Application w/plot plan a
TOWN OF QUEENSBURY
APPLICATION
TRANSIENT MERCHANT/
TRANSIENT MERCHANT MARKET
DATE:
APPLICANT'S NAME: /Jt/X7�✓� SIDES/-� �E/1��/ ir✓L
ADDRESS: /7 9 S�A 7E w'U TC 9
114't1t 9,�'o/16 c
/"�Y45- 3 5�3/,
--------------------------------------------------------------
1. Federal ID#: &- 7 d 5
2. NY State Sales Tax No.: O/ " �'? V V 6 9 G
3. Location of Market: '4 S �AoVe G
4. Dates and Hours of Operation: j(1X v7 e� /- & 19 4>n -
• 5. Description of Goods, Wares, Commodities or Services to be offered for
sale or to be used f r the purpose of bidding for services:
_0_tyHFE[ e.✓✓EdSIOAIS ,C �y/o7ie��/rGEs - t�,SPI.�� e .✓"q
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.
-I-
C. A plan or map showing the location of the proposed market in
prommity 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. t
SIGNATURE:
You are required to provide 15 copies of your submission.
40goo
tjALI
LEHMAN TR/KES, INC.
AGENT AUTHORIZATION
• I� 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.
Sign ed C��a� Date:
9303 - 110 A Street, Westlock, Alberta, Canada UP 2M4 Phone 403-349- 3738
TOWN OF QUEENSBURY
APPLICATION
FOR
SITE PLAN REVIEW
w
"Home of Natural Beauty. A Good Place To Live/--
Settled in 1763
Town of Queensbury
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 MQUIRED 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 QDHENSBDRY
DEPARTMENT OF COMMMITY DEVELOPMENT
SITE PLAN REVIEW APPLICATION
APPLICATION NO.
I. APPLICANT: LEfIN19n/ �ili/lES �/✓C . Zlffxy SiTel LG#/</l
ADDRESS: -//o i9 7 rET
12722,peKn 7�
Phone #: Home
Phone #: Work ��D�� 3 -37
APPLICANT'S AGENT:
,/J ,ryy2-✓! S/foES 'T 2/e�/ 17Ei/✓y
ADDRESS: /7 ?9 4.t-le We&4� 9
Phone #: Home
Phone #: Work
PROPERTY OWNER: C Sa Lad.
ADDRESS: //� di�Y0Q0�t
_,L�tPv- Mt a433O
Phone #: Home
Phone #: Work
PROPERTY LOCATION:
TAX MAP NO. /
ZONE CLASSIFICATION: �OMMEPCi>gL
DB I ION OF PR C F4 o HEEL
A T:S/OrYS G vi?C eLgC
DIRECTIONS TO THE PROJECT (for Board members & Staff to locate
project or site visits:
Je ,thp✓ -S c
S17
-2-
II. SITE DEVELOPMENT DATA
Tax Map Number: Section Blo k Lot 16
Zone Classification: -�&
Area of Parcel acres = sq. ft .
Maximum Size Buildirig Allowed sq. ft .
Disposition of Parcel :
Existing
Building Area g sq. ft . of parcel
Paved Area sq. ft. t of parcel
(including wa cs)
Green Area hIA 0 sq. ft . t of parcel
Proposed - /
/�p mt nP t LY7l��rt�
Building Area sq. ft ft . / * of parcel
• Paved Area sq. ft . t of parcel
(including walks)
Green Area sq. ft . W 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 -5,A 0
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• - tb,5 S7o,QC /R'i�/i✓6 L UT
Proposed Use of Property: .�b/SoLts� 73
nN✓i;2S/on/S -0e NIoT,et�/��ES
-3-
APPLICANT PLEASE READ AND SIGN BELOW
A COMPLETE APPLICATION IS NECESSARY FOR PLACEMENT ON THE
PLANNING BOARD AGENDA.
The Planning Office requires :
12 copies of your site plan application, maps, and supporting
documentation - i original and 9 copies.
2 copies of the deed and survey plat .
The f= for site plan review is $25 .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 E TO ABOVE STATEMENT
Applicant' s Signatur Date 7176
Applicant' s Agent Signature Date d9-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 4.e/ey S7,e/LG,luC ef-
I, , hereby designate "/E� f/�/i✓z ���X 7E�
s�vEs
as my agent regarding
Site Plan, Subdivision application
For Tax Map Nu er: ctioi
Block _/, Lot �U
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
Berkshire Hathaway D/B/A Dexter S oe
I
owner of premises 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: L! 7 %�V iDATE: 3/12/98
. Deed Reference: Book Page Date
-5-
CITE 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
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
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 .
�p[L� 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.
�✓/A N. Existing watercourses, wetlands, and other
waterbodies .
/YEA 0. 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 .
/✓�f� 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 .
/✓/� W. Identification of the location and amount of
building areas proposed for office,
manufacturing, retail sales or other
commercial activity.
N/✓� X. General landscaping plan and planting
schedule, including existing trees over 3
inches in diameter.
. — Y. Grading and stormwater management plan,
showing existing and proposed contours and
including drainage calculations .
/✓/� Z . Other elements integral to the proposed
development or considered necessary by the
Board and staff .
P - Provided
N/A - Not Applicable
-8-
1I•16-4 (9195)—Text 12
PRpJECT I.D. NUMBER 617.20 SEC
r _ 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. PPLJCANT/SPO 4SO PROJECT NAME '
ER S s L a 7
7. PROJECT LOCATION:
MunlelDallty S uteCounty
a. PRECISE LOCATION(Street address and road Intsrseet ons. Prominent landmarks,ate.,or provide map) ,Y
WeSAery
see map
S. IS PROPOSED ACTION:
❑New ❑ExDanslon ❑Modlflcatlordalteratlon I S. DESCRIBE PROJECT BRIEFLY: ✓�
p4 y AeE� TOE 3 mviczy �wjli-es i /S �,�
7. AMOUNT OF LAND AFFECTED:
Initially Q_C.r' Bens Ulllmatuy O acres
_ 8. WI PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
Yea ❑No It No,describe briefly
a. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
❑Residential ❑bwusuw lAy commwcw ❑Aona,Rurs ❑Parworaswpan iDae.
Deserlba:
10. DOES ACTION INVOLVE A PERMIT APPROVAL.OR FUNDING, NOW OR ULTIMATELY FROM ANY
STATE OR LOCAL)? OTHER GOVERNMENTAL AGENCY OrEDERAL.
❑Yes No If M list saw.—As)and parmlUapprovals .
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT oR APPROVAL? -
❑Yes No It ya,Bat agency nun and pemLlhpproral
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMTr"PPROVAL REQUIRE MODIFICATION?
❑Yes .. .0 No 7✓ _ ..�1::itt"�-•
I CERTIFY
,YTHAT
ATHE INFORMATION PRJJO�VIID..♦♦♦DEDED,,,AABOVE TRUE TO THE BEST OF MY KNOWLEDGE �:..•}���:rt..
Applicanvatponser name: iry/U. V Dalec
Slgnatare: _ _ .. . . ..
It the action Is In the Coastal Area, and you are a state agency, complete the
Coastal Assessment Form before proceeding with this assessment
OVER
11
PART. II—ENVIRONMENTAL ASSESSMENT (To be completed by Agency)
A. -DO--ES ACTION EXCEE D ANY TYPE I THRESHOLD IN 6 NYCAR, PAgT 617.a, II
0 Yes +aLe7Tia yes,coordinate the renew process and use the FULL EA;.
0
8. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS INS NYCRR,PART 617.6? 11 No,a negative dr_:arat,ori
may be sup reacted by another involved agency.
L Yes No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Ar•wers may be handwritten,It legible,
C1. Existing air Quality, surlace or groundwater Quality or Quantity, noise levels, existing traffic patterns. solid waste product er alspozal,
potential for erosion,drainage or flooding problems? Explain briefly:
110. ,
C2. Aesthetic,agricultural Archaeological.historic,or other natural or Cultural resources;or Community or neighborhood Character?Explain briefly;
no
C]. Vegetation W fauna.lisp,shellfish or wildlife acacias, significant habitats.or threatened or endangered soeeles? Explain briefly;
-CA. A community's existing plans or goals as officially adooted.or a Change in use or Intensity of use of land or other natural resources?Explain onefly.
V
CS. Growth,nsubsequent development,or related activities likely to be induced by me proposeo action?Explain briefly,
Y �V
C6. Long term,short term,cumulative,or other effects not Identified In Cl-CS? Explain briefly.
C7. Other imppacts(Including Changes In us*of*line(Quantity or type of energy)? Explain briefly.
k10
D. WILL THE PROJECT HAVE AN ILI ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA?
❑Yea Tema
E IS THERE, OR IS THERE LIKELY TO its.CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
❑Yes - "MNo If Yes,Mouth briefly
PART III—DETERMINATION OF SIGNIFICANCE (To be Completed by Agency)
t- INSTRUCTIONS: For each adverse offset Identified above,determine whis"Wit is stlDstendal,larga,Important or othernlsa Significant.
'�- Each affect should be assessed in Connection with Its (a) setting p.a. urban or roralk(b) Pfobabllity of occurring; (e) duration; (d)
Irreversibility;(0)geographic scope;and(f) magnitude. If necessary, add attachments or mferenee supporting materials. Ensure that
explanations contain sufficient datail to show that all relevant adverse impacts have been Identified and adequately addreasecL if
Question D of Part II was Chocked yes, the determination and significance must evaluate the potential Impact of the proposed action
on the environmental CharaetedsUCs 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 and/or prepare a positive declaration.
Check this box If YOU ,lave deleilnlned, based on the Information and analysis above and any aupporting
documentation, that the proposed action WILL NOT result In any significant adverse environmental Impacts
5�(G( AND provide on attachments as necessary, the reasons supporting this determination:
Name at Lead Agency
f l 0r 1 ICs In LOA Agency I It"Ponsible Officer
e e OnpWe ipr n lea y ,s"i;fe o le pus(I Cant roe responsible el Merl '
ale
O O ' . 11 r.l':•:Lie' ' "•s,.\i;... ...,..:
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