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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;... ...,..: vi is '?2•r':?%t;;iii:2i?:,i' 'i' v. ; :;•Sc •�v t r ' � ♦ r ', � ♦ ! yam♦ {{{/ .i 1 •t T, L 4 � ' r•• / / FROM 1:074-45$04 tDBeir 02-I3-94 04:I7 PM P07'