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Application LITTLE & O'CONNOR ATTORNEYS, P.C. NINETEEN WEST NOTRE DAME STREET-P.O.BOX 898 GLENS FALLS, NEW YORK 12801-0898 J.DAVID LITTLE AREA CODE 518 MICHAEL J.O'CONNOR TELEPHONE 792-2113 FAX 792-6972 NATHAN P.HALL ELIZABETH E.LITTLE OF COUNSEL September 12,2013 Queensbury Planning Board 742 Bay Road Queensbury,NY 12804 Re: 157 Mannis Road LLC Tax Map Parcel 289.18-1-7 Sundeck Dear Ladies and Gentlemen: Enclosed in connection with the above please find: 1.) Draft for filing fee of$100.00; 2.) Site Plan Application; 3.) Dock Survey and Plans Cr) pages);and 4.) Copy of Deed; Applicant is replacing dock that has fallen into disrepair. Applicant wishes to construct a compliant sundeck. The residence of applicant is same distance with a lot of steps up a step elevation incline so when they are enjoying their lake frontage, they want to have a deck to sit under or on. There used to be a cover over the dock that is being replaced;that cover was removed when it fell into disrepair.This sundeck blocks no view of any adjoining property. A variance is being sought due to the width of the dock but no variance is required for the sundeck. Yours very truly, ITTLE&O'CO OR ATTORNEYS, P.C. fAI L---------_______ By Michael J. 0 'Connor MJOC/dma Enclosures cc: 157 Mannis Road,LLC WEB SITE: www.littleoconnor.com EMAIL: mjoconnor @littleoconnor.com Site Plan Review Revised June 2009 General Information Tax Parcel ID: 289.18-1-7 Zoning District: WR Current Use: LAKE RESIDENCE Proposed Use: SAME- SUN DECK Location of project: NORTHWEST END OF MANNIS ROAD c/o ROMS Applicant Name Address: 56 WINCOMA HUGHES,M.U. 157 MANNIS ROAD, LLC QUEENSBURY,NY 12804 Home Phone Cell: (518) 761-0287 (518)744-0212 Work Phone Fax E-Mail: hughestm @yahoo.com Agent's Name: MICHAEL J. O'CONNOR Address: 19 W.NOTRE DAME ST-PO BOX 898 GLENS FALLS,NY 12801 Home Phone Cell: (518) 796-8822 Work Phone (518) 792-8728 Fax (518) 792-6972 E-mail mjoconnor @littleoconnor.com Owner's Name: Address SAME AS APPLICANT Home Phone Cell Work Phone Fax E-mail Town of Queensbury Planning Office• 742 Bay Road Queensbury, NY 12804 518-761-8220 2 Site Plan Review Revised June 2009 Site Development Data Area / Type Existing sq. ft. Proposed Total sq. ft. Addition sq. ft. A. Building footprint DOCK 740 -40 700 B. Detached Garage N/A C. Accessory Structure(s) 740 D. Paved, gravel or other hard surfaced area N/A E. Porches / Decks SUN DECK -0- 629 629 F. Other DOCK -SEE ABOVE N/A G. Total Non-Permeable [Add A-F] N/A H. Parcel Area [43,560 sq. ft. I acre] N/A I. Percentage of Impermeable Area of Site [I=G/H] N/A Setback Requirements Area Required Existing Proposed Front [1] N/A Front [2] N/A Shoreline N/A Side Yard [1] 20' 20' Side Yard [2] 20' 90'+/- Rear Yard [1] N/A Rear Yard [2] N/A Travel Corridor N/A Height [max] 15' 3" 16' Permeability N/A No. of parking spaces Town of Queensbury Planning Office. 742 Bay Road • Queensbury, NY 12804 • 518-761-8220 3 Site Plan Review Revised June 2009 Additional Project Information 1. Will the proposal require a Septic Variance from the Town Board of Health? NO 2. If the parcel has previous approvals, list application number(s): UNKNOWN 3. Does this project require coverage under the NYS DEC Stormwater Pollution Prevention Program? NO 4. Estimated project duration: Start Date 11/2013 End Date 5/2014 5. Estimated total cost of project: $30,000.00/$50,000.00 6. Total area of land disturbance for project: NONE Floor Area Ratio Worksheet FLOOR AREA RATIO (FAR) -- The relationship of building size to lot size, derived by dividing the total building floor area by the lot size in square feet, yielding a percentage. Zoning District Symbol Floor Area Ratio [FAR] Waterfront Residential WR 0.22 Commercial Moderate CM 0.3 Commercial Intensive CI 0.3 A. The combined area of all square footage, as measure from exterior walls of all structures on the property, including all floors of the structures, garages, basements and attics with more than five (5) feet of ceiling height and covered porches. Building square footage does not include: Open deck, docks and that portion of covered docks extending over water and one storage shed of one hundred twenty (120) square feet or less. Any additional sheds will be included. (See`FLOOR AREA RATIO"). B. Commercial or industrial: the total area in square feet as measured from the exterior of the outside walls of a building or structure, and when applicable, the sum total of all floor areas of the principal and accessory buildings or structures on the project site. Parcel Area N/A sq. ft. Existing Floor Area sq. ft. [see above definition] Proposed Additional Floor Area sq. ft. Proposed Total Floor Area sq. ft. Total Allowable Floor Area Area x ) [see above table] Town of Queensbury Planning Office• 742 Bay Road • Queensbury, NY 12804 • 518-761-8220 4 Site Plan Review Revised June 2009 § 179-9-080 Requirements for Site Plan Approval. The Planning Board shall not approve a Site Plan unless it first determines that such site plan meets the following Standards. Please prepare responses to each of the following topics. STANDARDS A. The proposed project furthers or is consistent with the policies of the Town's Comprehensive Plan. B. The proposed project complies with all other requirements of this Chapter,including the site plan review standards as set forth in Paragraph F of this section,the dimensional, bulk,and density regulations of the zoning district in which it is proposed to be located (Article 3 and Table 1), the applicable requirements of all other Articles that apply. C. The site plan encourages pedestrian activity internally and, if practicable,to and from the site with pedestrian paths or sidewalks connected to adjacent areas. D. The site plan must conform to Chapter 136 Sewage and Sewage Disposal, Chapter 147 Stormwater Management Local Law, and other applicable local laws. E. the proposed use shall be in harmony with the general purpose or intent of this Chapter,specifically taking into account the location,character and size of the proposed use and the description and purpose of the district in which such use is proposed, the nature and intensity of the activities to be involved in or conducted in connection with the proposed use and the nature and rate of any increase in the burden on supporting public services and facilities which will follow the approval of the proposed use. F. The establishment,maintenance and operation of the proposed use will not create public hazards from traffic,traffic congestion or the parking of vehicles and/or equipment or be otherwise detrimental to the health, safety or general welfare of persons residing or working in the neighborhood or to the general welfare of the town. Traffic access and circulation, road intersections, road and driveway widths, and traffic controls will be adequate. G. Off-street parking and loading facilities will be appropriately located and arranged and sufficient to meet traffic anticipated to be generated by the new use. The establishment of vehicle links between parking areas of adjacent properties are provided where feasible. This furthers the Town's goal of reducing curb cuts and reducing congestion. A twenty-foot wide connection is required. If adjacent properties are either undeveloped or previously developed without having made provision for future linkage, then a future connection must be identified and provided for in the site plan under review for such future linkage when the time arises. The Planning Board may require proof that the applicant has made contact with adjacent property owners for purposes of coordinating linkages with adjacent properties. H. The project shall not have an undue adverse impact upon the natural,scenic,aesthetic,ecological,wildlife,historic,recreational or open space resources of the town or the Adirondack Park or upon the adequate provision of supporting facilities and services made necessary by the project, taking into account the commercial, industrial, residential, recreational or other benefits that might be derived from the project. In making the determination hereunder, the Planning Board shall consider those factors pertinent to the project contained in the development considerations set forth herein under§ 179-9-080 of this chapter, and in so doing,the Planning Board shall make a net overall evaluation of the project in relation to the development objectives and general guidelines set forth in§179-9-080 of this Article. I. The provision for and arrangement of pedestrian traffic access and circulation,walkway structures,control of intersections with vehicular traffic and overall pedestrian convenience shall be safe and adequate for pedestrian movement. Pedestrian connections between adjacent sites shall be provided to encourage pedestrian use. J. Stormwater drainage facilities will prevent an increase of post development drainage flows as compared to pre-development drainage flows. Drainage of the site shall recharge ground water to the extent practical. Surface waters flowing off-site shall not degrade any streams or adversely affect drainage on adjacent properties or public roads. Facilities shall be in conformance with the drainage standards of Chapter 147 of the Town Code and the Town of Queensbury Subdivision Regulations where applicable. K. The water supply and sewage disposal facilities will be adequate and will meet all applicable and current requirements set forth by Department of Health regulations and Chapter 136 of the Town Code. L. The adequacy, type and arrangement of trees, shrubs and other suitable plantings, landscaping and screening shall effectively provide a visual and/or noise buffer between the applicants and adjoining lands, including the maximum retention of existing vegetation and maintenance,including replacement of dead or deceased plants. M. Fire lanes,emergency zones,and fire hydrants will be adequate and meet the needs and requirements of emergency service providers. N. The design of structures, roadways and landscaping in areas susceptible to ponding, flooding and/or erosion will minimize or avoid such impacts to the maximum extent practicable. O. The site plan conforms to the design standards,landscaping standards and performance standards of this chapter. Town of Queensbury Planning Office. 742 Bay Road • Queensbury, NY 12804 518-761-8220 5 Site Plan Review Revised June 2009 § 179-9-050 Application for Site Plan Review Application for site plan approval shall be made to the Planning Board using forms supplied by the Board. Application materials and the site plan shall include sufficient information for the Board to make its findings under§ 179-9-070 and 179-9-080 below. In determining the content of the site plan and supporting documentation, the Planning Board may waive certain requirements if the Planning Board deems such requirements or information unnecessary for the type of project proposed. Any such waiver shall be made in writing, and shall contain statements of the reasons why the waived information requirements are not necessary for an informed review under the circumstances. The Planning Board may grant such waivers on its own initiative or at the written request of an applicant. Such request shall set forth the specific requirements that are requested to be waived and the reasons for the requested waiver. Absent any waiver or waivers, an application for Site Plan Review shall include the following: Shown REQUIREMENTS on Sheet A A vicinity map drawn at the scale that shows the relationship of the proposal to existing community facilities which affect or serve it, such as roads, shopping areas, schools, etc. The map shall also show all properties, identify owners, subdivisions, streets, and 1 of 2 easements within 500 feet of the property. Such a sketch may be superimposed on a United States Geological Survey map of the area. B The site plan shall be drawn at a scale of forty feet to the inch (1"= 40 feet) or such other scale as the Planning Board may deem appropriate, on standard 24" x 36" sheets, with continuation on 8'/2" x 11" sheets as necessary for written information. The 1 of 2 information listed below shall be shown on the site plan and continuation sheets. C Name of the project,boundaries,date,north arrow,and scale of the plan. 1 of 2 D Name and address of the owner of record,developer,and seal of the engineer,architect,or landscape architect. If the applicant is not the record owner,a letter of authorization shall be required from the owner 1 Of 2 E The location and use of all existing and proposed structures within the property,including all dimensions of height and floor area,all EL-1&2 exterior entrances,and all anticipated future additions and alterations. PL-1&cR-1 F The location of all present and proposed public and private ways, off-street parking areas, driveways, outdoor storage areas, sidewalks, ramps, curbs, paths, landscaping, walls, and fences. Location, type, and screening details for all waste disposal N/A containers shall also be shown. G The location,height,intensity,and bulb type(sodium, incandescent,etc.)of all external lighting fixtures. The direction of illumination N/A and methods to eliminate glare onto adjoining properties must also be shown in compliance with§179-6-020. H The location,height,size,materials,and design of all proposed signs. N/A I The location of all present and proposed utility systems including: 1. Sewage or septic system; 2. Water supply system; N/A 3. Telephone,cable,and electrical systems; and 4. Storm drainage system including existing and proposed drain lines, culverts, catch basins, headwalls, endwalls, hydrants, manholes,and drainage swales. J Plans to prevent the pollution of surface or groundwater, erosion of soil both during and after construction, excessive runoff, and flooding of other properties, as applicable. A Stormwater Pollution Prevention Plan (SWPPP) for all land development activities (excluding agricultural activities) on the site that results in land disturbance of 1-acre or more. A SWPPP shall comply with the NIA requirements of the DEC SPDES MS-4 General Permit and Chapter 147 of the Town of Queensbury Code. It shall be at the discretion of the Planning Board as to whether a SWPPP or an erosion and control plan shall be required for a site plan review project land disturbance of less than 1-acre. K Existing and proposed topography at two-foot contour intervals, or such other contour interval as the Planning Board shall allow. All elevations shall refer to the nearest United States Coastal and Geodetic Bench Mark. If any portion of the parcel is within the 100- N/A year floodplain,the area will be shown, and base flood elevations given. Areas shall be indicated within the proposed site and within 50 feet of the proposed site where soil removal or filling is required,showing the approximate volume in cubic yards. L A landscape plan showing all existing natural land features that may influence the design of the proposed use such as rock outcrops, stands of trees, single trees eight or more inches in diameter, forest cover, and water sources, and all proposed changes to these N/A features including sizes and types of plants. Water sources include ponds, lakes,wetlands and watercourses, aquifers,flood plains, and drainage retention areas. M Land Use District boundaries within 500 feet of the site's perimeter shall be drawn and identified on the site plan, as well as any N/A Overlay Districts that apply to the property. Town of Queensbury Planning Office. 742 Bay Road • Queensbury, NY 12804 • 518-761-8220 6 Site Plan Review Revised June 2009 N Traffic flow patterns within the site,entrances and exits,and loading and unloading areas,as well as curb cuts on the site and within 100 feet of the site. The Planning Board may, at its discretion, require a detailed traffic study for large developments or for those in heavy traffic areas,which shall include: 1. The projected number of motor vehicle trips to enter or leave the site, estimated for weekly and annual peak hour traffic levels; N/A 2. The projected traffic flow pattern including vehicular movements at all major intersections likely to be affected by the proposed use of the site; 3. The impact of this traffic on levels of service on abutting public streets and at affected intersections. Existing and proposed weekly and annual peak hour traffic levels and road capacity levels shall also be given. O For new construction or alterations to any structure,a table containing the following information shall be included: 1. Estimated area of structure to be used for particular purposes such as retail operation,office,storage,etc.; 2. Estimated maximum number of employees; N/A 3. Maximum seating capacity,where applicable;and 4. Number of parking spaces existing and required for the intended use. P 1. Floor Plans. EL-1 &2 2. Elevations at a scale of one-quarter inch equals one foot(1/4"= 1 foot)for all exterior facades of the proposed structure(s)and/or and PL-1 alterations to or expansions of existing facades,showing design features and indicating the type and color of materials to be used. Q Soil logs,water supply well and percolation test results, and storm runoff calculations, as needed to determine and mitigate project impacts. NIA R Plans for disposal of construction and demolition waste,either on-site or at an approved disposal facility. N/A S Plans for snow removal,including location(s)of on-site snow storage. N/A T An Environmental Assessment Form("EAF"), as required by the SEQRA regulations,with Part 1 completed by the Applicant shall be submitted as part of the application. If the proposed project requires a special use permit and an EAF has been submitted in X conjunction with a special use permit application,a duplicate EAF is not required for the site plan application.. U If an application is for a parcel or parcels on which more than one use is proposed,the applicant may submit a single application for all such uses provided the proposed uses are accurately delineated on a site plan drawn pursuant to the requirements set forth above. The Planning Board may grant the application with respect to some proposed uses and not others. For purposes of N/A reviewing an application (and for SEQRA compliance) all proposed uses on a single parcel or on contiguous parcels shall be considered together. ✓ A brief narrative statement on how the project proposed for review furthers or is consistent with the vision,goals and policies in the Town's Comprehensive Plan. X NARRATIVE Applicant wishes to replace the existing dock that is in a state of disrepair and a safety concern. Applicant's replacement will downsize the dock, so that it will become compliant with current dock dimension regulations. Applicant wishes to construct a compliant deck over the replacement dock. The dock used to have a cover,w hich was removed due to disrepair some years ago. Town of Queensbury Planning Office. 742 Bay Road • Queensbury, NY 12804 • 518-761-8220 7 Site Plan Review Revised June 2009 Pre-Submission Conference Form [179-4-04oj 1. Tax Map ID 289.18-1-7 2. Zoning Classification WR 3. Code Reference for Review: -7q-_ •'q- 7j- (�ti0 4. Ordinance Reference#: Irct`�c(aS e C i1 C;U'L a r test c..`I e e Sr (e k c 1-et/+r 5. Pre-Submission Meeting Notes; Outstanding Items To Be Addressed Include: Deed Yes irNo General Information complete Yes No Site Development Data Complete Yes No Setback Requirements Complete Yes No Additional Project Information Complete Yes No ' �0,90 Q(.Q 'UI Coverage under DEC SWPPP Program Yes No 1 FAR Worksheet complete Yes No Standards addressed Yes No Checklist items addressed Yes No Environmental Form completed Yes No Signature Page completed Yes • Qc t c f1 .p cv?c C e-16 Sch`. 7L ea(RDSc<j -17) C(9/'S1vi�f CA (,o2 Scz� 5 c -'eG\- c 1C( ('un �rLA -1- 7 QC 4u�tcoec? ert)✓I atfec V4Ct6.n( a 0(D c C c-A ton A(---(9: e u ore 5 c,T7ec-‘ c-flGvAt`E *Applicant must provide office with Notice of Intent(NOI); SWPPP Acceptance Form, DEC letter issuing permit number; Notice of Termination (NOT) Staff Representative: CA,--)Cc 0s02— Applicant I Agent: Date: X1643 Town of Queensbury Planning Office- 742 Bay Road Queensbury, NY 12804• 518-761-8220 8 Site Plan Review Revised June 2009 14-18-4(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 2. PROJECT NAME 157 MANNIS ROAD, LLC SUN DECK CONSTRUCTION 3. PROJECT LOCATION: MenlcipalltyQUEENSBURY County WARREN 4. PRECISE LOCATION(Street address and road Intersections,prominent landmarks,etc.,or provide map) 157 MANNIS ROAD - NORTHWEST END OF MANNIS ROAD -GLEN LAKE -THERE IS A PRIVATE ROAD CUT FROM MANNIS ROAD TO GLEN LAKE - DOCK AT END OF PRIVATE ROAD 5. IS PROPOSED ACTION: ©New ❑Expansion ❑Modillcation/alteration 6. DESCRIBE PROJECT BRIEFLY: CONSTRUCT COMPLIANT SUN DECK OVER REPLACEMENT DOCK WHICH IS ALSO COMPLIANT 7. AMOUNT OF LAND AFFECTED: Initially 0 acres Ultimately 0 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ©Yes ❑No If No.describe briefly ENTITLED TO TWO DOCKS -WISH TO COMBINE AND HAVE ONE DOCK WITH SLIGHTLY LARGER SIZE THAN PERMITTED FOR ONE DOCK 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? 0 Residential ❑Industrial ❑Commercial El Agriculture ❑Park/Forest:Open space ❑Other Describe: SUMMER RESIDENCE 10. DOES ACTION INVOLVE A PERMIT APPROVAL.OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE OR LOCAL)? ❑Yes 0 No If yes,list agancy(s)and permit/approvals QUEENSBURY PLANNING BOARD SITE PLAN 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 0 Yes El No If yes,Ilst agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑Yes 0 No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE 157 MANNIS ROAD, LLC Applicant/sponsor name:BY: THOMAS HUGHE=S, Member Date: 91�`-3 12013 r Signature: //11/ 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 Town of Queensbury Planning Office- 742 Bay Road - Queensbury, NY 12804 • 518-761-8220 9 Site Plan Review Revised June 2009 • PART II—ENVIRONMENTAL ASSESSMENT(TO be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR PART 617.4? II yes,coordinate the review process and use the FULL EAF. ❑Yes No B. WtLL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negatives 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.it legible) C1. 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 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 CS. Growth,subsequent development,or related activities likely to be Induced by the proposed action?Explain briefly. C6. Long term,short term,cumulative,or other effects not Identified In C1-05?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 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 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: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Tide of Responsible Officer Signature of Responsible Officer in Lead Agency Signature or Preparer ill different from responsible officer) Date 2 Town of Queensbury Planning Office- 742 Bay Road - Queensbury, NY 12804 • 518-761-8220 10 Site Plan Review Revised June 2009 Signature Page This page includes the 1.) Authorization to Act as Agent Form: 2.) Engineering Fee Disclosure; 3.) Authorization for Site Visits; 4.) Other Permit Responsibilities; 5.) Official Meeting Disclosure and 6.) Agreement to provide documentation required. OWNER'S AGENT FORM: Complete the following if the OWNER of the property is not the same as the applicant Owner: Designates: As agent regarding: Variance Site Plan Subdivision For Tax Map No.: Section Block Lot Deed Reference: Book Page Date OWNER SIGNATURE: DATE: APPLICANT'S AGENT FORM: Complete the following if the APPLICANT is unable to attend the meeting or wishes to be represented by another party: Owner: 157 MANNIS ROAD, LLC Designates: MICHAEL J. O'CONNOR/DEVIN DICKINSON As agent regarding: VarianceX Site Plan Subdivision For Tax Map No.: 289.18 Section 1 Block 7 Lot Deed Referenc• 3581A� ok 37 Page 6/26/2008 Date OWNER SIGNATURE: �''T hZ� DATE: 9/7`) /2013 157 M NNIS ROAD,LLC 14(y:Thomas Hughes,M.D.,Member 2.) 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. 3.) 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. 4.) OTHER PERMIT RESPONSIBILITIES: 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. 5.) OFFICIAL MEETING MINUTES DISCLOSURE: It is the practice of the Community Development Department to have a designated stenographer tape record the proceedings of meetings resulting from application, and minutes transcribed from those tapes constitutes the official record of all proceedings. 6.) AGREEMENT TO PROVIDE DOCUMENTATION REQUIRED: I, the undersigned, have thoroughly read and understand the instructions for submission and agree to the submission requirements, I acknowledge no construction activities shall be commenced prior to issuance of a valid permit. I certify that the application, plans and supporting materials are a true and complete statement/description of the existing conditions and the work proposed, and that all work will be performed in accordance with the approved plans and in conformance with local zoning regulations. I acknowledge that prior to occupying the facilities proposed, I or my agents,will obtain a certificate of occupancy as necessary. I also understand that I/we may be required to provide an as-built survey by a licensed land surveyor of all newly constructed facilities prior to issuance of a certificate of occupancy I have r-sd and agree to - above. 157 MANNIS ROAD,LLC By:Thomas '<-...----- Hughes,M.D., Member 9/(6 /2013 Siun: ure •�lip cap) Print Name [Applicant] Date signed LL MICHAEL J. O'CONNOR 9/ 1f. /2013 Signature [Ag=ill Print Name [Agent] Date signed Town of Queensbury Planning Office. 742 Bay Road - Queensbury, NY 12804 • 518-761-8220 11