Application EHMAN TRIKES, INC. 9 9 ( a3 1 P; i »_ Sn
AGENT AUTHORIZATION
I, Marilynn Strilchuk of Lehman Trikes, Inc. of Westlock, Alberta, Canada, hereby
authorize Terry Robbins, or an appointed representative of Dexter Shoes of Lake
George, New York, to act as an agent regarding all permits, applications or any service
as required by theTown of Queensbury in the state of New York.
Signed ' � � 'L Date: IZ4 !fl/
9303 110 A Street, Westlock, Alberta, Canada T7P 2M4 0 Phone 403-349-3738
Please submit 15 copies of a completed application to the Town Clerks Of$ce
TOWN OF QUEENSBURYAPPLICATION
TRANSIENT MERCHANT/
TRANSIENT MERCHANT MARKET
DATE:
APPLICANT'S NAME:
ADDRESS:
L ,V y
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1. Federal ID#: D - U:5 S2 7• 5
2. NY State Sales Tax No.:
3. Location of Market: /�S
4. Dates and Hours of Operation:
5. Description of Goods, wares, Commodities or Services to be offered for sale or to be used for
the purpose of bidding for services: r
�- C t ,
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.
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 vehicular 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•/ & qL
s •
L3i'��q
SITE PLAN REVIEW APPLICATION
The Site Plan Review process involves presenting a proposal to the Planning Board
and answering any questions that may arise regarding your project. As part of its
review process. the Town of Queensbury Planning Board notifies the general public
and property owners within 500 feet of the proposed project. conducts a public
hearing and performs an environmental assessment of the proposal in accordance
with the N.Y.S. Environmental Quality Review Act (SEQRA) requirements.
This application was designed to solicit the information necessary for applicants to
comply with the Town of Queensbury Site Plan Review requirements. A pre-
application meeting with the Planning Staff is highly recommended. Staff
members are available by scheduling an appointment. our office is open weekdays
between 8:00 a.m. and 4:30 p.m.
Town of Oueensbury Planning Staff
Chris Round. Director Laura Moore. Planning Assistant
Craig Brown. Code Compliance Officer Pam Whiting, Office Specialist
SUBMISSION REQUIREMENTS:
Please submit one original and nine (9) copies of the completed application
package and plans with a $25 fee to the Planning Office by the last Wednesday
of the month for consideration during the following month. Call or visit our
offices with any questions.
This Application Package includes:
Page Description
2 General Information
3 Site Development Data & Setback Information
4 Floor Area Ratio Worksheet
(For Projects in the Waterfront Residential Zone)
5 Signature Page includes Agent Authorization & Engineering Fee
Disclosure
6&7 Application and Plan Checklist
A Short Environmental Assessment Form (EAF) is attached
Complete Part I of the EAF for Unlisted SEQR Actions (Consult «ith Staff)
Town of Queensbury
�- 742 Bay Road Queensbury, NY 12804
Phone:(518) 761-8220 Fax:(518) 745-4437
E-mail: planningLqueensbury.net www.queensbury.net
General Information
Property Location: //49 y Cfk 2-4f Wo u Ze 9
Tax Map ID: L 6-0✓ e
Zone Classification: ? m e VG!a e
11c - / ,4
Applicant
Address:
i�P� M5
Home Phone:
Work Phone/Fax:
Applicant's Agent: X
Address:
Phone:
Work Phone/Fax:
Property Owner Q C L
Address: /t/ Qom,/vultd %ve .
1�eX �ev, Ai aS/ 3�U
Phone:
Work Phone/Fax:
Directions to Site: 2 Kfe✓ �I�UeS
Applicant: Tax Map ID Page 2 of 7
•
Site Development Data
Area/Type Existing Proposed Total
(sq. ft.) Addition (sq. ft.)
(sq. ft.)
A) Building Footprint(s) UO •Ti•
B) Detached Garage
C) Accessory Structure(s)
D) Paved, gravel, or other
hard surfaced areasS� 5
E) Porches/Decks
F) Other �yQ1S ✓eGz �pa�p �f•
Total Non-Permeable
(Sum A through F)
Parcel Area '�• t� a e Ve.5
Percent Non-Permeable
(Total Non Permeable/ Parcel areal
Setback Requirements
Location Required Proposed
Front (1)
Front (2) (if corner)
Shoreline
Side Yard (1)
Side Yard (2)
Rear Yard (1)
Rear Yard (2)
Buffer/Travel Corridor
Applicant: Tax Map ID Page 3 of 7
FLOOR AREA RATIO WORKSHEET
Any construction. addition or replacement of structures in the Waterfront
Residential Zones (WR-lA & WR-3A) are subject to the Floor Area Ratio
requirements as defined in Section 1719-16 of the Town of Queensbury Zoning
Ordinance.
Floor Area Ratio (F.AR) is the relationship of building size to lot size derived by
dividing the total building square footage by the lot size in square feet. yielding a
percentage. The maximum allowable F.AR is 22 percent.
** Please note that FAR requirements are separate and distinct from the
permeable area requirements that may apply.
Building square footage includes all floors of the primary structure, covered
porches. and basements (when at least three (3) feet in height of one (1) wall is
exposed and the space meets the living space requirements as defined in Section
11 and 712 of the \YS Building Code). Detached storage buildings greater than
100 sq. ft. and detached garages are so included in the F.AR calculations. Building
square footage does not include: open decks. docks and that portion of covered
docks extending into the water, and one shed 100 sq. ft. or less. All additional sheds
are included in the FAR calculation.
Use/Location Area (sq. ft.)
Primary House
First Floor
Second Floor
Basement (living space)
Covered or enclosed porches
Covered decks
Gue.t House
Apartment
Detached Garage(s)
Shed (1 shed 100 sq. ft. or less exempt)
Covered Dock or Boathouses (portion on land)
Other (describe)
A.) Total Building Sq. Footage
B.) Lot Area in sq. ft. (Acres x 43,560
Floor Area Ratio = AB = %
Applicant: Tax Map ID Page 4 of 7
SIGNATURE PAGE
Please Read Carefully
This Page includes the Authorization to Act as Agent Form. Engineering Fee Disclosure,
Other Permit Responsibilities. and Agreement to provide the documentation required.
Complete the following if the OWNER of the property is not the same as the
applicant:
OWNER'S AGENT FORM
Owner. tnsP1P �L�. (Print Owner Name)
designates: r o (Print _agent Name)
as agent regarding Site Bla.4 _Subdivision
for Tax Map No : Section Block Lot jo_
SIGNATURE: Owner Signature)�f(Date)
Complete the following if the APP ICANT is unable to attend the meeting, or
wishes to be represented by another party:
APPLICANT'S AGENT FORM
Applicant / / �` C sprint Applicant Name)
designates: (print Agent Name)
as agent regarding, _ Subdivision
ection for Tax Map No. S Block Lot L0
SIGNATURE: X (Applicant Signat6��(-W te)
Engineering'Fee Disclosure: Applications may be referred to the Town consulting
engineer for review of septic design, storm drainage, etc. as determined by the Planning
Department. Fees for engineering review services will be charged directly
to the applicant. Fees for engineering review will not exceed S 1,000.00 without
notification to the applicant.
Please Note: Other Permits may be required for construction or alteration activity
subsequent to approval by the Planning Board. It is the applicant's responsibility to
obtain any additional permits.
Official Meeting Minutes Disclosure: It is the practice of Community Development
Department to have a designated stenographer tape record the proceedings of meetings
resulting from application, 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, the undersigned, have thoroughly read nd understand the instructions for
submission, agree to the submission re rements and completed the checklist.
APPLICANT'S SIGNATURE: S (Date
APPLICANT'S AGENT SIGNATURE: X (Date) j
Applicant: Tax Map ID Page 5 of 7
Check/Initial The Applicable Box Please complete every checkbox
Provided Not R-aiver I. GENERAL
Annheable Requested
✓ A. Title. name. address of applicant and person
responsible for preparation of drawing
B. North arrow. Tax Map 1D. date prepared and scale
(minimum 1 in. = 10 ft )
C. Boundaries of the property plotted to scale. zoning
boundar} _
D. Location of principal structures and accessory
tr_uctures with exterior dimensions
E. Location of site improvements including outdoor
storage areas. driveways (existing and proposed).
parking areas. etc.
/ F Setbacks for all structures and improvements.
II.WATER & SEWER
✓ V Location of on-nte sewage disposal facilities. design
details. construction detail, flow rates. and number
of bedrooms served
V' B. Location of water supply, o.e.. well) and septic on
adjoining lots with separation distances to existing
or proposed on-site water supply antiseptic,C. Separation distances for proposed sewage disposal
system to well and waterbodies-
D. Location and description of existing public or
private water suppl}- (well. lake. etc.). Method of
securing public or private water. location. design,
and construction of water supply including daily
_water.usage.
E. Percolation test location and results.
III. PARKING/PERMEABLE AREAS
V A. Number of spaces required for project including
_ _ calculation/justification.
✓ B. Number of existing parking spaces number to be
removed. number to remain, and type of surfacing
material (e.g. gravel, paved).
C. Provision for pedestrian and handicap access and
_ parking. _
✓ D. Location and design details of ingress. egress.
loading areas. and curbing.
✓ E. Delineation of existing permeable areas versus
proposed including character of ground cover (i.e.,
grass, wooded. etc.)
v F. Location and character of buffer areas (existing and
proposed), modification to buffer areas. including_
screening of storage and refuse areas.
1/ U. Lighting: location and design of all existing or
propose(] outdoor lighting
Applicant: Tax Map ID Page 6 of 7
Check/Initial The Applicable Box i Please complete every checkbox
Provided Not Waiver IV.ADDITIONAL SITE DEVELOPMENT &
Applicable Requested MISCELLANEOUS
A. Location of on-site and adjacent watercourses:
streams. rivers. lakes. wetlands
B. Location of proposed and existing. utility/energy
distribution systems (gas. electric. solar. telephone.
cable). include design and construction details.
/ C. Location. design and construction of all existing and
proposed site improvements including: drains.
culverts. retaining walls. fences. fire & emergency
zones and hydrants.
t/ D. Location and amount/portion of building area
proposed for office. manufacturing. retail sales. or
other commercial activities
E. Signage: location. size. type. design and setbacks.
ADDITIONAL REQUIREMENTS
A. Other elements integral to the proposed development as considered necessar} by the
reviewing board
B. Identification of any State and Counn permits required for the prgject s schedule
C. Record of application for approval status of all necessary permits from State and County
officials
WAIVER REQUEST
Applicant requests waivers from the following items as identified on the
checklist:
Applicant's Signature
Checklist Reviewed by: Date
Please complete this section with the assistance of staff
PLEASE NOTE COMMERCIAL DEVELOPMENT ACTIVITIES
TYPICALLY REQUIRE SUBMISSION OF:
A. Landscaping and Planting Plan
B. Stormwater Management Plan
C. Grading Plan
Applicant: Tax Map ID Page 7 of 7
I4=16J (12'971--.q
PROJECT 1-O NUMBER 61720 SEOR
APPENDIX C
STATE EWRONMENTAL QUALITY REVIEW
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Only
PART I—PROJECT INFORMATION (To be completed by Applicant or Project Sponsor)
1. APPLICANT/SPONSOR 2. PROJECT NAME
0. PROJECT LOCATION: [
Mun,cioality GUVJ 8[.l� County )V;JzeIeEN
4. PRECISE LOCATION:(S t address end road intersections,prominent Wridmants,etc.,or prowds map)
a
Cse e-
S. IS PROPOSED ACTION:
New O Expansion O Modification/attention
6. DESCRIBE PROJECT BRIEFLY:
�) i5PC'4}/ /�QEA �D2 �tiEEL L°on/✓C'/Zs�oi✓s
� G Ali) ,-e.eel e/_ S .
7. AMOUNT OF LAND AFFECTED:
Initially j Y ACue acres Ultimately 0 acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
xYes ❑ No If no,describe bnefiy
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
❑ Residential ❑ Industrial Commercial ❑ Agriculture O ParlvForest/Open Spaoe. 0 War
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(Federal.State or
Lowl)?
❑ Yes No If yea,list agency(s)and permiVapprovals
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL?
Yes V No It yes.list agency name and permrtnpproval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
❑ Yes O No W/n
1 CERTITIIFFyY THAT THE INFORMATION PROVIDED ABOVE IS TAUS T E BEST OF JMY KNOWLEDGE
Appi.canLSpenso ame Yt�� S Z& / /4 S Data
S.gnalur
If the action Is in the Coastal Area, and you are a state agency,
eomplete_the Coastal Assessment Form before proceeding with this assessment
OVER
PART II—ENVIRONMENTAL ASSESSMENT (To be completed by Agency)
A. DOES ACTION EXCEED ANY TYPE 1 THgESHOLD IN 6 NYCRR PART 617.a?
0 Yes ❑ No If Yes.coordinate the review Orooeas and use the FULL EAF.
B. WILL ACTION RECENE COORDINATED REVIEW AS pROVIDED FOR UNUSTED ACTIONS IN 6 NYCRR PART 617.6?
❑ Yes ❑COULD ACTION R RESUL E ff no,e n alive tleclanaon ma be su n idetl b another invoNed a en .
C. T IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be hantlwrmen,if legible)
CI. 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 charade?Explain briefly:
C3. Vegetation or fauna.fish.shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly:
C4. A communnys existing plans or goals as officially adopted,or a change in use or intensity of use of land or other natural resources?Explain briefly:
CS. Growth,subsequent development.cr rented acur iues likely to be induced by the proposed action?Explain briefly:
CIL Long term,short tens,cumulative,or other effects not identified in Cl-CS?Explain briefly:
C7. Other impacts lincluding changes in use of either quantity or type of energy)?Explain briefly:
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMEMAL CHAMCTERISTICS THAT CAUSED THE ESTABUSHMEM OF A CEA?
O Yes 0 No
E. IS THERE.OR IS THERE U
O Yes KELY TO BE.CONiq Wi ::Y RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
❑ No If yes,explain briefly
PART II—DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above,determine whether It is substantial, large, hnporhm or otherwise significant. Each effect should De
assessed in connection with its(a)selling(Le.,urban or cured: (b)probability of oeeumng;(e)duration:(tl)a S'g nioarrL (a h OHM Should
graphic slope;
andan : magnitude.
ie f easary,etld attachments or reference supposing materiels.Ensue that explanations contain sufficient detail to show that
pacts have been identified and adequately addressed.If question D of Pas II was Checked yes,the determination and Sig-
nificance must evaluals the Polemlal Impact Of the Proposed action on the environmamal characteristics of the CEA.
❑ Check this box if you have identified one or more potentially large and 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
Pram or Type Name of gesponsioie Officer in Lead Agency
Title of Responsible Officer
Signature of Responsible Officer in Lead Agency Signature of Prepare(If differam horn responsrele omeerl
Date