,I,',Q,R.A rugu[tolkins,with Part I compleledby the Applicant N/A
slj,�xjj be,subrnitwd os part ol'the appl ization. I f the proposed proico requires a special use permit and an 1'.AThas Won
Ndbafine,d in condunuion willi an special use PCFM-il application,a duplicate EAF is mmol rcquiwid ftir the;,iW pian application.
U Ilan application is ibr an parcel or parwh-,on vill ich nio re than one use is propo.wd,Lhc jkppjii�wnt jitay su btnit a single N/A.
application ror rill suclh kuqcs,provided the proposed uses ire acCUrawly defi nculckl on a site plandrawn pursuant W Ifie
forth above. '11w Planning Board may granl the app I iciction with respect to sonic:propmwd"w",amid,not
othLrq.. For purposes orreviewing an application(and roar SEQRA cornplianoa)all proposcd uses on P single parcei or on
contiguous parec[s shall I be wn,4diered together.
V.
hriernoarroatiwwM%loternant orl how the project proposed lbr review Norther,w is eainsiqtem with the:vision,gnal:s arm'!policies
in LlwTow n's Comprehensivc PlanAttached
7
Ske,P'lan Revjew application—Revised October 20 116
'Fown,ol'Queensbury Planning Office-742 Bay Road,QueensbUry, 'NY 12904
Pr°c-sulvllliNsoll [orm Suction 179-9-0-10
N. Applicant Name: k-) v
2. 1 A x od a p 11) :01401,12) A0511 Q
3. Zoning Chissirication
4. Reasoll for kvvivw:
w.
Zoning S(M.ion
C(-
6. 11rv-submission Nleoilig No(vs, OutManding, I'lVase Isrovide 11).
And
(knend lKhrmation compVc
-:
site Dovelojlrllorl'a Di'lla ('olliplete IL, .n
ScIback Rcqtjin;incpjb CmnNac Az !(' 04
A(ldjfl:j:ijj,,aj III-(Iject jnQjma6Nj Ctmyde
FAR addrussed
C ol 11111 ill I NC e '.%l i E I h /'ol I i 11 g Ord i 114 vilk:c
tlwo= Am addmaed
FWAonmeml Fonn wonWincki
Si,gmaturc Va �,,e completed
c r vo i
1-1402 LdLlll ak, Z.-
-co i.
.......... .......
...................
LAI I
tkq
,1C
c,
J'io
Stu IT
Applicani ," Dma
Signature Page
This page includes the I a) AuThorizzion to Act as Agent Furm: 2.) Engineering Fee Disclosure; 1) Authorization for She Visits, 4.)
Other Pertnit Responsibilities, 5.)Of Meeting Disc-losure mW 6 Agreement to provilde documentation required.,
OwN vit's ACEN't,FaRm:
Complete the follIQwing if the O,WNER of the property is not the sarne as the applicant
Owner: Maureen,'Valemi
Designates: Michael J- O'Connor
As agent regarding-. —Variance X siteplan ---Subildivision
Fo,r'I'ax Map No.: 289-17 Section I Block 40, -Lot
Deed lip ence: V4 $ aak 26 Page 11512.91.1 1 Date
OWNER ICPW TIN G:
J�' DATE: 101&2Qt7
S
ApnicivN,r's UEN'rFokmw
Complete the following if the APPLICANT is unable to attend the meleting or wishes to be represented by another party.
owner, Maureen Valenti
Designatm Michael I O'Connor
As agent regarding,,. X Variance X Site Plan Subdivision
For'T'ax ,Map 'No,:: 2 9.17 Section I Block 40, Lot
C Ref nze: 41f5 Bo 26 Page 115MIA Date
OWNERSIGNATURE: I)NIT, I W 12,017
2.1 FLNEINEERENG FEE DISCLOSURE, Apphcations alay be rcgerrcd to the 'Iuwn conmilfing erigincer ibr TeNicw of septic design, storm
draina8e, Lie. as delertnined,b.y the Zoning orlylantfing Department,, Fcus kv ojigirk=ring review services will be cllargcd dimekly to IN; Upplitaffl.
F'cvs for unginAmring Fuvicw will not�xcuvd$ 1,10,100,wilhout nolifitafion to the applicant.
3.) FUR g1'11VISIT's" By signing illisp,Rgo ondsubmilling the applicalien materials Wtoofied herain,tare Owner,Applicant,
,and hisilicrIfficir agunl(s) bomby IkkWI0TiZC lht� Zoning Board or Planning Board and Tnwn Slaffto cnwr thtsubject properties lbrthL pur,posc of
Tc wiewi ng Ilie Opp I icatioa submitted.
4J WtQr plermits unay Ix-requimd 6br construction Or all=*M HdivitY sabsequent to,approval by the
Zoning Bulard or Plarming Roard, It is TVI)POnsibi lily to obtain anyadditional pernnils,
5-11 NUNLETES DISCLO"U',M"; If is flig: practice offfie Community Developrncrtt 1parlrnant to ha vL a desigttatcd
sicnographcr tupu rovord, the proceedi:Rgs of gneoting's.TL9LJIkifIU firarn application, and ini,itums tranwribod firofn these tapes constitutes the ofricial
record ofiall preitLediap.
1,the undcl-signod,Wvn;0wroughly read and understand tho instructions
ror submission and agrfaa to the submission requimments, I ackilow1cftc rKi,4xilristrUdiAM acgivifics shall be comnicnecd prior'it)issijantL ofn valid
pea-unit. I cmify that the application,plans and supporting nialeritils um as girue and compIate staternant/description pftNu existing conidilions and the
work propos'cd, and diat all mark will bo, porforined ia aecwdancL with the:approved plans aurid in coul'brinance with local zoning mguladon& I
acknowlodge that prior to occupying the fiacilitiLs proposed, t or my agums,will 0tai:rt as corfificateofoccupancy as necessary. I ulso understand khal
11we anay be required to provide an as-built survey Orly au licensed,land wrvqor of alt iwwly constructed fiaCilitiCS P'Tilff 111P i'SNUMICe 011'a CUkii"I'MIL Of
uccupanqy
I have read and agree to the above,
Maureen Valend I 06" 12017
..........
Print Nanie: [Applicant] Date,signed
Michael J, O'Connor IW I2O17
Sign Print'Name [Agent]j Date s,igned
9
Site Plart Review application—Revised October 2016
Town ofQue-,ensbury Planning Office-742 Bay Road,Queensbury,NY 12804