Application r e lY�
FI NUMBER:� ,- 1y A,
� DATEarcniFr_r: Pnrn
TOWN OF QUEENSBURY
531 Bay Road, Queensbury, NY 12804
DEPARTMENT OF COMMUNITY DEVELOPMENT Z
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C
I . PROJECT APPLICANT: L Eo N Aa pO Lo A4 t p yL,Ip6
ADDRESS : ov ss a
PHONE # : Home: _ 75f g q (o T
PHONE # : Work: 7ci �a Z6 5A
S'
APPLICANT'S AGENT: CI 1514 ��,,� LrcT
ADDRESS : Q & fEp AE O T Z
2
l & h4S1-:1VQ02 .'f
PHONE # : Home: S 5 q Ib
PHONE # : Work: 51$4 I.r)S8
PROPERTY OWNER: LLO haA?L >o 1� 0 A LL 1012Y 1,0 A4 Yb A I&DO
ADDRESS : T2.r7Q 9 lwc)x 33
11 )c E g en ,2&6' Wy II9,At;__
PHONE # : Home: '7 43 7_z_(o
PHONE # : Work: 7 d 3 -7- S-
DESCRIPTION OF PROJECT: �}OD)TIO)�IS AI�Tt✓z.4T�onIS
DIRECTIONS TO THE PROJECT: Please make as clear as possible,
so Bear )d members
ers & Staff can find your project:
No OK� 's- Q - W+5z�S`T S I,o.E a�
:iE 57 1L-r' 4 to+ff- C-=^n.r a -rA4zPJ
SKETCH OR PHOTOCOPY OF OFFICE USE ONLY
ROAD MAP: Tax Map No.
Zoning:
Variance: A U S No
Site Plan: Yes No
LraGIB� Subdiv. : _Yes No
$1TE Q [ CEA: _Yes No
SEQRA: I, II, Unlisted
Warren Co. : _Yes No
APA: _Yes No
Wetlands : Yes No
)79m Iq9
II. SITE DEVELOPMENT DATA
Tax Map Number: Section 33 Block I Lot 100 13
Zone Classification: H-CIA
Area of Parcel 3, vS I acres = L/7, 7 5-0 sq. ft .
Maximum Size Building Allowed sq. ft .
) @ 1 'La��no �iT ) l (& 17,000 � 1 l4T 17,0aO S.P
Disposition of Parcel :
Existing 5 4E.E
Building Area sq. ft. % of parcel
Paved Area sq. ft . % of parcel
(including walks)
Green Area sq. ft. % of parcel
Proposed
Building Area sq. ft. % of parcel
Paved Area sq. ft . % of parcel
(including walks)
Green Area sq. ft . % of parcel
Building Setbacks 54 C- -Cx.,5 4 ) �-
Existing Proposed Required
Front Yard
Front ( if corner)
Side Yard ( 1 )
Side Yard (2 )
Rear Yard
Rear Yard (2 )
Shoreline
Width
Depth
Access (check where applicable)
Town Highway County x State
i
Length of Frontage 9 2 8 . O 7
Number of Parking spaces : Existing Proposed Alb
Town Water: Yes x No
Town Sewer: Yes LX: No
Any previous Planning or Zoning Board determination regarding
this property? �)!
Present Use of Property: 1Z,6-STs4QMA 4 Zn 97G/ p— T/�S
Proposed Use of Property: �l/I
A COMPLETE APPLICATION IS NECESSARY FOR PLACEMENT ON THE PLANNING
BOARD AND ZONING BOARD OF APPEALS AGENDAS - APPLICANT PLEASE READ
The Planning and Zoning office requires 10 copies of your site
plan or variance application and maps, one original and 9 copies,
along with supporting documentation.
O
In addition to the $25 . 00 fee for site plan applications and m
the $50 . 00 fee for variance applications, the applicant is required n
to pay for the costs related to engineering review. Applications ~
may be referred to the Town Consulting Engineer for review of T
septic design, storm drainage, etc. The hourly rate charge for the p
engineer review will be charged directly to the applicant. Fees Do
for engineering review will not exceed $1 , 000 . 00 without
notification to the applicant. y
Other permits may be required for construction or alteration 2
subsequent to approval by the Planning Board or Zoning Board of
Appeals . It is the applicant' s responsibility to obtain these.
I, the undersigned, have thoroughly read and understand the
instructions for submission, agree to the submission requirements
and completed the checklist. Furthermore, it is the practice of
the Department of Community Development to have a designated
stenographer tape record the proceedings of meetings resulting from
applications, and that minutes transcribed from those tapes
constitute the official record of all proceedings . If there is a
discrepancy between such record and the handwritten minutes taken
by the designated stenographer, the handwritten minutes shall be
deemed the official record.
I HAVE READ AND AGREE TO THE ABOVE STATEMENT
Applicant ' s Signatur Date g-7
Applicant' s Agent Signature 144- All Date&)ans
AREA VARIANCE APPLICATION
(Must be accompanied by site information pages.)
TOWN OF QUEENSBURY
531 Bay Road
Queensbury, New York 12804
Applicant:L :0 OA.-Do )Z M, 6&9-12o parcel No. 53 / j f 10 , 1 1- Ja
IN ORDER TO COMPLETE THIS APPLICATION, YOU WILL FIRST NEED:
1 . A map of your property, to scale, showing the location of any existing
buildings, septic systems, and wells. (Remember to indicate North
and the scale.)
2. A definite idea of where, and what size, you would like your house,
addition, pool, etc., to be.
3. The setback requirements for the zone (available from the Zoning
Department: 745-4436.)
COMPLIANCE WITH ZONING ORDINANCE:
Section(s) j:7 4' - Z S
Require(s) setbacks 0 lot width 0 buffer zone
other
that cannot be met by the project as proposed.
Specific setback requirements should be provided on Page 2 of the Project Information �J
pages. rn
USING THE MAP OF THE PROPERTY, SHOW:
1 . All proposed new buildings, etc., in relation to existing. Show dimensions a
clearly.'
2. All setbacks affected by the project, existing and proposed. A
Z
3. Distances to adjacent owner's septic and well, if application involves n
installation or modification to septic or well, or if it could affect adjacent Lrn
systems.
4. Other items appearing on checklist with Project Information pages, as
appropriate. (If in doubt, inquire.)
ELEVATIONS:
Some projects are understood better if a drawing of the what the project
will look like is provided, in addition to the map/plan.
Page 2
[THEFOLLOWING QUESTIONS REFLECT THE CRITERIA FOR GRANTING THIS TYPE OF
ANCE. PLEASE COMPLETE THEM, USING ADDITIONAL SHEETS IF NEEDED.
1. How would you benefit from the granting of this Area Variance? 5461-a p h-e�
2
2. What effect would this variance have on the character of the neighborhood and the health,
safety, and welfare of the community? d .� t= 0r_ r p
44 I: A LTI4 Q- SA=45'7Y S 12-A A..X. 7y-1 G S-TP-AC.ek C
1ht a U E.D 1 OE T2s LO C 4TE p 7M f2 A it X-ZO M -P2A `fir
3. Are there feasible alternatives to this variance?
�-/tE:-5 — SAEIT "DWln. 1
4. Is the amount of relief substantial relative to the Ordinance? 1-4 a — -Eo l L P1 44
Wei t, t- 17,> G C- G S ti o -tz Q.e Lk 117-71� -9 '2 4U<04-r. >"
5. Will the variance have an adverse effect or impact on the physical or environmental
conditions in the neighborhood or district? t4 _-a
m
n
I HAVE READ AND COMPLETED ALL APPLICABLE PORTIONS OF THE PROJECT n
INFORMATION SHEETS, AS WELL AS THIS SIGN VARIANCE. TO THE BEST OF MY
KNOWLEDGE, ALL INFORMATION PROVIDED IS TRUE AND ACCURATE.
l � Z
Applicant: �< �� Date: e-,
I � Z�s c� m
Agent: Date:� � 9
Ronald Richard Rucinski
Architecture
9 Maple Court
Town Of Wilton ��G� Z.
Gansevoort N.Y. 12831
518 584 1058
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to
NOTE: Where wore than Otte tyke of application is involved, (Iris page wirlr
original silnuuitres is reyrtired list each one.
if rite A PPL I CANT is twable frt a((ewl the weeatig, or wishes to br
respiesented by munller palsy, the applicant's signalme is needed on the
authuriiation joint below, designating rill agen(.
APPLICANT'S AGIENT DORM
I. L, Lou$14�2k?b . _--hewhy desinmaw r20_1-t C_;:1.l3K6
as Illy agent regarding• a Vtniauce, Sin• flan, U Subdivision
,tpplieatiou ]fir Tax Map Number: Seetit is . 111m it ��r� , Las
SI(;Nlil): DATE:
ii rite OWNER of the property is stiff site sans• as file applicanf, she oevu•e'.
sil;tvuutc is needed nil (it(. ruithoriiafiaa ham belole, designating file appliviws o1
age r rf.
( )WNEWS A(;IiN'1' 1;01(M
1. _.. Moller o1 premises Inward to Tax Map
Nomhet: Sectiotr Block lwa hetrhy desigoafe
_ as nry agent regrading au alrp►iration far of
UVaritrnce., Site flan, Silly, iv!sill n
at file (drove premises.
lid SIGNED: DAM:
Deed Re/ewitce: Book _ Page _ Date
UPFIC AI, REMRI) UP METTINGS
It is the Irraclice (sf the Delm meat. of <.ommunity Development at have it
designated stenogra titer talk recur(! proceedings of meetings resulting fiom
r(pplications, and that mimttes transcribed f iont those tapes cnnstiufte till, official
record of all proceedings. If there is (( discrepancy between such record and the
hiuf<lvvritten (ttiftutes taketf by the designated stenographer, the handluviuen
mituaes shall be deemed the official record.
1 HAVE READ AND AGREE -1.0 TIIK ABOVE STA'1•ts11IBNT.
Applicants signature?— Date Z_7 �.. ,.
Applicant's agentsignatme. --�L— Datef2S Jumls
PROJECTLO.NUMBER 617.21 SEOR
Appendix C
Stale Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I—PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1. APPLICANT/SPONSOR 2. PROJECT NAME
a 2-o d11 Y IL
19>7
9. PROJECT LOCATION:
Munlclpalily ts�yJ L9 YL� County U� A R2 V E
4. PRECISE LOCATION(Street address end road Intersections,prominent landmarks,etc.,or provide map)
C,1T49
IzTC LIZ, R
6. IS PROPOSED ACTION:
❑New Expansion ❑Modlllcallonlallerallon
9. DESCRIBE PROJECT BRIEFLY:
hDt�lT loN AL--TC-;YLR7LOifS T6 ,ADC ISY� �GI
tZ `17.&I L -9 L P4,r .
7. AMOUNT OF LAND AFFECTED:
Initially 1 �Z acres Ullimalely acres
B. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING On OTHER EXISTING LAND USE RESTRICTIONS?
❑Yes XNo 11 No,describe briefly
R6�'v tz-VL'c a-T )fikm 7 )S 7 S ^ P'ri.b 17o S C D J S Q 1,7 3
9. WHAT IS PRESENT LAND USE IN VICINITY OF PnOJECT?
❑Residential ❑Industrlal �Commerclal ❑Agriculture ❑ParklForestiOpen space ❑Other
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL,On FUNDING.NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL,
STATE OR LOCAL.)?
Yes ❑No If y¢s,Ils(a0ency(s)and
permlllepprovels
�'P [�/ 6 I+a—Rj K. L Y_)G, O LP GI, WA n WC—AJ CO- . P LA M A{ 1 Nor
11. 90ES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
Yes ❑No If yes,list agency name and permlVapproval
(a FAY -PLA A',*,11 0 G, W h rL ZeG&1 0b . T-L— J#1 IJ t k JG.
12. AB RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPIIOVAL REQUIRE MODIFICATION?
Yes ❑No
1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
AppllcanUeponeor name: P k Dale: -t
Signature:
It the action Is In the Coastal Area, and you are a stale agency, complete the
Coastal Assessment Form before proceeding with this assessment
OVER
1
PART II—ENVIRONMENTAL ASSESSMENT (To be completed by Agency)
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN a NYCRR,PART 617.12? If yes,coordinate the review process and use the FULL EAF.
❑Yes El No 1,
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration
may be superseded by another Involved agency.
❑Yee ONO
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten.It legible)
Cl. Existing air quality, surface or groundwater quality or quantity, notes levels, exlsling traffic patterns, solid waste production or disposal,
potential for erosion,drainage or flooding problems? Explain briefly:
C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character? Explain briefly:
C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species? Explain briefly:
CI. A community's existing plans or goals as officially adopted,or a change In use or Intensity of use or land or other natural resources?Exptaln briefly.
C5. Growth,subsequent development,or related activities likely to be Induced by the proposed action? Expleln briefly.
C6. Long term,shod term,cumulative,or other effects not Identified In CI-CS?Explain briefly.
C7. Other Impacts(Including changes In use of either quantity or type of energy)?Explain briefly.
D. IS THERE,OR IS THERE LIKELY TO SE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
❑Yes ❑No If Yes,explain briefly
PART III—DETERMINATION OF SIGNIFICANCE(To be completed by Agency)
INSTRUCTIONS: For each adverse effect Identified above,determine whether It Is substantial,large,Important or Otherwise duration;significant.
Each effect should be assessed In connection with Its (a) selling (i.e. urban or rural); (b) probability of occurring; ( ) ( t
Irreversibility;(a)geographic scope; and(Q magnitude. If necessary,add attachments or reference support
materials. Ensure that
explanations contain tiullicienl-detalf to show that all relevant adverse Impacts have been Identified and adequately addressed.
❑ Check this box It you have Identified one or more potentially large or significant adverse Impacts which MAY
occur.Then proceed directly to the FULL EAF and/or prepare a positive declaration.
❑ 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
AND provide on attachments as necessary, the reasons supporting this determination:
Name o Lea Agency
Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Ices
Signature at esponsl a Officer in Lead Agency _ Signature of Prepares(if different from responsible officer)
Date
2