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Application w/plot plan TOWN OF QUEENSBURY APPLICATION TRANSIENT MERCHANT/ TRANSIENT MERCHANT MARKET DATE: APPLICANT'S NAME: �rx 9r�2 S�1n fS//��� / EiZR�/ /i✓Z ADDRESS: /�q 9 S�f! 7E Pfau 7r 9 �Y -------------------------------------------------------------- 1. Federal ID#: 2. NY State Sales Tax No.: 0/ " 0 3. Location of Market: A S �Rh o V f" 4. Dates and Hours of Operation: j(M h P_ I b l f fl EVD 4-,n -9 0D Pm 5. Description of Goods, Wares, Commodities or Services to be offered for sale or to be used fAAr the purpose of bid ' g for services: Ly/7�EEL Q1V1/fe5/on/S ,e /y/07iY��/CLES - U�sPL��/ di✓Ly 6. Other Information to Be Provided:- A- If application is filed by an agent,the name of the firm or person represented and written authorization by the firm authorizing the representation. B. Authorization of an agent to receive Service of Summons. -1- C. A plan or map showing the location of the proposed market in proximity to property boundaries and any other temporary or permanent structure on the lot, the plan or map shall also show the location of the vendors within the market the provisions for dedicated parking vechicular access to and from the site, the zoning district in which the market is to be located,provisions for water supply and sewage disposal. SIGNATURE: ? n +, . Y (.1/I k S.cAcINre } You are required to provide 15 copies of your submission. LtA: E M N TRIKES, INC. AGENT AUTHORIZATION 1, Larry Strilchuk of Lehman Trikes, Inc. of Westlock, Alberta Canada,hereby authorize Terry Heinz or an appointed representative of Dexter Shoes of Lake George,New York, to act as an agent regarding all permits, applications or any other service as required by the Town of Queensbury in the state of New York. Signed: C �c�:� Date: 9303 - 110 A Street, Westlock, Alberta, Canada T7P 2M4 Phone 403-349- 3738 TOWN OF QUEENSBURY APPLICATION FOR SITE PLAN REVIEW .r..tiw "Home of Natural Beauty. A Good Place To Live" Settled in 1763 Town of Queensbury 5 Site Plan Review In accordance with Chapter 274 - a of the Town Law, the Planning Board is authorized to review and approve, approve with modifications or disapprove site plans, prepared to specifications set forth in Chapter 179 of the Zoning Code and in the regulations of the Planning Board. The application enclosed enables the applicant to provide the information necessary for the Planning Board to conduct a thorough and timely review of the proposal . The review process involves appearing before the Planning Board, presenting the proposal and answering any questions that may arise regarding the project . The immediate neighbors (within 500 feet) as well as the public at large will be notified of a public hearing to be held by the Planning Board during their scheduled review of the site plan. The Board will also undertake an environmental assessment of the site plan in accordance with the N.Y.S. Environmental Quality Review Act (SEQRA) . The result of this assessment will be a determination of significance as to whether or not the proposal will adversely impact the environment . All site plans are reviewed by the Planning Board. The Planning Board meets regularly on the third and fourth Tuesday of each month for the purpose of reviewing applications as they are submitted. The authority to approve site plans rests solely with the Planning Board. A 525 . 00 application fee is also required at the time of site plan submittal . Site plan applications may be referred to the Town Consulting Engineer for review of septic design, storm drainage, etc. The hourly charge for the engineer review will be charged directly to the applicant . Fees for engineering review will not exceed $1, 000 .00 without notification to the applicant . The Town has a fully staffed Planning Department consisting of an Executive Director, two professional planners, and one office specialist. Applicants are REQUIRED to bring in a draft completed application for review by staff, prior to submission, so that completeness concerns can be identified and delays in processing avoided. The planning staff is as follows : John Goralski Executive Director - 761-8221 Chris Round, Code Compliance Officer - 761-8218 Laura Nowicki, Planning Assistant - 761-8217 Pam Whiting, Office Specialist - 761-8220 The above individuals may be contacted at the above numbers during weekdays between 8 : 00 a.m. and 4 :30 p.m. -1- TOWN OF QUEENSBURY DEPARTMENT OF COMMUNITY DEVELOPMENT SITS PLAN REVIEW APPLICATION APPLICATION NO. I. APPLICANT: LENN//9N �Qi/(eS LNC • s7el'tr- u/l r o ADDRESS: s n 1W Phone #: Home Phone #: Work 7L D3 APPLICANT'S AGENT: .UEY7Ei2 Sff'oE-S — TE,e4y( ffEi�Z ADDRESS: 9 Side W&&tP 9 LAke &ezr4e . Y Phone #: Home °� T Phone #: Work / -7 9a " Da PROPERTY OWNER: (J e Sa GI'd. ADDRESS: Phone #: Home Phone #: Work / rr n PROPERTY LOCATION: /` fl S7 d'e �tt 9 Z a J� 4,u r4 e /✓y MFV!V --- 5V3.6 r� TAX MAP NO. ZONE CLASSIFICATION: LD�//NEE'�i�9L DSPPS PR C Ip�ION OF T: �/SPL/4� %/?Lr9 ) 0,e I✓NEEL /Ah/✓�i1S/or✓C /fro v7P ✓fL $ DIRECTIONS TO THE PROJECT (for Board members & Staff to locate project or site visits: -2- II. SITE DEVELOPMENT DATA Tax Map Number: Section Blo k Lot 16 Zone Classification: Area of Parcel acres = sq. ft . Maximum Size Buildi g Allowed sq. ft . Disposition of Parcel : Existing Building Area sq. ft . % of parcel Paved Area sq. ft . % of parcel (including wa ") Green Area hA 0 sq. ft . 4 of parcel Proposed / /YD m eLn P C�L n yt� Building Area sq. ft of parcel Paved Area sq. ft . 'k of parcel (including walks) Green Area sq. ft . of parcel Building Setbacks 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 Length of Frontage SAD Number of Parking spaces : Existing Proposed Town Water: Yes No Town Sewer: Yes No Any previous Planning or Zoning Board determination regarding this property? /� Present Use of Property: -S4, sAe l�exl,n16 L U7 Proposed Use of Property: �lSOLl4� 14,2cA 4 73 b4#tCL n(v vc-lSs %ls e e lvo-rope I-,Fs -3- APPLICANT PLEASE READ AND SIGN BELOW A COMPLETE APPLICATION IS NECESSARY FOR PLACEMENT ON THE PLANNING BOARD AGENDA. The Planning Office requires : IQ copies of your site plan application, maps, and supporting documentation - 1 original and 9 conies. 2 copies of the deed and survey plat . The f= for site plan review is 525 .00 . Applications may be referred to the Town consulting engineer for review of septic design, storm drainage, etc . The applicant is required to pay for the costs associated with this review. The hourly rate charge for the engineering review will be charged directly to the applicant . Fees for engineering review will not exceed $1, 000 . 00 without notification to the applicant . Other permits may be required for construction or alteration subsequent to approval by the Planning Board. It is the applicant' s responsibility to obtain these. I, the undersigned, have thoroughly read and understand the instructions for submission, agree to the submission requirements and completed the checklist . Furthermore, it is the practice of the Department of Community Development to have a designated stenographer tape record the proceedings of meetings resulting from applications, and that minutes transcribed from those tapes constitute the official record of all proceedings. If there is a discrepancy between such record and the handwritten minutes taken by the designated stenographer, the handwritten minutes shall be deemed the official record. I HAVE READ AND A Date E TO ABOVE STATEMENT pp gnatur Applicant' s Si 78 Applicant's Agent Signature (/ Date a4-W (if Authorization to Act as Agent form has been signed) -4- AUTHORIZATION TO ACT AS AGENT ' If the APPLICANT is unable to attend the meeting, or wishes to be represented by another party, the applicant' s signature is needed on the authorization form below, designating an agent . APPLICANT'S AGENT FORM Z S-f4ae{/ux- I, L_6NMi9I✓ Tif�/(E$ /lG , hereby designate X7E,e SIDES as my agent regarding Site Plan, Subdivision application For Tax Map Nu er: ctio 3 Block 1_, Lot /0 SIGNED: DATE: If the OWNER of the property is not the same as the applicant, the owner' s signature is needed on the authorization form below, designating the applicant as agent. OWNER'S AGENT FORM II f h Berkshire Hathaway D/B/A owner of located at Tax Map Number: Section 34 , Block 1 Lot 10 hereby designate Terri Hynes as my agent regarding an application for., a Site Plan, Subdivision at the above premise: SIGNED: 7 /�V,O,✓Y�DATE: 3/12/98 Deed Reference: Book Page Date -5- SITS PLAN REVIEW CHECKLIST The Plot Plan: Draw to scale (1 inch = 40 feet or less) a detailed description of the proposed site. Failure to include all the required information on your site plan will result in a determination of incompleteness and a delay in the processing of your application. * Items A through M must be included on the Plot Plan for the site plan review application. * Items N through Z shall be included on the Plot Plan if applicable. P N/A 4 A. Title of drawing, including name and address of applicant and persons responsible for preparation of such drawing. B. North arrow, scale and date. C. Boundaries of the property with dimensions in feet, including zoning boundary delineations . D. Location of all existing principal and accessory structures and their uses with exterior dimensions and lot line and waterfront setback. E. Location of all proposed principal and accessory uses and structures with exterior dimensions and lot line and waterfront � �/ �/.A, setbacks . F. Location of any existing or proposed driveways, outdoor storage areas and refuse containment areas, including setbacks and dimensions of the structures . G. Location of existing and proposed sewage disposal facilities including lot line, waterfront and well setbacks . For proposed system, or if expanding use, include design details, construction materials, flow rates or number of bedrooms served and percolation test results . Also, location of existing sewage and water systems on adjoining lots . H. Location and description of existing public or private water supply. -6- Description of the method of securing public or private water and location, design, and construction materials of such facilities . J. Total number of existing parking spaces, including the number of those to remain on to be removed, those to be paved, those to be graveled, and total number of proposed new paved spaces and proposed graveled spaced, including basis for determining parking adequacy. K. Location and design of all existing and proposed outdoor lighting facilities . L. Percent of lot which is presently permeable, including composition of ground cover (grass, shrubs, gravel, etc . ) N A M. Percent of lot which is proposed to be permeable, including composition of ground cover. N�A N. Existing watercourses, wetlands, and other waterbodies . O. Proposed maximum daily water usage in gallons per day. P. Location and design of all existing and proposed parking and loading areas, showing driveways, igress, egress, handicapped parking and curbing. For proposed parking and loading areas, include design details, construction materials and dimensions . Q. Provision for pedestrian and handicapped access . /✓�A R. Location, design and construction materials of all existing or proposed site improvements including drains, culverts, retaining walls, and fences . /✓�A S . Location of fire and other emergency zones, including the location of fire hydrants . N A T. Location of all existing and proposed energy distribution facilities and other utilities, including electrical, gas, solar energy, telephone, etc. For proposed facilities, include design details and construction materials . -7- U. Location, setbacks, size, design and type of all existing and proposed signs, including design and construction details of proposed signs . V. Location and proposed development of all buffer areas, including existing vegetation cover and screening of storage or refuse areas . 11- 14 . W. Identification of the location and amount of building areas proposed for office, manufacturing, retail sales or other commercial activity. �✓//� X. General landscaping plan and planting schedule, including existing trees over 3 inches in diameter. 1114 Y. Grading and stozmwater management plan, showing existing and proposed contours and including drainage calculations . /✓/14 Z . Other elements integral to the proposed development or considered necessary by the Board and staff . P - Provided N/A - Not Applicable -8- 14.154 (9/95)—Teat 12 PROJECT I.D. NUMBER 617.20 SEQ 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) . :�ISA04y NT/SPONSO PROJECT NAME ' E� ErNz s L 6tr ST LOCATION: lk ct Mily tC S u County LOCATION(StnN addrue and road Intersect ons, prominent landmarks,ate.,or provide map) fs/ �� Stte u tP see mAo SED ACTION: ew ❑Expansion ❑MOd111catlordalteration E PROJECT BRIEFLY: 09�1 AP�� Tod 3 a�NEEL Gon/✓t�s/ohs Q Mo'roe cl,4 ts. 7. AMOUNT OF LAND AFFECTED: Initially ~ Q-C✓ acres Ultimately 0 auta 6. WIL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTNEA EXISTING LAND USE RESTFUCT10N57 Yes ❑No It No,describe bnslly a. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (]Residential Dlndusutat �eommerGai ❑Aaricultura ❑ParaForntl0pal;p.e. ❑DtMr--- .Describe: 10. DOES ACTION INVOLVE A PERMR APPROVAL OR FUNDING,. NOW STATE OR LOCAL)? OW ULTIMATELYEN FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, ❑Yes No If yes,BSI agenayts)and perrttitrapprovals .]. 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PMAMrr OR APPROVALT ❑Yes ®No If ys%list agency name and penNVapproral 12. AS A RESULT OF PROPO3EDACnON WILL E)DsT1NG PEtiMrr1APPROVAL RC•OUIRE MODuricA ROM ❑Yes ._ DNo 7✓ tit I CERTIFY THAT THE INFORMATION PROVIDED ABOVE TRUE TO THE 5W OF MY WOWLEDGE •'•, 1 APPi11eant1sponsor name: elily .DO iQl e:7CJ 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 PART 11—ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EJ(CEED ANY TYPE I THRESHOLD IN 6 NYCAR, PAgT 517.47 If yes.coordmale Inc review process antl use the FULL EA:. n Yes ❑No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? It No,a negatl.e deruat�on may be supersedf-e-dt by Molnar involved agency. ❑Yes ONO C. CCl.OULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Ar•wers may be handwritten, It legiblel Existing air quality, surface or groundwater quality or quantity, noise levels. existing traffic patterns. solid waste Production or Cutdosal, Potential for erosion,drainage or flooding problems? Explain briefly. C2. Aesthetic, a9ficuilufaL archaeological• historic•or other natural or Cultural resources;or community or neighborhood Ctlaracter?Explain brneffy: C7. Vegetation or fauna.fish•shellfish or wildlife species,significant habitats,or threatened or endangered ACACIAS?Explain briefly; Ca. A Community's existing plans or goals as officially adopted•or a Change in usa w intensity 01 use of land or other natural ffsoufces?Explain briefly C5. Growth, subsequent derelooment•or related activities likely to be induced by the PIOpOsed action? Explain briefly. C5. Long term,short term,cumulatfvs,or other effects not identified In CI-CS? Explain briefly. C7. Other Impacts(Including changes In we-ot either quantity or type of energy)?Explain briefly. D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA? ❑Yes ❑No E. IS THERE, OR is THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑Yes •❑No If Yes,molsln briefly PART III—DETERMINATION OF SIGNIFICANCE (To be completed by Agency) _f INSTRUCTIONS: For each adverse affect Identified above,determine whether ItissubstantlaLlarge.Import ant or Otherwise significant. Each Offset should be assessed In donneetlon with Its (a) setting (Le. urban or rural);(b) probability of ocdurrin9; (c) duration; (a) irreversibility;(e)9009raphlc scope;and(f) magnitude. If necessary, add attachments or reference supposing material&Ensure that explanations contain sufficient detail to show that Jell relevant adverse Impacts have been identified and adequately addressed. if question D of Part II was checked yes,the determination and significance must evaluate the potential Impact of the proposed action On the environmental characteristics of the CEA. r .... .. _, ter__ .'. .__ .�''..---•- ❑ 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 and/or prepare a positive declaration. . ❑ Check this box If you have'deteifrtlned, 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: 4NAlablk 01 Lead Agency lust Of ym Namf Of in lift m Lea AAMCy - ^ — reM1Yr1 00 Responsible DONOR M Lead Agency Signature O Mi at r(it •different Iran,unponsrO OI Ken all O 5 Ix x �. IAN Aj Aq i 'J�5':2;?y�!j':p..{. ; :•.. t+: ': "ttg3'iiFp No ' t 2* w- i �• n / _ 1 'i • �1 y � 2 4i'4 � � ,so- 1 ,�>1> > F`• 1 f yv '`I, f : is , tR , F RGd 120'14:♦584� MAD 02-13-9T Of:li PM P02'