NEW REVISED INFO 19 Jan 2021Area Variance [ZBA approved: September 21 2016]
General Information
Tax Parcel ID Number: ____________________
Zoning District: ____________________
Detailed Description of Project [include current & proposed use]:
Current Use: _________________________________________________________________
Proposed Use: ____________________________________________________________
Location of Project: _______________________________________________________________
Applicant Name: Mailing Address
Home Phone City, State, Zip
Work Phone Cell Phone
E-Mail: FAX No.
Agent’s Name: Mailing Address
Home Phone City, State, Zip
Work Phone Cell Phone
E-mail FAX No.
Owner’s Name Mailing Address
Home Phone City, State, Zip
Work Phone Cell Phone
E-mail FAX No.
Page 1
Area Variance [ZBA approved: September 21 2016]
Site Development Data
Area / Type Existing sq. ft. Proposed
Addition sq. ft.
Total sq. ft.
A. Building footprint
B.Detached Garage
C.Accessory Structure(s)
D.Paved, gravel or other hard surfaced area
E.Porches / Decks
F. Other
G.Total Non-Permeable [Add A-F]
H.Parcel Area [43,560 sq. ft. / acre]
I.Percentage of Impermeable Area of Site [I=G/H]
Setback Requirements
Area Required Existing Proposed
Front Yard [1]
Front Yard [2]
Shoreline
Side Yard [1]
Side Yard [2]
Rear Yard [1]
Rear Yard [2]
Travel Corridor
Height [maximum]
Permeability
Number of parking spaces
Page 2
Area Variance [ZBA approved: September 21 2016]
Additional Project Information
1. Will the proposal require a Septic Variance from the Town Board of Health? _______________
2. If the parcel has previous approvals, list application number(s): _________________________
3. Does this project require coverage under the New York State Pollutant Discharge Elimination System (SPDES) Permit
Program? __ Yes / __ No
4. Estimated project duration: Start Date: __________ End Date: __________
5. Estimated total cost of project: _______________
6. Total area of land disturbance for project: _______________
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 / Commercial
Intensive
CM / CI 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.
Parcel Area ___________________________ sq. ft.
Existing Floor Area ___________________________ sq. ft. [see above definition]
Proposed Additional Floor Area ___________________________ sq. ft.
Proposed Total Floor Area ___________________________ sq. ft.
Total Allowable Floor Area ___________________________ (Area x _____) [see above table]
Page 3
Area Variance [ZBA approved: September 21 2016]
Compliance with Zoning Ordinance
Requesting relief from SECTION: ________________________________
Need relief from the requirement(s) listed below which can not be met by the project as proposed.
[Check all that apply] Setback Buffer Zone Lot Width Other ______________________
The following questions reflect the criteria for granting this type of variance. Please complete them; use additional sheets if
needed.
1. Whether an undesirable change will be produced in the character of the neighborhood or a detriment to
nearby property will be created by the granting of this area variance?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
2. Whether the benefit sought by the applicant can be achieved by some method, feasible for the applicant
to pursue, other than an area variance?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
3. Whether the requested area variance is substantial?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
4. Whether the proposed variance will have an adverse effect or impact on the physical or environmental
conditions in the neighborhood or district?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
5. Whether the alleged difficulty was self-created?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Page 4
Area Variance [ZBA approved: September 21 2016]
Section 179-14-030 –Application materials
Application materials and site plan drawing is to include sufficient information for the Board to review and provide a decision. The
applicant is to provide a site plan drawing(s) – a survey showing existing conditions, a proposed conditions map (see page 00 for
specific criteria) and include any other attachments that address A - D as applicable to the proposed project.
A. General Shown on Sheet #
1 Title, Name, Address of applicant & person responsible for preparation of drawing
2 Deed
3 North arrow, Tax Map ID, date prepared and scale [minimum: 1 inch = 40 feet ]
4 Boundaries of the property plotted to scale, zoning boundary
5 Principal structures, accessory structures with exterior dimensions
6 Site improvements incl. outdoor storage areas, driveways, parking areas, etc.: existing &
proposed
7 Setbacks for all structures and improvements: existing & proposed
8 Elevations and floor plans of all proposed and affected structures
B. Water & Sewer Shown on Sheet #
1 Project sewage disposal facilities, design details, construction details, flow rates, and number of
bedrooms proposed
2 Water supply [i.e. well] & septic on adjoining lots with separation distances to existing or
proposed on-site water supply and septic
3 Separation distances for proposed sewage disposal system to well and water bodies
4 Existing public or private water supply [well, lake, etc.]. Method of securing public or private
water, location, design and construction of water supply including daily water usage
5 Percolation test location and results
C. Parking / Permeable Areas Shown on Sheet #
1 Number of spaces required for project including calculations and justification: existing &
proposed
2 No. of existing parking spaces, number to be removed, number to maintain and type of surfacing
material [e.g., gravel, paved]
3 Provision for pedestrian and handicap access and parking: existing & proposed
4 Design details of ingress, egress, loading areas and cutting: existing & proposed
5 Location and character of green areas [existing and proposed], modification to green area, buffer
zone to remain undisturbed
6 Lighting, location and design of all existing and proposed outdoor lighting
D. Additional Site Development and Miscellaneous Shown on Sheet #
1 On-site & adjacent watercourses, streams, rivers, lake and wetlands
2 Utility / energy distribution system [gas, electric, solar, telephone]: existing & proposed
3 Location, design and construction details of all existing and proposed site improvements
including: drains, culverts, retaining walls, fences, fire & emergency zones and hydrants, etc.
4 Square footage of bldg. area proposed for office, manufacturing, retail sales or other commercial
activities: existing & proposed
5 Signage: Location, size, type, design and setback: existing & proposed
6 Waiver Request: provide letter with application requesting any waivers: please reference
specific items
7 Commercial / Industrial Development requires submission of Landscaping, Stormwater
Management, Grading & Lighting Plans
8 Identification of Federal, State or County permits required for the project together with a record
of application for all necessary permits
Page 5
Area Variance [ZBA approved: September 21 2016]
Pre-Submission Conference Form / Section 179-9-040
1. Applicant Name: __________________________________________________
2. Tax Map ID ________________ Location: _______________________
3. Zoning Classification __________
4. Reason for Review: __________________________________________________________
5. Zoning Section #: ________________________
6. Pre-Submission Meeting Notes: Provided Outstanding; Please provide by
Deed ____ _____________
General Information complete ____ _____________
Site Development Data Complete ____ _____________
Setback Requirements Complete ____ _____________
Additional Project Information Complete ____ _____________
FAR addressed ____ _____________
Compliance with Zoning Ordinance ____ _____________
Checklist items addressed ____ _____________
Environmental Form completed ____ _____________
Signature Page completed ____ _____________
__________________________________________________________________________________________________
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__________________________________________________________________________________________________
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__________________________________________________________________________________________________
__________________________________________________________________________________________________
Staff Representative: ________________________________
Applicant / Agent: ________________________________ Date: ___________
Page 6
Page 1 of 3
Short Environmental Assessment Form
Part 1 - Project Information
Instructions for Completing
Part 1 – Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the
application for approval or funding, are subject to public review, and may be subject to further verification. Complete Part 1 based on
information currently available. If additional research or investigation would be needed to fully respond to any item, please answer as
thoroughly as possible based on current information.
Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the
lead agency; attach additional pages as necessary to supplement any item.
Part 1 – Project and Sponsor Information
Name of Action or Project:
Project Location (describe, and attach a location map):
Brief Description of Proposed Action:
Name of Applicant or Sponsor: Telephone:
E-Mail:
Address:
City/PO: State: Zip Code:
1.Does the proposed action only involve the legislative adoption of a plan, local law, ordinance,
administrative rule, or regulation?
If Yes, attach a narrative description of the intent of the proposed action and the environmental resources that
may be affected in the municipality and proceed to Part 2. If no, continue to question 2.
NO YES
2.Does the proposed action require a permit, approval or funding from any other government Agency?
If Yes, list agency(s) name and permit or approval:NO YES
3.a. Total acreage of the site of the proposed action? __________ acres
b. Total acreage to be physically disturbed? __________ acres
c. Total acreage (project site and any contiguous properties) owned
or controlled by the applicant or project sponsor? __________ acres
4.Check all land uses that occur on, are adjoining or near the proposed action:
5. Urban Rural (non-agriculture) Industrial Commercial Residential (suburban)
Aquatic Other(Specify):□ Forest Agriculture
□ Parkland
Page 2 of 3
5.Is the proposed action,
a.A permitted use under the zoning regulations?
b.Consistent with the adopted comprehensive plan?
NO YES N/A
6.Is the proposed action consistent with the predominant character of the existing built or natural landscape?NO YES
7.Is the site of the proposed action located in, or does it adjoin, a state listed Critical Environmental Area?
If Yes, identify: ________________________________________________________________________________
NO YES
8.a. Will the proposed action result in a substantial increase in traffic above present levels?
b.Are public transportation services available at or near the site of the proposed action?
c.Are any pedestrian accommodations or bicycle routes available on or near the site of the proposed
action?
NO YES
9.Does the proposed action meet or exceed the state energy code requirements?
If the proposed action will exceed requirements, describe design features and technologies:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
NO YES
10.Will the proposed action connect to an existing public/private water supply?
If No, describe method for providing potable water: _________________________________________
_____________________________________________________________________________________________
NO YES
11.Will the proposed action connect to existing wastewater utilities?
If No, describe method for providing wastewater treatment: ______________________________________
_____________________________________________________________________________________________
NO YES
12. a. Does the project site contain, or is it substantially contiguous to, a building, archaeological site, or district
which is listed on the National or State Register of Historic Places, or that has been determined by the
Commissioner of the NYS Office of Parks, Recreation and Historic Preservation to be eligible for listing on the
State Register of Historic Places?
archaeological sites on the NY State Historic Preservation Office (SHPO) archaeological site inventory?
NO YES
13. a. Does any portion of the site of the proposed action, or lands adjoining the proposed action, contain
wetlands or other waterbodies regulated by a federal, state or local agency?
b.Would the proposed action physically alter, or encroach into, any existing wetland or waterbody?
If Yes, identify the wetland or waterbody and extent of alterations in square feet or acres: _____________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
NO YES
b. Is the project site, or any portion of it, located in or adjacent to an area designated as sensitive for
Page 3 of 3
14.Identify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply:
□Shoreline □ Forest Agricultural/grasslands Early mid-successional
Wetland □ Urban Suburban
15.Does the site of the proposed action contain any species of animal, or associated habitats, listed by the State or
Federal government as threatened or endangered?NO YES
16.Is the project site located in the 100-year flood plan?NO YES
17.Will the proposed action create storm water discharge, either from point or non-point sources?
If Yes,
a.Will storm water discharges flow to adjacent properties?
b.Will storm water discharges be directed to established conveyance systems (runoff and storm drains)?
If Yes, briefly describe:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
NO YES
18.Does the proposed action include construction or other activities that would result in the impoundment of water
or other liquids (e.g., retention pond, waste lagoon, dam)?
If Yes, explain the purpose and size of the impoundment:______________________________________________
____________________________________________________________________________________________
_
NO YES
19.Has the site of the proposed action or an adjoining property been the location of an active or closed solid waste
management facility?
If Yes, describe: _______________________________________________________________________________
_____________________________________________________________________________________________
NO YES
20.Has the site of the proposed action or an adjoining property been the subject of remediation (ongoing or
completed) for hazardous waste?
If Yes, describe: _______________________________________________________________________________
_____________________________________________________________________________________________
NO YES
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF
MY KNOWLEDGE
Date: _____________________ Applicant/sponsor/name: ____________________________________________________ __________________________
Signature: _____________________________________________________Title:__________________________________
EAF Mapper Summary Report Wednesday, December 2, 2020 8:11 AM
Disclaimer: The EAF Mapper is a screening tool intended to assist
project sponsors and reviewing agencies in preparing an environmental
assessment form (EAF). Not all questions asked in the EAF are
answered by the EAF Mapper. Additional information on any EAF
question can be obtained by consulting the EAF Workbooks. Although
the EAF Mapper provides the most up-to-date digital data available to
DEC, you may also need to contact local or other data sources in order
to obtain data not provided by the Mapper. Digital data is not a
substitute for agency determinations.
Part 1 / Question 7 [Critical Environmental
Area]
Yes
Part 1 / Question 7 [Critical Environmental
Area - Identify]
Name:Glen Lake, Reason:Benefit to human health, natural setting,
Agency:Queensbury, Town of, Date:11-30-89
Part 1 / Question 12a [National or State
Register of Historic Places or State Eligible
Sites]
No
Part 1 / Question 12b [Archeological Sites]Yes
Part 1 / Question 13a [Wetlands or Other
Regulated Waterbodies]
Yes - Digital mapping information on local and federal wetlands and
waterbodies is known to be incomplete. Refer to EAF Workbook.
Part 1 / Question 15 [Threatened or
Endangered Animal]
No
Part 1 / Question 16 [100 Year Flood Plain]Digital mapping data are not available or are incomplete. Refer to EAF
Workbook.
Part 1 / Question 20 [Remediation Site]No
1Short Environmental Assessment Form - EAF Mapper Summary Report
EAF Mapper Summary Report Wednesday, December 2, 2020 8:29 AM
Disclaimer: The EAF Mapper is a screening tool intended to assist
project sponsors and reviewing agencies in preparing an environmental
assessment form (EAF). Not all questions asked in the EAF are
answered by the EAF Mapper. Additional information on any EAF
question can be obtained by consulting the EAF Workbooks. Although
the EAF Mapper provides the most up-to-date digital data available to
DEC, you may also need to contact local or other data sources in order
to obtain data not provided by the Mapper. Digital data is not a
substitute for agency determinations.
Part 1 / Question 7 [Critical Environmental
Area]
Yes
Part 1 / Question 7 [Critical Environmental
Area - Identify]
Name:Glen Lake, Reason:Benefit to human health, natural setting,
Agency:Queensbury, Town of, Date:11-30-89
Part 1 / Question 12a [National or State
Register of Historic Places or State Eligible
Sites]
No
Part 1 / Question 12b [Archeological Sites]Yes
Part 1 / Question 13a [Wetlands or Other
Regulated Waterbodies]
Yes - Digital mapping information on local and federal wetlands and
waterbodies is known to be incomplete. Refer to EAF Workbook.
Part 1 / Question 15 [Threatened or
Endangered Animal]
No
Part 1 / Question 16 [100 Year Flood Plain]Digital mapping data are not available or are incomplete. Refer to EAF
Workbook.
Part 1 / Question 20 [Remediation Site]No
1Short Environmental Assessment Form - EAF Mapper Summary Report
Page 1 of 2
Agency Use Only [If applicable]
Project:
Date:
Short Environmental Assessment Form
Part 2 - Impact Assessment
Part 2 is to be completed by the Lead Agency.
Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by
the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by
the concept “Have my responses been reasonable considering the scale and context of the proposed action?”
No, or
small
impact
may
occur
Moderate
to large
impact
may
occur
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
establishment of 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 proposed action create a hazard to environmental resources or human health?
Page 2 of 2
For every question in Part 2 that was answered “moderate to large impact may occur”, or if there is a need to explain why a
particular element of the proposed action may or will not result in a significant adverse environmental impact, please
complete Part 3. Part 3 should, in sufficient detail, identify the impact, including any measures or design elements that
have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency
determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting,
probability of occurring, duration, irreversibility, geographic scope and magnitude. Also consider the potential for short-
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 not result in any significant adverse environmental impacts.
_________________________________________________ _______________________________________________
Name of Lead Agency Date
_________________________________________________ _______________________________________________
Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer
_________________________________________________ _______________________________________________
Signature of Responsible Officer in Lead Agency Signature of Preparer (if different from Responsible Officer)
Short Environmental Assessment Form
Part 3 Determination of Significance
Agency Use Only [If applicable]
Project:
Date: