ApplicationRECEIVED
/,_ �JUN 2 9 200
G�
General Information F N N Cif' Q�1,rE-- iSEiURY
Pi.Abli .iG')F! u
Application No. (Office Use Only)
Project Location:
Tax Map ID:
Zone Classification:
Detailed Description of Project:
(include current & proposed use): _ s Pc kQ d SpfLz--5 Or �v S
syds Gt�z�f3o5 + Pusan
Applicant: (ALSn t S
Address: (o Z A1cz—a- e-,5 G-i.4
CL
Home Phone:
Work Phone / Fax: 'lS 3
Applicant's Agent: I fL� e�YL.0 ` �ifazc s i�h
Address:
Q-
Home Phone:
Work Phone / Fax:
Property Owner. 91V<L 2r ZT ,} A%'T ° 5�' S
Address:
Q-
Home Phone:
Work Phone / Fax: -19 2 -
Directions to Site: Qk�-fiC,'2 (Z'� ?w�� Z --� `d' Z * 4 16T4
4
Site Development Data
Area / Type
Existing sq. ft.
Proposed Addition
. ft.
Total sq. ft.
A. Building Footprint
B. Detached Garage
C. Accessory Structure(s)
D. Paved, gravel or other
hard surfaced areas
E. Porches / Decks
F. Other
Total Non -Permeable
(Sum A through F)
09 eco
Parcel Area
Percent Non -Permeable
(Total Non-Permeable/Parcet Ares)
p
Setback Requirements
Required
Existing
Proposed
Front 1
";-Z)
Front (2)
Shoreline
Side Yard (1)
Side Yard (2
Rear Yard (1
Rear Yard (2
Buffer / Travel Corridor
Height
Permeability
FLOORAREA RATIO wORKSI=T
ay cc:c
.-==cn, adacr or t�iac=mt Of suuc=ras a the W=erfr=, Resiceaal Zcaes (WR-IA & WR-
=AA) is subject to the F:ocr Area Ratio requiremeuts as deed is Seca 179-16 of the Town of Quemsbury
Zcnmg Ordinance.
Flccr Area Ratio (FAR) sae reiaticnsaro of building si to Ioc size derived by dividm2 the *OW building
square fcmge by the loc = in square feet, yielding a perc--,rrage. The maw allowabie FAR is 22
"Please ncce that FAR are separae and di.—"nct from the permeabie arm tays_ =xs that
may =ply.
Building square fectage rid. des ail floors of the primary = ctrre- covered oerr: m and bw=e (when ac
leas tree !I) feet is he_ cr One (1) wail is exposed and =e space meets me living lace tecmremem_s as
deed is Sec;cn 711 and 712 of the YYS Building Code — see reverse Bice of _ase. Deaced storage
buildings nearer than IC.0 sc. fr. and demcagarages ed are so aciuded in the FAR calcai�cas. Building
s.-uz*e fccmge does act mc`:rde: coon declrs, docks and d= portion of covered decks oa=diag iaro the
w=--:% and cne shed 100 r. i or less. All additicnai sheds are included is the F.LR mtorfacens
tiscLcc�^oa I F-misdna Area (sc. E) I Proposed Area (sin. E)
--rr� House I I i
F_rst Foor I I
S� F1oor j
?,== (living spar: I j
C n=-w+ or = esed ocrca
Cue . Uouse
Azar—.= I I
c-= C-aragas) I I
rs . (I sued 100 %L R cr :=
Ca. =-- arBo oau;perroaoaLana) I j
Lzt am Ac:= x
1 cmi A1lowabie ' ccr _r = A x ._
C. =d=.- der .%i=' ei - m acrnz fines
_= x,^- iv de; eiambie = B minus C I
li E is Iarger tL-, D. a variance or rnisiens to your plan may be neede�
Please consult with Staff.
Checklist - Please prepare a map depicting existing and proposed conditions. Failure to complete
the following checklist or include all the required information on your plot plan will result in a
determination of incompleteness and a delay in the processing of your application.
*Check/Initial Each Box
P-Provided
NA -Not Applicable
WI? - Waiver Re ruested
i
ADDRESS EACH ITEM
P
NA
WR
i GENERAL
A Title, name. address of applicant & person responsible for preparation of drawing
B. North anew, Tax Map ID, date prepared and scale (minimum 1 in. = 40 fl.)
C. Boundaries of the property plotted to scale. zoning boundary
Location of principal structure, accessory smictures with exterior dimensions
E. Location of site improvements including outdoor storage areas, driveways (existing
and areas, etc.
/
F. Setbacks for all structures and improvements
WATER & SEWER
/
✓
A Location of on -site sewage disposal facilities, design details, construction details,
flow rates, and number of bedrooms served
/
J
B. Location of water supply (i.e. well) and septic on adjoining lots with separation
distances to existing or pmposed on -site water supply and septic.
C. Separation distances for proposed sewage disposal system to well and waterbodies.
D. Location and description of existing public or private water supply (well, lake, etc.).
Method of seauing public or private water, location, design and constriction of
water nmdv including daily water usage.
E. Percolation test location and results.
PARK NG / PERMEABLE AREAS
A No. of spaces required for pmject including calculations and justi&canom
✓
B. No. of existing perking spaces, no. to be removed no. to maintain and type of
surfacing material (e.g., gravelpaced).
✓ ,
C. Provision for pedestrian and handicap access and perking.
D. Location ad design details of ingress, egress, loading areas and cutting
E. Location and character of green areas (existing and proposed), modiScation to green
area, buffer zone to remain undisturbed.
{I
F. Lighting, location and design of all existing or proposed outdoor lighting
ADDITIONAL SITE DEVELOPMENT AND MISCELLANEOUS
f
A Location of on -site & adjacem watercourses: streams, rivers, lake and wetlands.
/
✓
B. Location of proposed & existing: utility/energy distribution systems (gas, electric,
solar, telephone.
/
1
C. Location, design, and construction of all existing and proposed site improvements
including: drains culverts retaining walls, fences, fire & emergency zones and
hydrants.
D. Location and amount / portion of building area proposed for office. manufacturing,
retail sales. or other commercial activities.
/
E. Sign -age: Location, size, type, design and setback
14.16-4 (11/951—Text 12 •
PROJECT I.D. NUMBER 617.20 SEAR
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. APPLICANT /SPONSOR
&A�ElEA Tt.1E �'tc-2Q.�TtS
2. PROJECT NAME
S• E
3. PROJECT LOCATION:
Municipality County t.)
A. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map)
5. IS PR-nOFPSED ACTION:
UKevr ❑Expansion ❑ ModificatlonlaHaralion
6. DESCRIBE PROJECT BRIEFLY:
-J, SA-t.r--s of (LJ�s ,sd�ir P�,n�s�7s
,Gres
7. AMOUNT OF LAND AFFECTED:
Initial) Y acres UI[imately acres
8. WIILLL/@ROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
Ly Yes ❑ No If No, describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY O,F/P
gOJECT7
,-
❑ Residential ❑ Industrial LOCommercial ❑ A ricultura ❑ ParWForestlODen space ❑Other
Describer.
10. DOES ACTION INVOLVE A PERMIT APPROVAL OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL -
STATE OR LOCAUI?--��
❑Yes No If yes, list agency(s) and pennieapprevals
11. DOES ANY ASPEOT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
❑Yes EYNo If yes, list agency name and permidapproval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
❑ Yes [ N.
I CERTIFYTHATTHE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant/sponsor name: "-'� c� 'Tiv-mac L71sK-iLc
Date
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
1
rwtil u—ervvrrlvniteCRIAL Abbk:""l (10 De completed by Agency) r
A DOES ACTION EXCEED ANY TYPE I THRE .. LD IN 6 NYCRR PART 617.4? If yes, coordinateW review process and use the FULL EAF.
❑ Yes ❑ No
B. WILL ACTION RECEIVE COORDINATED REVIEW As PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration
may be superseded by another involved agency.
❑Yes ❑ No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible)
Cl. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattems, 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 character? Explain briefly
C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly:
C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly
C5. Growth, subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly.
C6. Long term, short term, cumulative, or other affects not identified in Cl-05? Explain briefly. -
C7. Other impacts (including changes in use of 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, explain briefly
PART ill —DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS For each adverse effect identified above, determine whether it is substantial, large. important or otherwise significant.
Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d)
irreversibility; (a) geographic scope; and (l) magnitude. If necessary, add attachments or reference supporting materials. Ensure that
explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If
question D of Part 11 was checked yes, the determination and significance must evaluate the potential impact of the proposed action
on the environmental characteristics 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 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:
if &F <:�uleetSbury Pla&nlrY 36zfr/
Cra�q
YYia.0 fcr.�fU
or y
.Name OI Re ponm le Onicer in Leaa Agency
/h:nl
iigiradbfe
Or Respons.o a Onicer rn r
rifle or Re,; a sm:e On:ner
signature or Preparer jit ainerent !ram responsmie orticer)
a
Signature Page
This Page includes the Authorization to Act as Agent Form, Engineering Fee Disclosure
Responsibilities and Agreement to provide documentation required Other Permit
Complete the following ifthe OWNER of the property is not the same as the applicant
Owner's Agent Form
Owner.
G_
Designates:
As
agent regarding
For Tax Map No.:
a Vfnance Site Plan _ Subdivision
Deed Reference:
_ Section _ Block _ Lot
Book Page
_ _ _Date
SIGNATURE:
(Owner) (fie)
Complete the following if the APPLICkNT is unable to attend the meeting or wishes to be represented by
another party
Applicant's Agent Form
Owner:
Designates:
As agent regarding: _Variance Site Plan _Subdivision
For Tax Map No.: _ Section _ Block _Lot
SIGNATURE: (Owner) pate)
Emm�eerinQ Fee Disclosure Applications may be referred to the Town consulting engineer far review of
septic design, storm drainage etc. as detemimed by the Zoning or planning
engineering review services Rill be Department Foes for
exceed S I,000 without netifiradon to the y to the applicant Fps for engineering review will ant
Please dote: Other permits may be required for construction or alteration activity subsequent to approval by
the Zoning Board or Planning Beard. k is the applicant's responsibility to obtain any additional permits.
Osig nazdesignatedial Vleetin2ytinutes
designated Disclosure: It is the practice of the Community Development Dept to have a
stenographer tape record the proceedings of meetings resulting from applieitioq and that minutes
=mscibed from those tapes constitute the official record of all proceedings. If there is a discrepancy
between such record and the handwriam 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 requirements and completed the chec ' t
SIGNI ATLRE OF APPLICAy7: I Data Z43�0�
SIGNAT'i,RE OF AGEVT: Dare
Garden Time) Barrett Auto Sales Display GIS location map
SCALE. One Inch Represents 400 Feet °
Produced by the Town of Queensbury, NY, Planning Department w�s
e
07/13/2000