Application v
8/20/02 Site Plan RevRE C E I V E D
�` General Information OCT 1 5 2&►'---/ FILE TOWN OF QUEE
PLANNING OFFICE
Application No. (Office Use Only)
Project Location: v
Tax Map ID: P►eT OF Z46.1Z - I - Zq
Zone Classification: QROFC66icNLnL �PF1G�
Compliance with Zoning Ordinance Section:
Detailed Description of Project:
include current& proposed use): GyRRI`NT L^Jt-,G UN PEVELo PLP
1¢oP0seo Z -,>TbR'f to,oCn bP OFFiee: Wi-rH FARwlxJ4
AMP SrMW0r-V-
Modification to existing Site Plan, Yes: No: u
(If so,indicate Site Plan No. &approval date)
Square Footage of proposed structure: la 000 sr
Applicant: f2jaWA2P SC14F2MEeH0eN Je.
Address: t5 F l31¢cIE Polver
0OF-EN56bv2'( NYC IZS64
Home Phone:
Work Phone/Fax: -14-5 -46S'S
Applicant's Agent: ,oN l-APPeR, Es4 JANes /11I/die
Address: i WASHIN4T01-4 ST I49 WAVILAWD ep.
GLENS BALLS W 12tot QUEE N`(12804
Home Phone: -ill?, -ZI 17 :r Z -4ri SS
Work Phone/Fax: -14 Z - 5509 -l9 Z- 96,11
Property Owner: - &mg A6 APPL./o ,,ir
Address:
Home Phone:
Work Phone/Fax:
Directions to Site: �J�
EAST -SI DE OF Pa4`( FL0A0 We)e714 OF I(r EWAC.4L
OFF
ice lboiL.D1 NG (�f-It7El2 C.^� STQLXr70/V
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8/20/02 Site Plan Review
Site Development Data
Area/Type Existing sq. ft. Proposed Air Total sq. ft.
sq. ft.
A. Building Footprint
O $',o0f 53 004
B. Detached Garage
a o a
C. Accessory Structure(s)
O o O
D. Paved, gravel or other O 17 t 54 I"1, 154
hard surfaced areas
E. Porches/Decks
p O O
F. Other
O p O
Total Non-Permeable O ZZ, 15`d 22, 1 SS
Sum A through F)
Parcel Area
�1� 45 z 61 t 4SZ 61 I ¢SZ
Percent Non-Permeable
Tgtal Non-Permeable/Parcel Area Q>�'�6 3G• I% 3G.1�e
Setback Requirements
Required Existing Proposed
Front(1) Fst►'t 92`0^0 -15' O -77
Front(2)
Shoreline S'f¢BAJ+^ -151 O 14 1
Side Yard(1) Io ' 0 11
Side Yard(2) 10 ' 0 C.(• Z"I
Rear Yard(1) Io O '14
Rear Yard(2)
Buffer/Travel Corridor
Height 40 MAY- v 36
Permeability NO% ( (o5•q/
Sign Setback 15 ' o Is '
No. of Parking Spaces 33. 3 0 3ts
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8/20/02 Site Plan Review
Checklist—please prepare a map depicting existing and proposed conditions. Failure to complete the following
checklist or include all required information may result in a determination of incompleteness and a delay in the
processing of iour application
PR I NA wR Ad r .s 'a lx*'1#J4.
GENERAL
X A. Title,name, address of applicant&person responsible for preparation of drawing
�c B.North arrow, Tax Map ID,date prepared and scale(minimum I in.=40 ft.)
)C C. Boundaries of the property plotted to scale,zoning boundary
X D. Location of principal structures,accessory structures with exterior dimensions
E. Location of site improvements incl. outdoor storage areas, driveways (existing & proposed) parking
X areas, etc.
F. Setbacks for all structures and improvements
)< G. Elevations of proposed structures
WATER& SEWER
A. Location of on-site sewage disposal facilities, design details, construction details, flow rates, and
X number of bedrooms proposed
B. Location of water supply (i.e., well) and septic on adjoining lots with separation distances to existing
X or proposed on-site water supply and septic
C. Separation distances for proposed sewage disposal system to well and waterbodies
D. Location and description of existing public or private water supply (well, lake, etc.). Method of
K securing public or private water, location, design and construction of water supply including daily water
usage
X E. Percolation test location and results
PARKING/PERMEABLE AREAS
?t A.Number of spaces required for project including calculations and justification
B. Number of existing parking spaces, number to be removed, number to maintain and type of surfacing
X material e. ., gravel,paved)
C. Provision for pedestrian and handicap access and parking
D. Location and design details of ingress, egress,loading areas and cutting
E. Location and character of green areas (existing and proposed),modification to green area,buffer zone
X to remain undisturbed
F. Lighting,location and design of all existing or proposed outdoor lighting
ADDITIONAL SITE DEVELOPMENT AND MISCELLANEOUS
x A. Location of on-site&adjacent watercourses, streams,rivers, lake and wetlands
B. Location of proposed&existing: utility/energy distribution systems(gas,electric,solar,telephone)
C. Location, design and construction of all existing and proposed site improvements including: drains,
k culverts,retaining walls, fences,fire&emergency zones and hydrants
D. Location and amount/portion of building area proposed for office,manufacturing,retail sales or other
k commercial activities
k E. Signage: Location, size,type,design and setback
x F.Waiver Request: provide letter with application requesting any waivers
G. Commercial / Industrial Development requires submission of a Landscaping Plan, Stormwater
X Mana ement Plan,Grading Plan and a Lighting Plan
K H.The Bd.may request other elements as considered necessary.
X I. Identify any Federal, State or County permits required for the project.
X J. Please submit record of application for approval status of all necessary permits required from Federal,
State and County officials.
Legend: PR— Provided; NA—Not Applicable; WR—Waiver Requested /
TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY. 12804-5902
Town of Queensbury
Planning Board
Waiver Request
I hereby request that the Planning Board grant me a waiver from the
requirement for the submission of the following plans.
❑ Stormwater Management Plan
❑ Grading Plan
❑ lighting Plan
❑ Landscaping Plan
❑ Skptch Plan approval ( Subdivision )
I acknowledge that these plans are required and I seek such waiver(s)
knowingly and for the following reasons:
Applicant Date
L:\Crcig\Templates\waiverReq86O2.doc
8/20/02 Site Plan Review
14164111roA-Taut 12
PROJECT I.D.NUMBER 617.20 SEOR
Appendix C
State 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
Rtaµa 2D Sc a k P I etJA t ¢
S. PROJECT LOCATION: I� 1_JCfr' 1'il IO
Municipality IJ't� J Coun Q
4. PRECISE LOCATION(Street address and road Interosctims,Prominent landmadu,etc,"preMde map)
EAST OF PJA'( 9-DA17
I,_(c:f0rr F eDF MVIPI"9— P,X�ILOIN4 CJNDCi2 Co►—tS"[R j1oN
5. IS PRO FD ACTION:
CNew ❑EApanslon ❑ModifkatbNtllerstim
6. DESCRIBE PROJECT BRIEFLY:
-(Zito s"(w-"( to,000 "E:.F oFF1cE P�c�eLtDt hJ�i
r� }�'SgGtG1A rEP SIT= QEV'5'- /C A6tJ"r
7. AMOUNT OF LAND AFFECTED Initial ( ' 4' acres Ummate '4 u
a. WIL4 PROPOSED ACTION COMPLY WITH IXISIINO 20NIN0 OR OTHER IXISTNO LAND U6E RESTRICf1ONSt
Yea ❑No Of No.describe briefly
e. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT(
OResidentlal ❑Industrial ❑Commercial ❑Agriculture ❑ParluForesvow space OrOtIMr
Describe
O F•t=IG>=
10. DOES ACTION INVOLVE A PERMIT APPROVAL.OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL_
STATE OR LOCAL)?
14Yas ❑No It yes,list faerx:Nsl arM Pe.It/&PPrWsIs
Wta¢¢.EN (5oC¢0
—row r4 nF over QjU11,17i"
it. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
❑Yes ON. It Yes,list agsncy name arr0 Permltisppro sl
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITlAPPROVAL REQUIRE MODIFICATION?
❑Vest ON,
1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applkanuspornar nYnyr( Data: I� IS'OZ
Slanaturr. /yn/�///�'^
If the action Is In the Coastal Area, and you are a state agency, complete the
Coastal Assessment Form before proceeding with this assessment
OVER
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8/20/02 Site Plan Review
• PART 11—ENVIRONMENTAL ASSESSMENT(To be completed by Agency)
' A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR PART 617.4? It yes,coordinate ins rfti"process and use the FULL EAF.
❑Yea ON.
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.67 11 No.a negative decaratro
may be superseded by another Involved agency.
❑Yen ❑No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Anawar,may W handwritten,If laglble)
Ct. Existing air quality, surface or proundwalar quality or quantity, noise levels, existing tratnc 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 Mefly.
C1. Vegetation or fauns,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly.
C4. A community's existing plane a goals as officially adopted.or a change in use or intensity of use of land or other natural wourpes?Explain briefly
C6. Growth,subsequent development,or related activities foully to he Induced by the Proposed action?Explain briefly.
C6. Long term short term,cumulatM,or other effects not Identified in CIiS?Explain briefly. -
C7. Other Impacts(Including changes In use of either quantity or type of energy)?Explain briefly.
D. WILL THE PMMECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF-A CFA?
❑Yes 11 No
E. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
❑vex O No If Yes,explain briefly
PART It]—DETERMINATION OF SIGNIFICANCE(To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above,determine whether It is substantial,large,Important or otherwise,significant.
Each effect should be assessed In connection with its(a)"Icing(Le. urban a rural.(b) probability of.occurring;(c)duration;(it)
invive siblllty;(a)geographic scope;and M magnitude.If netxasary,add attachments or reference supporting materials Ensure that
explanations contain sufficient platen to shoe that an relevant adverse impacts haw been Identified and adequately addressed.if
question O of Part 11 was checked yes,the determination and significance must evaluate the peardial Impact of the proposed action
on the srivhalmerltal characteristics of the CEA -
❑ Check this box If you have identified one or more potentially large or significant adverse impacts which MAY
Occur.Then proceed directly to the FULL EAF andfor prepare a positive declaration.
0 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:
Naine of Lead Agency
Print or Type Name of Roponf e Offices in Lvd Agency Tire of Officer
ip,alere of RerPoa*itae Officer in Le Y i"urne of Pne"n., r event 1.respwn o ice)
Date
2
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8/20/02 Site Plan Review
Signature Page
This Page includes the Authorization to Act as Agent Form, Engineering Fee Disclosure, Other Permit
Responsibilities and Agreement to provide documentation required.
Complete the following if the OWNER of the property is not the same as the applicant
Owner's Agent Form
Owner: (ziGt llaR n `J�HE�/SIJL(-7o� �R .
Designates: -Saw ( aPPCt2, abo M144ree
As agent regarding _Variance X Site Plan _Subdivision
For Tax Map No.: y46,1&Section !Block Z4 Lot
Deed Reference: k Page Date
_Bo
SIGNATURE: _Z X�_(Owner) 16-(S•OZ(Date)
Complete the following if the APPLICANT is unable to attend the meeting or wishes to be represented
by another parry:
Applicant's Agent Form
Owner:
Designates:
As agent regarding: _Variance Site Plan _Subdivision
For Tax Map No.: _Section _Block _Lot
SIGNATURE: (Owner) (Date)
En?ineerin¢ Fee Disclosure: Applications may be referred to the Town consulting engineer for review
of septic design, storm drainage, etc. as determined by the Zoning or Planning Department. Fees for
engineering review services will be charged directly to the applicant. Fees for engineering review will
not exceed$1,000 without notification to the applicant.
Please Note: Other permits may be required for construction or alteration activity subsequent to approval
by the Zoning Board or Planning Board. It is the applicant's responsibility to obtain any additional
permits.
Official Meeting Minutes Disclosure: It is the practice of the Community Development Dept.to have a
designated stenographer tape record the proceedings of meetings resulting from application, 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.
1, the undersigned, have thoroughly read and understand the instructions for submission, agree to
the submission requirements and completed the checklist.
SIGNATURE OF APPLICANT: -Date 10-15-02
SIGNATURE OF AGENT: - Date
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8/20/02 Site Plan Review
PRE—APPLICATION CONFERENCE FORM
Please note that the Town of Queensbury Zoning and Subdivision of Land Codes contain many requirements
that potentially affect a project.
Effective immediately all applicants must meet with staff for a Pre-Application Conference prior to completing
your application and submitting it to the Community Development Department for processing. Please call
(518) 761-8220 to make an appointment. The intent of this requirement is to assist applicants in meeting the
minimum submission requirements, and to address any other issues or recommendations identified by staff.
Applications must be complete to be placed on an agenda.
When you meet with staff, we will initial and date this form. When you submit your application, please attach
this completed form. The completed form is considered part of your application. Thank you for your
cooperation. Our goal is to help you! r1 Applicant Name 5A-97-- PIAIFIaD Jc. SGHEtXACe- 001J
Tax Map No.
Zoning Classification
APA, CEA
Zoning Ordinance Compliance Section:
DESCRIPTION OF PROJECT: Iwo
PRE-APPLICATION MEETING NOTES:
C^1PStAP1u6 PLAN
St" WAT rvtcyml 0(ihJ
Ltt;"bw, W(tV
S L rVt4<T-) '5
Su B ooy APOWAt_ 1Jew 5 viODI D. tW;Y14fv
W B v Date(s) of Pre-Application Conference
A.I.S. Applicant Initials
® Staff Member Initials
Nothing stated in this meeting is to be construed as an approval or disapproval. The sole intent of the pre-
application meeting is to address submission requirements and to identify potential concerns. All content of
submissions is the responsibility of the applicant or authorized designee.