Site Plan Application PAUL E.PONTIFF BARTLETT,PONTIFF, STEIVART &RHODES,P.C. JAAxES R.BuRxprr
ALAN R.RHODES STEFANiE DILALLo BITTER
ROBERT S.MCMILLEN ATTORNEYs AT LAw KARLA WiLuAms BuETTNER
PJimp C.MCINTIRE P.Q.BOX 2168 ELISABETH B.MAHONEY
MARx A.LEBowiuz ONE WASHINGTON STREET JOHN D.WRIGHT
J.LAWRENCE PAL"iROWITZ (�",LErjS r{ALLS JESSICA HUGABONE VINSON
MALcout B.O'HARA NE �7 oRK 12801-2168
PATRicu E.WATims p
MARK E.CERASANO RICHARD J.BARTLETT
BRUCE O.UnNSKi 'TELEPHONE(518)'7-92-2117 1926-2015
PAULA NADEAU BERUBE FAX(518)792-3309 ROBERT S.STEWART
1932-2001
JONATHAN C.LAPPER FMAIL infoGZbpsdaw.com BERTRAM J.DUDE
BENTAwN R.PRATT,JR. WEBSITE www.bpsr1aw.com 1916-1999
EILEEN M.HAYNES
SERVICE BY FACSIMILE NOT ACCEPTED
October 16, 2017
Steve Traver, Chairman
Planning Board
Town of Queensbury
742 Bay Road
Queensbury,NY
Re: 3300 State Route 9L
Dear Members of the Planning Board,
Enclosed please find the application of Crreg Teresi and Lawrence Davis requesting Site Planreview
for parcel SBL 239.18-1-27.2,which is a preexisting parcel. The proposal is to construct a new 3-
bedroom single family residences with associated driveway, grading, utilities and stormwater
management. The wastewater system shall be installed on adjacent parcel 239.118-1-27.1. The
project has been designed so that no area variances are required.
Very truly yours,
BARTLETT,PONTIFF, STEWART
&RHODES, P.C.
:Z—
By:-
on
an C. Lapper, Esq
D re t#: (518) 832-6434
Dir ct Fax#: (518) 824-1034
DI. ect E-Mail: 'cl bpsr1--m
JCL:
Cc: Greg Teresi, Esq (via E-mail)
Lucas Dobie
General Information
Tax Parcel ID Number: 239.18-1-27.2
Zoning District: Waterfront Residential
Lot size: 0.215 acres
.... ......... _ ........
Detailed Description of Project [includes current&proposed use]:
Construction of a new 3-bedroo rt 1 1 r f l xgwith amo 0 d�w� w ayY gfgdimti w�a W tu t anwat r
management,wastewaters stem to be installed on parce1239.18-1-27.1
Location of project:
State Route 9L
Applicant Name: Address: 3300 State Route 9L
Gregory Teresi Lake George,NY 12845
Home Phone Cell:
(518)225-6523
Work Phone Fax
(518)543-5291 (518)543-5290
E-Mail: greg@teresilittle.com
Agent's Name: Address: 169 Haviland Road
Hutchins Engineering Queensbury NY 12804
Home phunu— Bartlett,Pontiff,Stewart& Cell: 1 Washington St.,P.O.Box 2168
Rhodes Glens Falls NY 12801
Work Phone Hutch:(518)745-0307 Fax Hutch:(518)745-0308
BPSR:(518)832-6434 BPSR:(518)824-1034
. - ___.._._._...... ................. ...........
E-mail Hutch: lwdobie@hutchinsengin ring.com
BPSR:jcl@bpsrlaw.com
---------- .... ................. ........
Owner's Name Address 300 Three Island Blvd
Lawrence Davis Hallandale Beach,FL 33009
. ..._._._... _........ _._._ _..... ..
Home Phone Cell
(518)368-7500
Work Phone Fax
E-mail
larry.davis@commsoft.net
2
Site Plan Review application–Revised October 2016
Town of Queensbury Planning Office-742 Bay Road,Queensbury,NY 12804
Site Development Data
WWW
Area/Type Existing sq. ft. Proposed Total sq. ft.
Addition sq. ft.
w_ wwwww
A. Building footprint
0 895 895
B. Detached Garage 0 0 0
C. Accessory Structure(s)
WWall Around Parking Area 0 285 285
v
D. Paved,gravel or other hard surfaced area 0 795 795 So%Credit for Pe measle
Pavement-1,586 5F Total
E. Porches/D._.................................... ........ecks
0 365 365
F. Other
0 0 0
«wawa_
G. Total Non-Permeable [Add A-F] 0 2,340 2,340
H. Parcel Area [43,560 sq. ft./acre] 9,373 0 9,373
I. Percentage of Impermeable Area of Site [I=G/H] 0 24.97% 24.97%
Setback Requirements
Area _ Required Existing Proposed
.............................................. ---------------
Front[I]
30' 0 44.2'
Front[2]
Shoreline
75' 0 78.9'
Side Yard[1]
12' 0 12.1'
East
Side Yard[2]
12' 0 12.1'
West
Rear Yard [1]
Rear Yard[2]
Travel Corridor
Height [max]
_...... ._............. w .�.�..._�.......................-......._..........-......................
�_._._
Permeability 100% 75.03%
_._.................................... . __________.... ......................
No. of parking spaces
3
Site Plan Review application—Revised October 2016
Town of Queensbury Planning Office-742 Bay Road,Queensbury,NY 12804
Additional Proiect Information
1. Will the proposal require a Septic Variance from the Town Board of Health? No
2. If the parcel has previous approvals, list application number(s): n/a
i
3. Does this project require coverage under the New York State Pollutant Discharge Elimination System
(SPDES)Permit Program? ............. Yes
4. Estimated project duration: Start Date Spring End Date Fall 2018
p j g2018. ._ _..._..........-._.
5. Estimated total cost of project: ...._ $400,000
6. Total area of land disturbance for project: 10,500 SF
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]
.........._.....
_....
Waterfront Residential WR 0.22
.......__ .......
Commercial Moderate/Intensive CM/Cl 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.
WW ..._......wawa ... .....
A. Parcel Area 9,373 s . ft.
B. Existing Floor Area ............._..... __ __W....... 0 sq. ft. see above definition
C. Proposed Additional Floor Area 1,812 sq. ft.
D. Proposed Total Floor Area 1.812
..........__ sq. ft.
66666666. 6 .........
E. Total Allowable Floor Area 2,062 (Area x o.22 ) [see above table]
.rvrvrvrvrv�
*If D is larger than E. a variance or revisions to your plan may be needed. Consult with Staff.
4
Site Plan Review application—Revised October 2016
Town of Queensbury Planning Office-742 Bay Road,Queensbury,NY 12804
§ 179-9-080 Re uir m ent for Site Plan Approval.
The Planning Board shall not approve a Site Plan unless it first determines that such site plan meets the
following Standards. Please prepare responses to each of the following topics:
STANDARDS
..... ..w ................................. 6666 ... _ .............. ......._....
A The proposed project furthers or is consistent with the policies of the Town's Comprehensive Plan.
_..... _. _. _ ..._._.._... _w...... _ ....................................._........... ... ..............._.....
B The proposed project complies with 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 in which it is proposed to be located(Article 3 and
Table 1),the applicable requirements of all other Articles that apply.
---
C.
..e_C, The site plan encourages pedestrian activity internally and,if practicable,to and from the site with pedestrian paths or sidewalks connected
to adjacent areas.
.............................................. ........ ..... vv�
D The site plan must conform to Chapter 136 Sewage and Sewage Disposal,Chapter 147 Stormwater Management Local Law,and other
applicable local laws.
E The proposed use shall be in harmony with the general purpose or intent of this Chapter,specifically taking into account the location,
character and size 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 with 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.
F.^..............The..establishment,maintenance and operation of the proposed us................... ..l n t create
............................. .................... ,traffic
mm a will n
p p p of create public hazards from traffic,traffic congestion or the
parking of vehicles and/or equipment or be otherwise detrimental to the health,safety or general welfare of persons residing or working in
the neighborhood or to the general welfare of the town. Traffic access and circulation,road intersections,road and driveway widths and
traffic controls will be adequate.
G. Off-street parking and 19oading facilities will be appropriately located and arranged and sufficient to meet traffic anticipated to be generated
by the new use. The establishment of vehicle links between parking areas of adjacent properties are 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 made provision for future linkage,then a future connection must be identified and
provided for in the site plan 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.
W w_w
H. The project shall not have an undue adverse impact upon the natural,scenic,aesthetic,ecological,wildlife,historic,recreational or open
space resources of the town or the Adirondack Park or upon the adequate provision of supporting facilities and services made necessary by
the project,taking into account the commercial,industrial,residential,recreational or other benefits that might be derived from the project.
In making the determination hereunder,the Planning Board shall consider those factors pertinent to the project contained in the
development considerations set forth herein under§ 179-9-080 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§ 179-9-080 of this Article.
ww. «wawa
I The provision for and arrangement of pedestrian 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.
J Stormwater drainage facilities will prevent an increase of post development drainage flows as compared to pre-development drainage flows.
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 on adjacent properties or public roads. Facilities shall be in conformance with the drainage standards of Chapter
147 of the Town Code and the Town of Queensbury Subdivision Regulations where applicable.
K. The water supply and sewage disposal facilities will be adequate and will meet all applicable and current requirements set forth by
Department of Health regulations and Chapter 136 of the Town Code.
L The adequacy,type and arrangement of trees,shrubs and other suitable plantings,landscaping and screening shall effectively provide a
visual and/or noise buffer between the applicants and adjoining lands,including the maximum retention of existing vegetation and
maintenance,including replacement of dead or deceased plants.
M. Fire lanes,emergency zones and fire hydrants will be adequate and meet the needs and requirements of emergency service providers.
N The design of structures,roadways and landscaping in areas susceptible to ponding,flooding and/or erosion will minimize or avoid such
impacts to the maximum extent practicable.
The site lar conforms to the design star _ ................... �..�.... ..... ..... .. ..................
0 p gn dards,landscaping standards and performance standards of this chapter.
5
Site Plan Review application—Revised October 2016
Town of Queensbury Planning Office-742 Bay Road,Queensbury,NY 12804
Applicant: Gregory Teresi, 3300 State Rt. 9L - Lake George
179-9-080 Responses to standards questions A-O
A. The proposed project to improve the site is consistent with the policies of the Town's
Comprehensive Plan.
B. The proposed project complies with all other requirements of this chapter.
C. The proposed residential project has been designed to improve internal pedestrian
activities as necessary and applicable to this type of use.
i
D. The proposed residence will conform with Chapter 136 Sewage and Sewage
Disposal, the proposed project is designed to conform with Chapter 147, the
Stormwater Management Local Law and all other applicable laws.
E. The proposed project has been designed to be in harmony with the general purpose
or intent of this Chapter.
F. The proposed project has been designed to have adequate site access and parking.
G. The proposed project has been designed with the intent to provide safe, adequate,
and functional off-street parking and loading facilities to the greatest extent feasible.
H. The proposed project has been designed to not impact natural, scenic, aesthetic
ecological, wildlife, historic, recreational or open space resources of the Town.
1. The proposed project has been designed to improve internal pedestrian activities as
necessary and applicable to this type of use.
J. The proposed project has been designed to be in compliance with Chapter 147 as
applicable.
K. A new, enhanced treatment wastewater system has been designed in compliance
with NYS Department of Health standards as well as the requirements of Chapter
136 of the Town Code.
L, The proposed project has been designed to provide an attractive, well-landscaped
facility while meeting all functional requirements.
M. The project has been designed in effort to meet the needs of emergency service
providers adequately.
N. The site grading and drainage provisions have been developed with the intent of
avoiding flooding and ponding with the exception of areas required for stormwater
controls.
O. The site has been designed with the intent of conforming to the design standards,
landscaping standards, and performance standards of this Chapter.
§ 179-9-050 Checklist-Application for Site Plan Review.
Application materials and site plan shall include sufficient information for 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
applicant may request a waiver from A-V and is to provide reasons for waiver(s) requested. Please label
information to be submitted.
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, S2
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 1/2"x 11"sheets as necessary for written ALL
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. ALL
D. Name and address of the owner of record,developer,and seal of the engineer,architect or landscape architect. If the ALL
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 exterior entrances,and all anticipated future additions and alterations. Al-A2
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 S2
containers shall also be shown.
G The location,height,intensity and bulb type(sodium,incandescent,etc.)of all external lighting fixtures. The direction of Al-A2
illumination and methods to eliminate glare onto adjoiningproperties must also be shown in com liance with 179-6-020.
..........
H The location,height,size,materials and design of all proposed signs. NONE
i 1 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 S2-S3
4. Storm drainage system including existing and proposed drain lines,culverts,catch basins,headwalls,endwalls,
hydrants,manholes and drainage swales.
Plans to prevent the pollution of surface or.
J p p 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 one 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 S2,S4
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 one 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 S1-S2
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 than 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 S2
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. S1
6
Site Plan Review application—Revised October 2016
Town of Queensbury Planning Office-742 Bay Road,Queensbury,NY 12804
.. ...----.--
REQUIREMENTS (CONTINUED) Sheet#
__ ....._. ._.
N Traffic flow patterns within the site,entrances and exits,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
3 annual peak hour traffic levels;
2. The projected traffic flow pattern including vehicular movements at all major intersections likely S2
to be affected by the proposed use of the site;
I
3. The impact of this traffic on levels of service on abutting public streets and at affected
F intersections. Existing and proposed weekly and annual peak hour traffic levels and road capacity
levels shall also be given.
0. For new construction or alterations to any structure,a table containing the following information shall be included:
1. Estimated area of stricture to be used for particular purposes such as retain operation,office,
Storage,etc.;
2. Estimated maximum number of employees; N/A
3. Maximum seating capacity,where applicable;and
4. Number of parking spaces existing and required for the intended use.
P1. 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 alterations to or expansions of existing facades,showing design features and indicating the type and color of materials Al-A2
to be used.
Q. Soil logs,water supply well and percolation test results,and storm water runoff calculations as needed to determine and
mitigate project impacts. S2
R. Plans for disposal of construction and demolition waste,either on-site or at an approved disposal facility, S2
___
S Plans for snow removal,including location(s)of on-site snow storage. S2
TI An Environmental Assessment Form("EAF")as required by the SEQRA regulations,with Part 1 completed by the Applicant
shall be 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. TYPE 11
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 an application(and for SEQRA compliance)all proposed uses on a single parcel or on APP
contiguous parcels shall be considered together.
V.
A brief narrative statement on how the project proposed for review furthers or is consistent with the vision,goals and policies
in the Town's Comprehensive Plan. COVER
7
Site Plan Review application—Revised October 2016
Town of Queensbury Planning Office-742 Bay Road,Queensbury,NY 12804
Town of Queensbury Site Plan Pre-Submission Conference Form Section 179-9-040
1. Applicant Name: Greg Teresi
2. Tax Map ID 239.18-1-27.2 Location: State Route 9L
3. Zoning Classification Waterfront Residential
E�c (u,
4. Reason for Review:
5. Zoning Section
6. Pre-Submission Meeting Notes: Provided Outstanding; Please provide by
Deed L/1
............................
General Information complete ............il.!.1.7. ----------------------------------- .........................
..........
Site Development Data Complete V,
Setback Requirements Complete
Additional Project Information Complete
FAR addressed
Requirements for Site Plan-Standards
Checklist items addressed
Environmental Form completed
Signature Page completed
NO
0%C11f,A i V1 t -7 tj f
p J,
L
"T
c")
M CIL A C,
rn U-0
....... .........................
Staff Representative:
.............................
C
Applicant/Agent: Date:
AL
8
Site Plan Review application—Revised October 2016
Town of Queensbury Planning Office-742 Bay Road,Queensbury,NY 12804
Signature Page
lis page inchWcs Hm 14 AuthoWathn to Act as Agou Wait: 2j Engbee;ring Fee Mscimurc ) AudroHndmn Ir She Visks; C)
(Nher PerrnR Rnpon=kx 5j OWM Nkmkg Disdosm and 6,1 Agreennem to pyWe dmuntemmim reciAmd.
OWNER's AGENT FORM:
CornMew the hHowhg o6 he OWNER of the property is not the senne as the applicant
ownet% Lawrence Davis
......... ..........................
As apra mgmd5g: Variance Y Site Plan Subdivision
For Tox Map 1 m: 239. 1 Bla Lot
V? 2� page
1hed ReAmnee. I Ho OWN Daw
OWNER SIGNATURE: DATE:
.................................. ............ ...............
APPUCANt-s AGEvr Fow
CbnWhme We fbHo"Ing jr Ke APPIL11CANIV umWe W attend Me meet rig w wisks M be rctimiemed by awba port,
Delp taautes: .......... Hutic 1,ne
os 11 P-g
Asapntregarding; VaHmwe I Site Plan SubTANon
For'r'ax Map No.: 239AR Section 1 Mock 272 Lot
Deed R<derkAce3 Book 28P Page 8/3/15 IDate
....RSI OWNE. GNATURE! DATE� 10/13/2017
. ............ ............ ........... .......................................................... ............. .............. ......
Applicalinni, lmiy be r0erred t(.l Me him,ol coi�aLhrting, a°aatuuneer fill o kuaaw op �qniv dcsign, Amin
drainage,eGc. xi detemflned Y dw Zmvg W PNrd"T Qlaramm ices AW crlgwecting rwmw" wmwn "M be 6awd dKoh W dw qTkWo
ties poreoapt.iar eoiirag re peas "M w;eueed S 1100"hWu"m6kadon ho Q apQant,
It A(400AIZAIJON Liq±4±
MIKE& By SWI&I mis pup MW tauadruaaotuiiaag Ore uppikats"MMA6 amowd1wrAn we omer"W0011w
wand MQn/Ack ageno"remy audsorde the Zoming BoaM w PNmhg HwoJ mW Imm SmA m enur Ow sW*ct pa epertis Or Te pupose 4)O
reviewhg the apt,hation subrindred,
Q ODIVR VQVIVIT (Jnhar pennots maty hLrcqjtdred l6ir conmruc6on or akLir'mion ac6vk� subsequelm to approkifl bdic
ij o1j,y s XL NLF!"rl,"v�( MJNLLV�! a1h is SCLQ's 0,�: Te pmoke or Vu CwmwKq !Mdopmont Dvprmlero uo tl�ot,,
J��L _j,!_
ocnopapher hqic record Au promcdhtgs of moubgs remilkt, Win up"Viubw and rm"m omnsurHad Rom ullaame hip. comhwws Me orlMnl
reowd oraH prvoccedlops,
.�-)j fli�n d. die undar,,�npncd, have Owrooghdy read nind understand the knsiauc6on.i
for submission and agree M Ow nkmisshn NqAwmenry I ubmwkWe no ammmahn acirvoic,; ,shail be cornmenced tirko lo 1smouoao or a kand
pvrnor, d cerlkf� Omt rhe appkcaiJon, pimis and supNming rnme,fah am a now and smMim MmnmW&wdNKn "Ow ukkg mmNh"mW Ole
"oA pmtrowl mW dost M! "ork %OH be podkined in accodanec xvkh We (RMmned pWrrs and in conioninarice k6m locr,.d zolniq, rcpdafions, l
uckwwKedge duo prkw to om"Yq We N=W pmpowl I w m) apmh."M Awk a avMutu ni'twcupmu) us necesavy, I uko undammuld that
[,,, e nmy be required lo provide an asQuill maw, by as hu"wd hnd sunesor of A! ne"i) cunmrm:wd N61his pr or to issumce ofa certhkuw of
DCUUpcoCy
I have read and :lice to the above
Gregory J.Teresi 101/1 13/20117
ala �Ap h Mil Print Name [Applicant] Date signed
Lucas W.Dobie,P.E. 10/13/2017
Are P�04
I nl:ury A, "it P% Nwne jAgent] Date signed
9
She Phn Review; uppHeadon - Revised October 20 16
lb"n ofQwensbwy Phnning(Mlim-74213ay Road,Queenshoq. NY 12804
Signature Page!
This page includes the 1.)Authorization to Act.as Agent Fo=:2.) Engineering,F"Disclosure; 3,,)Authorization for Site Visits;4.)
Other Pett it Responsibilifivs,5.)Officist Ma; ling Disclosure and 6.)Agreement to provide,dorumentation required.
OWN.E'�ll's AGENT FOR341
Complete the following if the OERof the property is not the swne as the applicant
Owner: Lawrence Davis
Designates: Hutchins Firm,Grp g Te"sl,Jqg_4,ppRK
As agent regarding: Variance Site Plan Subdivision
For Tax Map No� ) 239.118 Szc " n 1 Block 27.2 Lot
Deed Reference,.""/" I W� " 'X'Pne B/ILLS Date
TURE
OWNER SIGNA : DATE.
AIPPUCg�NVS AGE,NT FORM:
Complete tile follawing if the APPLICANT is,unable to attend tine meeting or wishes to be represented by another part3r
Owner. _ Applicant;Gre!gTerest —
Desigmtes., Hutchins 21WReeri n&an.d Ion Upper
As,agent reWdlnariance v/ Site Plan Subdivision
For Tax,Map Nb - 2,39.18 Section I Block '27.2, Lot
Deed Refaw-rtnce'., 2303 11odic 288 Page 811LIS,Date
--F- I DATE, I
OWNER SIGNATURL
jjF,LCi 11
Q15 -. App, cations may be.referred to the Town consulting eai&eer&T review of septic design, storm.
drainage,etc, as&1emaned by the ZoniRg or Plarming Department. Fees for caginearing review services will be charged directly to the applicant.
for"&eering review will not exceed$ 1,000,without notification to tbe,applicant.
3,) EQH 511E USTI By signing this page and subrdifing the appikadon nuierjWs attached herein,the Owner,Applicant,
and hisftveriftix hereby aufte=the Zoning Beard or Planning Board and Town staff to enter the subject properties for the purpose of
rcVtewIqg the applicatilon sitbmittvd,
Other permits may be requirt4l liar construction or alteration activity subsequem to approvai by,the
Zoning Dowd or Planning tBoard. It is the applicant's respansibility to,obtain my additional perm-its.
�5.1 0Fr,11_CjAL MKU'1N_G f wfIt is Wive practice of the: Community Development Departriwril to have a designated
stems upper lope;record The proo"dings, of mectings reskildng from Application, and minutes tnscribed from,those w wnsfilutes the official
,recQrd of all proceed ings.
Q AMEMENT 10 FROY"M DOCTIMENIAMN RE QUIRE, : 1.1 the undmigned,hmv ffiorougbly med and understand 1he i'wtuctions,
for submission said agree to the submission rquiremmts,, I ackrimyledge no,construction Activities shall be con urienced prior to,Issuance of as valid,
pe-nn U. I cerflithat the application,plans and supporting matertals are a tme W complete statemeTit/description of the existing conditions and tlic
work proposed, and brat all voork will be performed in acoaTdarice with the approved,plans and in confomance: with local zoning regulations., I
acknowledge that prior to,occupying the fuil,ities proposed,I or my agents,will 6btain acortificate of occupancy as necessary. I also understand that
I/we may be required to provide an,as-built survey by a licensed land smveyor o�f all newly constructed facilitles priAT to W=ce of certificate of
occupancy
I ba ve read and agree,totine above:,
Gregory Terest
Signature[A liq Print Namc[Appli=t] Date,si,gnM.
GrSeg Teresi 11114/17
Sign rtu-n-, [Agcotj Print Narne f Agent) Dato signed,
9
Site P[an Review application,-Revised October 2016,
Tovm otQme�nsburyPlanningO�ffirp.-742 Bay Road,Queensbury,NY 12804