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.
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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.
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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:
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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
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