Application - - -_ - -
LvwiN war �1C L_. 'JURY
L
COMMERCIAL, INDUSTRIAL, PROFESSIONAL OFFICE
SITE PLAN REVIEW Date Submitted to Department
To Be Reviewed By: Queensbury Planning Board
Adirondack Park Agency Referral: Date Accepted and Fee Received
Type I or Class A: ❑ Warren County Planning Referral: (amount)
Type II or Class B: Received by: (initial)
Application is hereby made for COMMERCIAL SITE PLAN REVIEW pursuant to
the procedures set forth in the TOWN OF QUEENSBURY ZONING LAW.
(FOR OFFICE USE ONLY) FILE Copy
This application is hereby approved(disapproved) and permission is hereby granted
(refused) to the applicant to apply for a Building Permit. This approval is good for one
year from date of issuance.
Subject to the following conditions: (including Beautification Committee and riLAA
YYY
Board Recommendations)
199
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1)EpA1VrA; �yNINE..
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Approved by:
Variance Granted _yes _ no
Variance Number Date of Variance Approval
I. GENERAL INFORMATION
1. Applicant's Nae: ( �Ip� d / t
Street Address:m M GU(+8CA- h O
City, State, Zip: n �p D
Telephone No. (5)S)
. 8
2. Agent's Name:
t
Street Address:
City, State, Zip:
Telephone No. (i)
3. Owner's Name: y�
Street Address: _7(_ �/ /pJ
City, State, Zip: rO-L Aft /V Y
Telephone No. [P� �(Sa) /3/L
4. Property Location: fail op%+ ®lJ.w1� M /IJ NFU Xn ('�fFbOrrrl R>lV ��
IN THE SPACE PROVIDED BELOW,draw an overview (si
your property is located in the Town of Queensbury. (y�,.��
Show north arrow, street corners (name them) �"�w101 ryy .9 It ` 10
note: this particular map does not have to be draw: 'Y
rt
ex,t rI s ° e t COLA�(ry, TaPot�+
19
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ryy 1 inn
5. Description of how to find the property:
/&'O� 0Y
6. Tax Map Number: Section: LL Block: 3 Lot:
&wa 7. Zone Classification: I
8. Is the lot in question within 500 feet of a County or a State Right of Way or
Park, Municipal Boundary, or watershed draining any County or State facilities,
requiring review of the WARREN
COUNTY PLANNING BOARD:
YES: I NO:
II. APPLICANT'S PROPOSED ACTION (Check where applicable)
New Site Change of Use Site Change
. Addition Demolition Renovation
1. Present Use of Property (If vacant existing building, describe last prior use.)
2. Proposed Use of Property (describe the proposed project):
•
Proposed Use (Check where applicable and provide floor area for each use.)
� ,�//USE GROSS FLOOR AREA
VGeneral Office sq. ft.
_ Professional Office sq. ft.
v/Retail Sales 320 sq. ft.
Motel, Hotel sq. ft.
Wholesale/Distribution sq. ft.
Fast Food sq. ft.
Restaurant, barroom sq. ft.
Manufacturer sq. ft.
Other (specify) 315S9L sq. ft.
3. Number of Employees in Maximum Shift Toulu
Ill. SITE DEVELOPMENT DATA
� µUcYiO
p�
Area of Parcel 3 1 5 Q p acres = sq. ft.
Maximum Size Building Allowed sq. ft.
Disposition of Parcel:
Existing
Building Area sq. ft. . 5 % of parcel
Paved Area sq.ft. Iy,S % of parcel
(including walks)�TJ—
Green Area 1fA.k1 ( sq. ft. _ % of parcel
Proposed
. Building Area L,3 ZO sq. ft. '3, % of parcel
Paved Area 2SfL sq.ft. �� , % of parcel
(including walks)
Green Area { q sq. ft. rj % of parcel
Building Setbacks
Front Yard $�
Rear Yard a 6
Left Side YardZ
. Right Side Yard
Access (check where applicable)
Town Highway )L County _ State
Length of Frontage 5U
Number of Parking Spaces: Existing qv Proposed V
Town Water: X Yes No
Town Sewer: Yes X No
IV. BUILDING DATA
Type of Building to be built:
W
Height of Building (at peak):
Number of seats (where applicable):
r
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NVTH
STI<-J� fG�ItiN�N�
l76 Qu ell M 0-1yy
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4416.4(2/87)—Text 12 -~
P:.WECT I.D. NUMBER 617.21 SEOR
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART 1—PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1. A LICA T I5 NOR OJE NA
3. PROJECT L CATION:
Municipa fly County
!. PRECISE LOCATION(Street address so road Intersections,prominent landmarks,etc.,or pr Ide map)
t
5. IS PROPOSED ACTION:
❑New M Expansion ❑Modlticatlonlalteration
6. DESCRIBE PROJECT BRIEFLY:
_ t3 mme, ajt' /Y X 3A n .
T. AMOUNT OF LAID FECTED: V
Initially 7 acres Ultimately ' acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
®Yes ❑No If No,describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
❑Residential ❑Industrial ®Commercial ❑Agriculture ❑ParklForesUOpen space ❑Other
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL,
STATE OR LOCAL)?
®Yes ❑No If yes,list agency(s)and permitlapprovals
./>A� QU d- N sea
11. DOES 4NY ASPECT OF t(E ACTION HAVEk CURRENTLY VALID PERMIT OR APPROVAL?
❑Yes ®No If yes,list agency name and permlVapproval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION?
❑Yes ENO
I CERTIF4HATTKE INFORMATI=PROVIDABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE /,11
Applicant/sponsor name: A Date:
Signature:
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
1
PART II—ENVIRONMENTAL ASSESSMENT (To be ipleted by Agency)
A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.12? If yes,coordinate the review process and use the FULL EAF.
❑Yes ❑No
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.
❑Yes ❑No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,If legible)
C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing 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:
Ce. A community's existing plans or goals as officially adopted,or a change In use or Intensity of use of land or other natural resources?Explain briefly.
C5. Growth,subsequent development,or related activities likely to be Induced by the proposed action?Explain briefly.
06. Long term,short term,cumulative,or other effects not identified In C1C5?Explain briefly.
C7. Other Impacts(Including changes In use of either quantity or type o1 energy)?Explain briefly.
D. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
❑Yes ❑No If Yes,explain briefly
PART III—DETERMINATION OF SIGNIFICANCE (ro 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) getting (I.s. urban or rural); (b) probability of occurring; (c)duration; (d)
Irreversibility;(a)geographic scope; and M magnitude. If necessary,add attachments or reference supporting materials. Ensure that
explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed.
❑ Check this box If you have Identif led 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 of Lead Agency
Print or Type Name of Responsible Officer in Lead Agency Til e o Responsible officer
Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from mponsibleofficer)
Date
2
t .
A COMPLETE APPLICATION IS NECESSARY FOR PLACEMENT
ON THE QUEENSBURY PLANNING BOARD AGENDA
APPLICANT PLEASE READ
The Planning Department requires 14 maps of your site plan, one original application
and 13 copies of the application with narrative and supporting reports, if applicable. Also,
2 copies each of the deed and survey plat. Review fees as required.
In support of your application, it would help the Planning Board if a copy of the
elevations showing how the structure(s) will appear were made available to them.
All maps must be folded to an 8Yzz by 14 inch or smaller format. All components
of the submittal must contain all information required under the applicable Town Law or
Regulation and Planning Department checklist.
Section 5.041 Application and Fees for Site Plan Review Approval. In addition to
the fee listed on the schedule of fees, the Planning Board may charge a fee
to developers of projects requiring legal and technical review provided that
the fee charged reflects the actual cost of legal and technical assistance to
the Planning Board. This fee is not to exceed One Thousand ($1.000) Dollars
without notice to the applicant.
The necessary information that you will need for a complete site plan is listed on
the next page: (Queensbury Planning Board Checklist)
WE RECOMMEND YOUR PURCHASING THE ZONING ORDINANCE SO THAT YOU MAY
BE FULLY APPRISED OF ALL TOWN OF QUEENSBURY REGULATIONS.
Please return the original application with all pages intact.
Applicant please initial S ,6t'
J
Signat of Applicant
Signature of Agent
Dated this day of year /V
ANY MODIFICATIONS OR STIPULATIONS ON A SITE PLAN WHICH IS A P P R O V E D
BY THE PLANNING BOARD SHALL BE IDENTIFIED ON A REVISED SITE PLAN AND PRESENTED
TO THE PLANNING DEPARTMENT WITHIN 10 DAYS OF THE MEETING AT WHICH THE SITE
PLAN IS APPROVED.
OTHER PERMITS MAY BE REQUIRED FOR CONSTRUCTION OR ALTERATIONS SUBSEQUENT
TO APPROVAL BY THE PLANNING BOARD OR ZONING BOARD OF APPEALS. IT IS THE
APPLICANTS RESPONSIBILITY TO OBTAIN THESE.
I have read the above and understand the instructions:
Signat of Applicant r Agent
1
V.
List the names and location of the parcel (Include Tax Map Number and Zone) of
adjoining property owners:
HOW TO USE THE TAX MAPS
Every property in Queensbury is identified by a number. These numbers relate
to the Town Tax Maps. Each parcel has a 3 number code by which you can locate
it in the Town.
If you know the name of the person who owns the property you can find the
Tax Map Number of the parcel by looking up the person in the "Alphabetical Listing
Book'. This listing has the owners name and identifies his property by the tax map
number.
If you have a Tax Map Number but need to know the owner you look in the
"Numerical Listing Book". This book identifies the property owners.
If you only know the property location and need to find the owner, the adjacent
neighbors or the zoning, you need to go to the Tax Map. The first sheet of the tax
maps shows the Town broken into a number of areas which are numbered. These
areas indicate which map (below the cover sheet) to look onto for the property.
This map number is also the first number of the tax map identification number.
For example, in number 32-2-12.3, the 32 indicates Section Number 32. The Section
Number appears in the lower right hand corner of the map. Once you are on the
correct map you need to find the Block Number. The Block Number is the second
number on the tax map. For example, in 32-2-12.3, the 2 is the Block Number.
The Block Number usually has a circle around it.
. The last number of the tax map is the parcel number. For example, 12.3 would
indicate the exact piece of property. This number is usually on the map parcel or
has an arrow indicating to which parcel it belongs.
If you have to identify property or adjacent properties for an application it
is very important that you accurately identify the numbers. The first number is
the Section Number. The second number is the Block Number and the third number
is the Parcel Number.
NORTHERLY: // J
Tax Map Number: /01 t -3—.5 L T
Zone: /
Name:
C6142-
Location:
•
SOUTHERLY:
Tax Map Number:
Zone:
Name:
Location:
EASTERLY:
Tax Map Number:
Zone: LC- /0-�
Name:
Location:
WESTERLY: 2
Tax Map Number:
Zone: C
Name:
Na
Location: xlwt
AUTHORIZATION TO ACT A AGENT FOR
I, (seller, owner) of premises located at
i
Tax Map Number hereby designate
as my agent regarding an application for (Subdivision, Site Plan Review, Variance) of the
above premises.
Deed Reference Book Page Date
Does the above parcel represent owner's entire contiguous holdings? Please attach
explanation.
Signed: Date:
PLEASE READ AND SIGN
"The parties hereto consent that the proceedings which result from the within
• application may be tape-recorded and transcribed by the Town Clerk or his agent and
that such minutes as may be transcribed shall constitute the official record of all
proceedings regarding this application, unless the same may vary from the handwritten
minutes taken by the Town Clerk or the Secretary of the Planning Board or Zoning Board
of Appeals, in which event the handwritten minutes as to such inconsistencies shall be
deemed the official record."
Applic nt's Signature
Date: 3 40