Site Plan Application8/20/02
Site Plan Revi E C E 1 VE D
PRE APPLICATION CONFERENCE FORM
Please note that the Town of Queensbury Zoning and Subdivision of Land Codes
that potentially affect a project.
CC T 1 4 20C4
Effective immediately all applicants must meet with staff for a Pre -Application Conference prior to completing
your application and submitting it to .the Community Development Department for processing. Please call
(518) 761-8220 to make an appointment. The intent of this requirement is to assist applicants in meeting the
minimum submission requirements, and to address any other issues or recommendations identified by staff.
Applications must be complete to be placed on an agenda.
When you meet with staff, we will initial and date this form. When you submit your application, please attach
this completed form. The completed form is considered part of your application. Thank you for your
cooperation. Our goal is to help you!
Applicant Name
,•—,
Tax Map No.
2. f�07 :-1 — 3
Zoning Classification
14
APA, CEA
/4- zlaC
Zoning Ordinance Compliance
11
Section:
5- -tom
DESCRIPTION OF PROJECT:.
PRE -APPLICATION MEETING NOTES:
ce a �//'i'av�t
icatian
41 Uy Date(s) of Pre -Application Conference
Applicant Initials Zoning Administrator
Staff Member Initials TOWN OF QUEENSBURY
Nothing stated in this meeting is to be construed as an approval or disapproval. The sole intent of the pre -
application meeting is to address submission requirements and to identify potential concerns. All content of
submissions is the responsibility of the applicant or authorized designee.
8/20/02
General Information
Application No. (Office Use Only)
Project Location:
Tax Map ID:
Zone Classification:
Compliance with Zoning Ordinance Section:
Detailed Description of Project:
Site Plan Review
Rrmvc- 6w ,/Jobs- #,o
Modification to existing Site Plan, Yes: No:
(if so, indicate Site Plan No. & approval date)
Square Footage of proposed structure: Zoo S�
Applicant: MP2k 4F-.,I -x r
Address: 4 C Lwb &S c o d`
Home Phone: ;X-
Work Phone / Fax:
Applicant's Agent:
Address: �( � � L t-
ice!
U ,t: I
Home Phone:
Work Phone / Fax: G 3 6 �—
Property Owner: 77,11 '57`r "
Address: t t/, G-r
' n, /.1 ' 6 _
Home Phone: 3 - Qs--Q 7
Work Phone / Fax:
Directions to Site: (��/;, ci
Site Develo ment Data
Area / Type
Existing sq. ft.
Proposed Addition
ft.
Total sq. ft.
A. Building Footprint
' � ..., ,r
1
�`
1 � � ,,F•
B. Detached Garage
C. Accessory Structure(s)
D. Paved, gravel or other
hard surfaced areas
E. Porches / Decks
F. Other
�5
7
Total Non -Permeable
Sum A through F
-,
-0/ 2—
'3 5�62—
Parcel Area
Percent Non -Permeable
Total Non-Penneable/Parcel Area
Setback Requirements
Required
Existing
Proposed
Front (1)
Front (2)
Shoreline
o20
391
3
Side Yard (1)
Side Yard (2)
4
Rear Yard (1)
N 4
Rear Yard (2)
� 0,
Buffer / Travel Corridor
Height
` S
Permeability
Sign Setback
No. of Parking Spaces
FLOOR AREA RATIO WORKSHEET
Any construction, addition or replacement of structures in the Waterfront Residential Zones (WR-lA & WR-
3A) 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 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 FAR 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 711 and 712 of the NYS Building Code — see reverse side of page. Detached storage
buildings greater than 100 sq. & and detached garages are so included in the FAR 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. & or less. All additional sheds are included in the FAR calculations.
Use/Location
Existing Areas . f
Proposed Areas . ft
Primary House
First Floor
Second Floor
Basement (living space)
Covered or enclosed porches
Covered decks
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
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.
Last Revised: August 20, 2002
8/20/02
Site Plan Review
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 our application
PR
NA
WR
GENERAL
A. Title, name, address of applicant & person responsible for preparation of drawing
r
B. North arrow, Tax Map ID, date prepared and scale (minimum l in. = 40 ft.)
C. Boundaries of the property plotted to scale, zoning boundary
�—
D. Location of principal structures, accessory structures with exterior dimensions
E. Location of site improvements incl. outdoor storage areas, driveways (existing & proposed) parking
areas, etc.
r
F. Setbacks for all structures and improvements
,�—
G. Elevations of proposed structures
WATER & SEWER
l
A. Location of on -site sewage disposal facilities, design details, construction details, flow rates, and
number of bedrooms proposed
/
B. 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
—�
C. Separation distances for proposed sewage disposal system to well and waterbodies
,l
D. 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
E. Percolation test location and results
PARKING / PERMEABLE AREAS
A. Number of spaces required for project including calculations and justification
B. Number of existing parking spaces, number to be removed, number to maintain and type of surfacing
material e.., gravel,paved)
C. Provision for pedestrian and handicap access and parking
-�
D. Location and design details of ingress, egress, loading areas and cutting
E. Location and character of green areas (existing and proposed), modification to green area, buffer zone
to remain undisturbed
F. Lighting, location and design of all existing or proposed outdoor lighting
ADDITIONAL SITE DEVELOPMENT AND MISCELLANEOUS
A. Location of on -site & adjacent watercourses, streams, rivers, lake and wetlands
✓
B. Location of proposed & existing: utility/energy distribution systems (gas, electric, solar, telephone)
.
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. Signage: Location, size, type, design and setback
F. Waiver Request: provide letter with application requesting any waivers
G. Commercial / Industrial Development requires submission of a Landscaping Plan, Stormwater
Management Plan, Grading Plan and a Lighting Plan
H. The Bd. may request other elements as considered necessary.
I. Identify any Federal, State or County permits required for the project.
J. Please submit record of application for approval status of all necessary permits required from Federal,
State and County officials.
Legend: PR — Provided; NA — Not Applicable; WR Waiver Requested
TOWN OF QUEE NSBURY
742 Bay Road, Queersbury, NY. 12804-5902
Town of Queensbury
Planning Board
Waiver Request
I hereby request that the Planning Board grant me a waiver from the
requirement for the submission of the following item(s);
cd"' Stormwater Management Plan
❑✓Grading Plan
g' Lighting Plan
v�-Landscaping Plan
o"�Sketch Plan approval ( Subdivision )
❑ Other (Explain)
I acknowledge that these plans are required and I seek such waiver(s)
knowingly and for the following reasons:
N 6T A p(-"L ,16 A �Lr F-I� rJA�k
;•Applicant
L:\Craig\Templates\ WoiverReg8602.doc
Date
i
PROJECT ID NUMBER SEAR
APPPENDIENDI X C
STATE ENVIRONMENTAL QUALITY REVIEW
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Only
PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor)
1. APPLICANT / SPONSOR
2. PROJECT NAME
rfloat Oknw4o
0-IL +-Kv �e
3.PROJECT LOCATION:
Municipality
County
4. PRECISE LOCATION: Street Addess 4nd Road Intersections. Prominent landmarks etc - or provide map
PGe l VA-4-f t < JY6xv o Otis Cr
5. IS PROPOSED ACTION: ❑ New ❑ Expansion cation / alteration
6. DESCRIBE PROJECT BRIEFLY. /- y� r1 /�
/7 A-40 � Ef4 LA)<_e
n
W 40 ,dry E Ale
7. AMOUNT OF LAND AFFECTED:
Initially acres Ultimately acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
Yes ❑ No If no, describe briefly:
9. WH IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.)
Residential ❑ Industrial . ❑ Commercial ❑Agriculture ❑ Park / Forest / Open Space ❑ Other (describe)
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGEN (Federal, State or Local)
es ❑ No If yes, list agency names and permit / approval:
L.. f> , C,
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
❑Yes �TJo If yes, list agency name and permit / approval:
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION?
❑Yes
No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant / Sponsor,ame Date:
'+ i
Signature
If the action is a Costal Area, and you are a state agency,
complete the Coastal Assessment Form before proceeding with this assessment
PART II - IMPACT ASSESSMENT (To be completed by Lead Agency)
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 If yes, coordinate the 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.
El Yes ElNo
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible)
C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal,
potential for erosion, drainage or flooding problems? Explain briefly:
F_
........................................ . ..........
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:
F_
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:
I J
C6. Longterm, short term, cumulative, or other effects not identified in CI-05? Explain briefly:
F_
C7. her 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 CRITICAL
ENVIRONMENTAL AREA CEA ? tf es, ex lain briefl
Yes D No
E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ex lain:
-if-yes
Yes 0 No
PART III - 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; (e)
geographic scope; and (f) 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 ii was checked
yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA
Check this box ifyou have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the F
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 ai
WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting
determination.
Name of Lead Agency
Date
Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer
Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer)
f
8/20/02 Site Plan Review
Signature Page
This Page includes the Authorization to Act as Agent Form, Engineering Fee Disclosure, 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
Owner's Agent Form
Owner:
Designates:
As agent regarding
For Tax Map No.:
Deed Reference:
SIGNATURE:
t1,W77s[
Fr2�N c Dcnh�� a
Variance --gite Plan Subdivision
z' , Section _� Block Lot
Book Page Date
(Owner) (Date)
Complete the following if the APPLICANT is unable to attend the meeting or wishes to be represented
by another party:
Applicant's Agent Form Owner: 11-111RA_
Designates: 0o
As agent regarding: Variance --Site Plan Subdivision
For Tax Map No.: 2 y(_ of Section Block / Lot
Engineering 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.
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 requirements and completed thesJwcklist:
SIGNATURE OF APPLICANT:
SIGNATURE OF AGENT:
- Date
- Date`O p
T6 RJ,5/40090
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