Application ' Revised: 10/04/06 ,
Site Plan Review
' GENERAL INFORMATION
' Application No. (Office Use Only)
Project Location: Route 9, Queensbury
' Tax Map ID: 296. 13-1-17
Zone Classification: HC-INT
Zoning Ordinance Compliance Section:
' Detailed Description of Project:
(include current & proposed use Approval of siding color. Originally approved
' siding color was not available in a factory colored siding. Painting the
existing siding is an option, however, the owner prefers the current color.
' Modification to existing Site Plan? Yes: x No:
If Yes, indicate SP No/approval date SP 04-2005 4-26-05
Square Footage of proposed structure: N/A
' Applicant Name: Baba-Joani & Mama, LLC
Address: Route 9
' Queensbury, NY 12804
Home Phone:
Work Phone / Fax: Cell - 796-7939
Applicants Agent Name: Jarrett-Martin Engineers. PLLC
' Address: 12 E. Washington Street
Glens Falls, NY 12801
' Home Phone:
Work Phone / Fax: (518) 792-2907 / (518) 798-1864
IName of Property Owner: Baba-Joani & Mama, LLC
' Address: Route 9
Queensburv, NY 12804
Home Phone:
' Work Phone / Fax: Cell 796-7939
Directions to Site: Route 9 just past Walmart Plaza
' Page 10 - To be submitted
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' Revised: 10/04/06 • •
Site Plan Review
SITE DEVELOPMENT DATA - Not Applicable
' Area / Type Existing sq. ft. Proposed Addition Total sq. ft.
I sq. ft.
A. Building Footprint
' B. Detached Garage
' C. Accessory Structure(s)
D. Paved, gravel or other hard
Isurfaced area
E. Porches / Decks
' F. Other
ITotal Non-Permeable
(Sum of A - F)
IParcel Area
I Percent Non-Permeable
(Total Non-Permeable/Parcel
Area)
I SETBACK REQUIREMENTS
' Required Existing Proposed
Front (1)
' Front (2)
Shoreline
Side Yard (1)
I Side Yard (2)
Rear Yard (1)
I Rear Yard (2)
Buffer / Travel Corridor
Height
IPermeability
Sin Setback
' No. of Parking Spaces
' Page 11 - To be submitted
' Revised: 10/04/06 • •
Site Plan Review
FLOOR AREA RATIO WORKSHEET - Not Applicable
' Any construction, addition or replacement of structures in the certain zones is subject to the Floor
' Area Ratio requirements as defined in Section 179-16 of the Town of Queensbury Zoning Ordinance.
Floor Area Ratio (FAR) is the relationship of building site to lot size dividing the total building square
' footage by the lot size in square feet,yielding a percentage. The maximum allowable FAR is indicated on
Table 4 Summary of Bulk / Dimensional Requirements [attached].
' ** 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 711 and 712 of the WS Building Code. Detached storage buildings
greater than 100 sq. ft. and detached garaged are so included in the FAR calculations. Building square
I 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 calculations.
' Use / Location Existing Area(sq. ft.) Proposed Area (sq. ft.)
Primary House
' First Floor
Second Floor
Basement (living space)
ICovered or enclosed porches
Covered docks
' Guest House
Apartment
Detached Garage(s)
' Shed (1 shed 100 sq. ft. or less exempt)
Covered Dock or Boathouse (portion on land)
' Other (describe)
A Lot area: Acres x 43,560 =
' B. Total Allowable Floor Area = A x .22
C. Existing Floor Area; Total from above lines
I D. Remaining Area:
potentially developable = B minus C
E. Proposed Area of Construction*
' * If E is larger than D,a variance or revisions to your plan may be needed. Please consult with Staff.
' Page 12 - To be submitted
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' Revised: 10/04/06
Site Plan Review No Beings being provided - only phS
CHECKLIST: Please prepare a map depicting existing and proposed conditions. Failure to complete the following checklist or
include all required information may result in a determination of incompleteness and a delay in the processing of your
application. Legend: PR(Provided); NA(Not Applicable)
PR NA
' GENERAL
Title, name,address of applicant&person responsible for preparation of drawing
North arrow, Tax Map ID, date prepared and scale(minimum 1 in. = 40 ft.)
' Boundaries of the property plotted to scale, zoning boundary
Location of principal structures,accessory structures with exterior dimensions
I Location of site improvements incl. outdoor storage areas, driveways (existing & proposed) parking
areas,etc.
Setbacks for all structures and improvements
' Elevations of proposed structures
WATER& SEWER
Location of on-site sewage disposal facilities, design details, construction details, flow rates, and
' number of bedrooms proposed
Location of water supply (i.e., well)and septic on adjoining lots with separation distances to existing or
proposed on-site water supply and septic
I Separation distances for proposed sewage disposal system to well and waterbodies
Location and description of existing public or private water supply(well, lake,etc.). Method of securing public or
private water, location,design and construction of water supply including daily water usage
I Percolation test location and results
PARKING/PERMEABLE AREAS
Number of spaces required for project including calculations and justification
Number of existing parking spaces, number to be removed, number to maintain and type of surfacing
material e. .,gravel,payed)
Provision for pedestrian and handicap access and parking
' Location and design details of ingress, egress, loading areas and cutting
Location and character of green areas (existing and proposed), modification to green area, buffer
zone to remain undisturbed
Lighting, location and design of all existing or proposed outdoor lighting
ADDITIONAL SITE DEVELOPMENT AND MISCELLANEOUS
I Location of on-site&adjacent watercourses,streams, rivers, lake and wetlands
Location of proposed&existing: utility/energy utility/energy distribution systems , electric, solar, telephone)
Location, design and construction of all existing and proposed site improvements including: drains,
I culverts, retaining walls,fences, fire& emergency zones and hydrants
Location and amount/portion of building area proposed for office, manufacturing, retail sales or other
commercial activities
' Signage: Location,size, type, design and setback
Waiver Request: provide letter with application requesting waivers
I Commercial / Industrial Development requires submission of a Landscaping Plan, Stormwater
Management Plan, Grading Plan and a Lighting Plan
The Board may request other elements as considered necessary.
I identify any Federal, State or County permits required for the project.
Please submit record of application for approval status of all necessary permits required from
Federal, State and County officials.
' Page 13 - To be submitted
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' Revised: 10/04/06 • •
Site Plan Review
SIGNATUREPAGE
This Page includes the Authorization to Act as Agent Form, Engineering Fee Disclosure, Authorization for Site
' Visits, Other Permit Responsibilities and Agreement to provide documentation required.
Complete the following if the OWNER of the property is not the same as the applicant
' Owners Agent Form
Owner: Baba-Joani & Mama, LLC
Designates: Jarrett-Martin Engineers, PLLC
' As agent regarding _Variance x Site Plan _Subdivision
For Tax Map No.: 2 9 6.13 Section 1 Block 17 Lot
Deed Reference: _Book _Page _Date
' SIGNATURE: 1'_ �ch�l' fo t- (Owner) i \4A, (Date)
Complete the following if the APPLICANT is unable to attend the meeting or wishes to be represented by another party:
I Applicant's Agent Form
Owner: Baba-Joani & Mama, LLC
Designates: Jarrett-Martin Engineers, PLLC
' As agent regarding: _Variance X Site Plan _Subdivision
For Tax Map No.: 296. 13 Section 1 Bloch, 17 Lot
SIGNATURE: 1_112L,r_k`Z_ ,-o ++ (Owner) (Date)
IENGINEERING FEE DISCLOSURE: Applications may be referred to the Town consulting engineer for review of
septic design, storm drainage, etc. as determined by the Zoning or Planning Department. Fees for engineering
' review services will be charged directly to the applicant. Fees for engineering review will not exceed $1,000
without notification to the applicant.
' AUTHORIZATION FOR SITE VISITS: By signing this page and submitting the application materials attached
herein, the Owner, Applicant and his/her/their agent(s) hereby authorize the Zoning Board or Planning Board and
Town Staff to enter the subject properties for the purpose of reviewing the application submitted.
' PLEASE NOTE: Other permits may be required for construction or alteration activity subsequent to approval by
' the Zoning Board or Planning Board. It is the applicant's responsibility to obtain any additional permits.
OFFICIAL MEETING MINUTES DISCLOSURE: It is the practice of the Community Development Dept. 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 and understand the instructions for submission, agree to the submission
I requirements and completed the checklist.
PO
SIGNATURE OF APPLICANT: - Date
SIGNATURE OF AGENT: Z - Date
' Page 16 To be submitted
Revised: 10/04/% • •
Site Plan Review
I •11.16J ryUYl1—Tat 12
PROJECT I.D.WARREN 61720 SEOR
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART l—PROJECT INFORMATION(To be compleW by Applicant or Project sponsor)
1. APPLICANT SPONSOR 2. PROJECT NAME
Baba-Joani & Mama, Red Roof Inn
S. 1fOJE,T LOCATION:
Mwwcipaw Queensbury Warren
e. PRECISE LOCATION(Shoo addras and rued inWasaWs.pmIMMM wWM& M sae.,W wome na o
Route 9 just north of corner of Weeks Road and Route 9
S. IS PROPOSED ACTION:
❑mw ❑awsmien 1%.Wk OOIVMWalloe Approval of siding color
6. DESCRIBE PROJECT BRIEFLY.
Approval of siding color.
7. AMOUNT OF LAND AFFECTED:
ease UI
e. WILL RNG COMPLY WITH EXISTING ZONING OR OTHER EIS LAND USE REFTRICMM
❑YN El%o If NIX deserft briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
❑RnmemNl ❑Inempow ❑AyffoUll a ❑PWWFina6Opan spa. ❑Olaf
OMGrIbc
I
10. DOES ACTION INVOLVE A PERMIT APPROVAL OR FU DeRr,Now OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY OWDERM_
STATE OR L.OGAI.)7
OYa El No If m of MI'Mlsi and flarflslfapplors4
11. DOER ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PE INY OR APPROVAL?
17Ya t3No It Ya.9K 696MY nanr and PW dU Pell d
12. A8 A
Ya 121 REMILT I PROPOSED ACTION WILL EXISTING PERLSnAPRgYAL REQUIRE MODIFICATION?
❑ No
I CEIMFY THAT THE INFORMATION PROVIDED ADM IS TRUE TO THE BEST OF MY KNOWLEDGE
AppGeantfapoloef nsas Shaki Bhatti, President DO. S l�
am..fw:
If to action Is in the Coastal Area,and you ate a stela ■patcy. DDmplete the
CDastal Assessment Form before proosetlbto with this asaMemana
OVER
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' Revised: 10/04/06 •
Site Plan Review
I • PART II—ENVIRONMENTAL ASSESSMENT(To be completed by Agency)
A DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR PARr 617.4? N yes,CooNpwte the ravlew proems and nee the FULL SAP.
❑Yes ❑No
9. Wt1.L ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR.PART 617.67 If No.a negative declaration
' may be superseded by an~involved agency.
❑Yes ❑No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOMtM3.(Answers may be handwritten,it IeglMel
Ct. Existing air tryu6ty, surfer a groundwater quality a gwntivy, noise finale,"long Vflle pattams,valid waive pmdueeon W dkpoaaL
Potential far erwiolt,drainage m flooding.PrOWWM?E al"briefly:
CL Aesthetic agricultural.arehaeologieal.fdstono.a*flan attend a UMM81 r09ornMs;W bommumty W neighborhood Cha acteR Explain briefly:
' CS. VlpetattOn W fauna,then,ahalmah a wildlife apm"significant habiints,W threatened or endangered speCWs?Explain brMiy:
' Cs. Aeonaminays existing plane a gWW as Officially adopter.a a WwW in was ar intensity of wall of land a other nrtunl rvertant?ExpWW briefly
ICS arCwth,wbsaquent development,w related activlltas likely to be.induced by Can proposed aetlon7 Ex01aW IxWIF_
' CIL Lang tare.ahmt larm.tvmtWNve.OF Odw Intends not WwttUW W C14W Explain Wafty.
C7. Other Impacts flrralixSng Changes in use of ertlter quantity at tYpe o/energyp Explain briefly.
I
p..WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA?
' ❑Vas ONo
E. IS THERE,OR K.THERE LNLELY To aE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
❑Yes ❑No if Yes,explain briefly
PART NI'—DETERMINATION OF SIGNIFICANCE(TO be completed by Agency►
' INSTRLM ON& Forewh adverse effect WanONed above,detxmllrebedwTRls tlUSIMMU tlel.large,important or otMnR6e significant.
Each-effaot should be,anessed.in Conn oddin With Iva(0)so"p.a urban or role%(b)probability of owurdng;(c)dersaon:(y)
ImMy"Nar.Pot geaP@phic$COPC and magnitude.It nwsfeYy.,Add-adaolmlants or reference Supporting meta des,Easoe Said
explandiam conWn raftW t d*Wl.to*hold that all reMvarlt admix impacts have been itlentitied and adequately addressed.If
I titillation D of Pan If teas Clt Aded Yes,the-doWnW atlon and.S(QnMC Nm must tWNWte the PotentiW Impact of the MDPaaad WOO
on the efWlfemllflntal enaacMrlauce,of the OEA.
❑ 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 andfor papers a POSHANS declaration.
I ❑ Check this.pox If YOU have dataTmNad, based on the information and analysis above and-any support
documentation, that the proposed action WILL NOT result In any significant adverse environmental impacts
AND It ovide on attachmems as"Owssary,the masons supporting this determination.
' Mean,of Land Agency
bta Type Nand of Respamilde Officer on
ThIn at Responsible Office,
' In Land AtenCV slipmae,a phavew(
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