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Site Plan Application Review Process: to be held no later than 1 week prior todeadline day. Incomplete applications will not be considered for placement on any agenda until all missing information has been submitted. DOCUMENTATION REQUIREMENTS (hard copy & electronic): 1 original & 14 copies Completed Application Pre-Submission Meeting Notes: Copy of Deed Checklist & Plot Plan Environmental Assessment Form Fee: Staff & Contact Information: craigb@queensbury.net lmoore@queensbury.net sunnys@queensbury.net (518) 761-8220 www.queensbury.net ï     ùðó ûÙÊ×É ø×Æ×ÐÍÌÈÔ×ÙÇÊÊ×ÎÈÐÃÆÛÙÛÎÈÌÛÊÙ×ÐÓÎÈÍÛÎ   ÉÖï×ØÓÙÛÐíÖÖÓÙ×ÚÇÓÐØÓÎÕÈÍÙÍÎÈÛÓÎÛÎÓÏÛÕÓÎÕÙ×ÎÈ×ÊÛÎØÍÈÔ×ÊÍÖÖÓÙ×ÇÉ×É ÍÎÈÔ× ûÙÊ×ÌÛÊÙ×ÐèÔ×ÌÊÍÒ×ÙÈÌÊÍÌÍÉ×ÉÈÍÓÎÙÐÇØ×ÌÛÊÑÓÎÕÉÌÛÙ×ÉÍÎÉÓÈ×ÖÍÊÈÔ×ÇÉ×ÍÖÈÔ×ÚÇÓÐØÓÎÕ×ÏÌÐÍÃ××ÉÛÎØÆÓÉÓÈÍÊÉ ùÍÊÎ×ÊÍÖùÍÊÓÎÈÔêÍÛØÛÎØùÛÊ×ÃêÍÛØ Applicant Name: õóåóðçÌÊÍÌ×ÊÈÓ×Éððù øÓÆÓÉÓÍÎéÈÊ××ÈéÇÓÈ×     ðÛÊÊÃüÚÍÎÛÙÓÍÙÍÏ Agent’s Name:  ðÍÎÕûÐÐ×Ãéé  èÔ×ðûõÊÍÇÌ   ÏÚÊÍÚÉÈÍÎüÈÔ×ÐÛÕÊÍÇÌÙÍÏ Owner’s Name ïÇÊÊÛÃéÈõÐ×ÎÉöÛÐÐÉîã  úÍÐØÉÈÛÊððùòÓÏùÍÏÚÉÊ×Ì î Area / TypeExisting sq. ft. Proposed Total sq. ft. Addition sq. ft. îû       AreaRequiredExistingProposed   Additional Project Information îÍ îÍ Ç»­ Ù»²»®¿´ л®³·¬ º±® ­¬±®³©¿¬»® ¼·­½¸¿®¹» º®±³ ½±²­¬®«½¬·±² ¿½¬·ª·¬·»­  ïÓÐÐÓÍÎ û Floor Area Ratio Worksheet  A.Parcel Area B.Existing Floor Area  C.Proposed Additional Floor Area  D.Proposed Total Floor Area   E.Total Allowable Floor Area ì § 179-9-080 Requirements for Site Plan Approval. ìÐ×ÛÉ×Ê×Ö×ÊÈÍÈÔ×îÛÊÊÛÈÓÆ×Ê×ÐÛÈ×ØÈÍÉÓÈ×ÌÐÛÎÊ×ËÇÓÊ×Ï×ÎÈÉÖÍÊØ×ÈÛÓÐ×ØÛÎÉÅ×ÊÉÊ×ÕÛÊØÓÎÕÈÔ×ÖÍÐÐÍÅÓÎÕÉÈÛÎØÛÊØÉ ë § 179-9-050 Checklist-Application for Site Plan Review REQUIREMENTS ùÍÆ×Ê ûÐÐ ûÐÐ ùÍÆ×Ê ð ð ðð ð ð ð ð ð ð ð ùÍÆ×Ê ê REQUIREMENTS (CONTINUED) ð ùÍÆ×Ê ûÊÙÔ ìÐÛÎÉ ð ð é÷ûö îû îÛÊÊÛÈÓÆ× é [[146,1531,2422,1583][11][B,I,][Times New Roman]]__________________________________________________________________________________________________ [[146,1610,2422,1662][11][B,I,][Times New Roman]]__________________________________________________________________________________________________ [[146,1689,2422,1741][11][B,I,][Times New Roman]]__________________________________________________________________________________________________ [[146,1768,2422,1820][11][B,I,][Times New Roman]]__________________________________________________________________________________________________ [[146,1847,2422,1899][11][B,I,][Times New Roman]]__________________________________________________________________________________________________ [[146,1926,2422,1978][11][B,I,][Times New Roman]]__________________________________________________________________________________________________ [[146,2005,2422,2057][11][B,I,][Times New Roman]]__________________________________________________________________________________________________ [[146,2084,2422,2136][11][B,I,][Times New Roman]]__________________________________________________________________________________________________ [[146,2163,2422,2215][11][B,I,][Times New Roman]]__________________________________________________________________________________________________ [[146,2242,2422,2294][11][B,I,][Times New Roman]]__________________________________________________________________________________________________ [[146,2322,2422,2374][11][B,I,][Times New Roman]]__________________________________________________________________________________________________ [[146,2401,2422,2453][11][B,I,][Times New Roman]]__________________________________________________________________________________________________ [[146,2480,2422,2532][11][B,I,][Times New Roman]]__________________________________________________________________________________________________ [[146,2559,2422,2611][11][B,I,][Times New Roman]]__________________________________________________________________________________________________ [[146,2638,2422,2690][11][B,I,][Times New Roman]]__________________________________________________________________________________________________ , íðçòïí íïòïïí î ïîñçñîðïç íðçòïí íïòïïí î ïîñçñîðïç [[733,178,1824,253][16][B,I,][Times New Roman]]Short Environmental Assessment Form Instructions for Completing Part 1 - Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Part 1 - Project and Sponsor Information ëÇ××ÎÉÚÇÊÃóÏÛÕÓÎÕ ùÍÊÎ×ÊÍÖùÍÊÓÎÈÔêÍÛØÛÎØùÛÊ×ÃêÍÛØ ø×Æ×ÐÍÌÈÔ× ûÙÊ×ÌÛÊÙ×ÐÖÍÊÛ  ÉÖÏ×ØÓÙÛÐÍÖÖÓÙ×ÚÇÓÐØÓÎÕÈÍÙÍÎÈÛÓÎÛÎÓÏÛÕÓÎÕÙ×ÎÈ×ÊÅÓÈÔïêóÇÎÓÈÉäÊÛÃÏÛÙÔÓÎ×ÉÛÎØùè ÏÛÙÔÓÎ×ÉèÔ×Ê×ÅÓÐÐÚ×ÛØØÓÈÓÍÎÛÐÍÖÖÓÙ×ÉÌÛÙ×ÍÇÈÉÓØ×ÈÔ×ÓÏÛÕÓÎÕÙ×ÎÈ×ÊèÔ×ÌÊÍÒ×ÙÈÉÓÈ×ÅÓÐÐÓÎÙÐÇØ×ÇÈÓÐÓÈÃÙÍÎÎ×ÙÈÓÍÎÉÛÎØÍÎÉÓÈ×ÌÛÊÑÓÎÕ ÉÌÛÙ×É    õóåóðçÌÊÍÌ×ÊÈÓ×Éððù ÐÛÊÊÃüÚÍÎÛÙÓÍÙÍÏ øÓÆÓÉÓÍÎéÈÊ××ÈéÇÓÈ× éÛÊÛÈÍÕÛéÌÊÓÎÕÉîã  NO YES  NO YES      NO YES N/A   NO YES  NO YES  NO YES    NO YES  NO YES  NO YES  NO YES   NO YES    NO YES  NO YES  NO YES    2 NO YES  NO YES  NO YES  I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE èÔ×ðûõÊÍÇÌìù  ìêóîèöíêï Part 2 Answer all ofthefollowingquestionsin Part 2 using theinformation contained in Part 1 and other materialssubmitted by theprojectsponsoror otherwise available to the reviewer. When answeringthequestionsthereviewershould be guided by theconc No, or Moderate small to large impact impact may may occuroccur 1.Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? 2.Will the proposed action result in a change in the use or intensity of use of land? 3.Will the proposed action impair the character or quality of the existing community? 4.Will the proposed action have an impact on the environmental characteristics that caused the establishmentof a Critical Environmental Area (CEA)? 5.Will the proposed action result in an adverse change in the existing level of traffic or affect existing infrastructure for mass transit, biking or walkway? 6.Will the proposed action cause an increase in the use of energy and it fails to incorporate reasonably available energy conservation or renewable energy opportunities? 7.Will the proposed action impact existing: a.public / private water supplies? b.public / private wastewater treatment utilities? 8.Will the proposed action impair the character or quality of important historic, archaeological, architectural or aesthetic resources? 9.Will the proposed action result in an adverse change to natural resources (e.g., wetlands, waterbodies, groundwater, air quality, flora and fauna)? 10.Will the proposed action result in an increase in the potential for erosion, flooding or drainage problems? 11.Will the proposedaction create a hazard to environmental resources or human health? 12 Page of ìêóîèöíêï Foreveryquestion in Part 2 that was particularelementoftheproposed action may orwillnotresultin a significantadverseenvironmentalimpact, please completePart3. Part 3 should, in sufficient detail,identifytheimpact, including anymeasuresor design elements that havebeen included by theprojectsponsorto avoid or reduceimpacts. Part 3 should also explain howthelead agency determined that theimpactmayorwillnotbesignificant. Each potential impactshould be assessed considering itssetting, probabilityofoccurring, duration, irreversibility, geographic scopeandmagnitude. Also consider thepotentialforshort- term, long-term and cumulative impacts. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action will notresult in any significant adverse environmental impacts. ________________________________________________________________________________________________ Name of Lead AgencyDate ________________________________________________________________________________________________ Print or Type Name of Responsible Officer in Lead AgencyTitle of Responsible Officer ________________________________________________________________________________________________ Signature of Responsible Officer in Lead AgencySignature of Preparer (if different from Responsible Officer) ìêóîèöíêï 22 Page of