Application Site Plan Review Revised June 2009
General Information
Tax Parcel ID: c &' /' /- `i
Zoning District: G-S
Current Use: Cc,r►.nP,' C,AL Qv. lolin5 °� re si clP,�f�Q( house
Proposed Use C 4 itoin5 4" q5 oci4i'(c( Cook (a)- C3 C1 {,∎//'/eS
Location of project: /S/ I c kt_ gl-e, 9 44 ice 6-e0 e'j e i,/. /,2 c1/S
Applicant Name Address: •.14 f (,,) /4 to ,ec( f1/qc
A'vdrew LicccCr
Qt,
Home Phoneeew'StLU/`,`��lIoZfG�(
Cell:
Slk- 141c-1ig9 3-I8r- 3b/- o k? i
Work Phone _ Fax
E-Mail: l'Ik 7(/ 'I/i 5 51 k- 74((-01,13
1.-it.t CC/ 6 k�c4Cd!^Uw:.Lie./'-i_orrti,
Agent's Name: Address:
Home Phone Cell:
Work Phone
Fax
E-mail
Owner's Name: Address
al`l /NtLd[.i,,lo el N/gCe I e.9rffi Hi y h 4ecii-t Y Hu n e VC-' av CC.054(/'y I ti//tFc 'Home Phone Ul
a---7 5/s-/9 9
Work Phone Fax
5/ )- - 74/s-fQ? 9 S!f--7 4/S o/2-3
E-mail
y
NOV 15 ZUL
Town of Queensbury Planning Office- 742 Bay Rcad -Queensbury, NY 12804 - 518-761-8220
2
Area Variance Revised June 2009
Site Development Data
Area / Type Existing sq. ft. Proposed Total sq. ft.
_ Addition sq. ft. _
A. Building footprint
kk5ide,f1,4/ /IovSe /G/. 0 0 « o o
B. Detached Garage
/�Lq y S ,00L1 51.1 '73 o V 1 3 0
C. Accessory Structure(s)
s ED/,-7,;alt„i c oZ A '1 n a 4
D. Paved, gravel or other hard surfaced area
1/ .2_ 0 425"0
E. Porches/ Decks
136 o ( i'6
F. Other
D 0 O
G. Total Non-Permeable [Add A-F]
,zo 0 aZo
H. Parcel Area [43,560 sq. ft. /acre]
S0, 091/ 0 ,.o , oq `f
I. Percentage of Impermeable Area of Site [I=G/H]
7 s 7¢ b
Setback Requirements
Area Required Existing Proposed
Front [1] I
Front [2]
Shoreline
Side Yard [1]
Side Yard [2]
a v
Rear Yard [1]
Rear Yard [2]
Travel Corridor
2 o
Height [max] / n
/ K - 6 0
Permeability c
3o 40 3v Y0 0
No. of parking spaces
id ocZ :VW S
Town of Queensbury•Zoning Office•742 Bay Road•Queensbury, NY 12804. 518-761-8238 3
4
Site Plan Review Revised June 2009
Additional Project Information
1. Will the proposal require a Septic Variance from the Town Board of Health? ,A, Ls
2. If the parcel has previous approvals, list application number(s): 1 ' '7 .
3. Does this project require coverage under the NYS DEC Stormwater Pollution Prevention Program?
/ , �
4. Estimated project duration: Start Date(JD:;,i /44::,n,"r End Date L in QrG I T/tS
5. Estimated total cost of project: ,710i vo 0
6. Total area of land disturbance for project: nJ o:etic'
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.
j Zoning District Symbol Floor Area Ratio [FAR]
I
Waterfront Residential WR 0.22
Commercial Moderate CM 0.3
Commercial Intensive Cl 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 (0, cot ii •sq. ft.
Existing Floor Area (,LpU 4 `} ?a sq. ft. [see above definition]
Proposed Additional Floor Area 0 sq. ft.
Proposed Total Floor Area . 12 C) sq. ft.
Total Allowable Floor Area / 00 0 (Area x ) [see above table]
Town of Queensbury Planning Office• 742 Bay Road • Queensbury, NY 12804• 518-751-8220 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 r view 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. YEs
C. The site plan encourages pedestrian activity intemally and,if practicable.to and from the site with pedestrian paths or sidewalks connected to
adjacent areas.i G f c_c,l et C L f t G AfE
!1 f�i ✓1 c(l`�� � �. f l�C e S n Vier
D. The site plan must conform to Cha ter 136 Sewage and Sewage Disposal, Chapter 147 Stormwater Management Local Law, and
applicable local laws.
i Ls-c-r pl 1 SEE eta�a ctie4
E. the proposed use shall be in harmony with the gefieral 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. Yf- •
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. /u
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. JE 5
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 ArticleS�� i / +C l
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. A, /`1
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.,.
fee ff6u"n,w47eiui 1'E'fio,^t
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. rr1 _tat_ j;c e s S ( LyN,✓C Lff%1 c to �'� J [-C'r�
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. !fG�� d r1 /�1G I� !f}ffL{C�Pc'� Li t
M. Fire lanes,emergency zones,and fire hydrants will be adequate and meet the needs and requtreifr,is f 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-
/L'/
O. The site plan conforms to the design standards,landscaping standards and performance standards of this chapter. P S
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
on Sheet
REQUIREMENTS #
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
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 8Y2" x 11° sheets as necessary for written information. The , ` /
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. /
D Name and address of the owner of record,developer,and seal of the engineer,architect,or landscape architect. lithe applicant is
not the record owner,a letter cf authorization shall be required from the owner r /
E The location and use of all existing and proposed structures within the property,including all dimensions of height and floor area, all
exterior entrances,and all anticipated future additions and alterations.
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
containers shall also be shown. Cf/V
G The location, height,intensity,and bulb type(sodium,incandescent,etc.)of all external lighting fixtures. The direction of illumination
and methods to eliminate glare onto adjoining properties must also be shown in compliance with§179-6-020. :Ce 40-4(..k e,1
H The location,height,size,materials,and design of all proposed signs. See perm;-r P/3 7;1
I The location of all present and proposed utility systems including:
1. Sewage or septic system;
2. Water supply system; / , /
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 / )
requirements of the DEC SPDES MS-4 General Permit and Chapter 147 of the Town of Queensbury Cade. 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 S k
elevations shall refer to the nearest United States Coastal and Geodetic Bench Mark. If any portion of the parcel is within the 100-
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. Lt 4;vet,
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 /
features including sizes and types of plants. Water sources include ponds,lakes,wetlands and watercourses, aquifers,floodplain,
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
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
j 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 6
100 feet of the site The Planning Board may,at its discretion,require a detailed traffic study for large developments or for those in ) f p�rLr/
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
2. The projected traffic flow pattern including vehicular movements at all major intersections likely to be affected by the C ow S��N
proposed use of the site; �Rf �IG
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;
3. Maximum seating capacity,where applicable;and
4. Number of parking spaces existing and required for the intended use. 9 SP4GC S ex J9' S,fe„,ded usc. .
P 1. Floor Plans. ! /f1(�(�
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
alterations to or expansions of existing facades,showing design features and indicating the type and color of materials to be used.
0 Soil logs,water supply well and percolation test results, and storm runoff calculations, as needed to determine and mitigate project wSkV
impacts.
R Plans for disposal of construction and demolition waste,either on-site or at an approved disposal facility. 4({✓L dwil y
S Plans for snow removal,including locations)of on-site snow storage. CN , l�e
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 ;`
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 /
reviewing an application (and for SEQRA compliance) all proposed uses on a single parcel or on contiguous parcels shall be �
considered together.
S C' I�17AC/l<c
V A brief narrative statement on how the project proposed for review furthers or is consistent with the vision,goals and policies in the ()Aft PA y
Town's Comprehensive Plan.
Town of Queensbury Planning Office'742 Bay Road • Queensbury, NY 12804 •518-761-8220 7
Site Plan Review Revised June 2009
g-0(40 Pre Submission Conference Form [179-4-0401
• Tax Map ID
2. Zoning Classification C
3, Code Reference for Review:
F S���SC �(c
4. Ordinance Reference (� Y
5. Pre-Submission Meeting Notes;Outstanding Items To Be Addressed Incl d
1/Yes
Deed - Yes No
General Information complete , "yes No
Site Development Data Complete x Yes
TT Yes Yes
(i�l No
Setback Requirements Complete No
Additional Project Information Complete No
`Coverage under DEC SWPPP Program ✓ s No
FAR Worksheet complete t I l rZ
Standards addressed
�rYes
No
Checklist items addressed ,/ Yes No
Environmental Form completed ✓Yes No
Signature Page completed
—0 use to
6 l: sic r ?e.�Sec�lt C
�CcLAcr� ma, k1( �5 G�.� ScicU
R�. ,��c.Q Cr PP ce-)A-cc_tak.Q
rZ U V�� -�. e� G
C�C l�4)r/'r��
L� rllZV_ . „� inn �t'n�c_A
vi'1
41
i Z' its 16.1-• yr •1.c 2 � CAA (/l *fa • ((
`Applicant must provide office with Notice of Intent(NOI); SWPPP Acceptance Form, DEC letter issuing permit number:
Notice of Termination(NOT)
N.CDO
Staff Representative:
Applicant!Agent:
Date: ( 3e7 ) I3
Town of Queensbury Planning Office-742 Bay Road•Queensbury,NY 12804.518-761-8220 8
617.20
Appendix B
Short Environmental Assessment Form
Instructions for Completing
Part 1 -part oft Ie application for approval or funding,are sponsor
ubject to public review,and nd may belsubject to further verification.
become part Part the pp
Complete Part I based on information currently available. If additional research or investigation would be needed to fully
respond to any item,please answer as thoroughly as possible based on current information.
Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful
to the lead agency;attach additional pages as necessary to supplement any item.
Part 1-Project and Sponsor Information
Name of Action or Project:
Gam-- ',v ,.t. oC a•, •O ' • C-1 111
"-
Project Location(describe,and attach a location ma.
/'3 • s to " ° - • .A - - AL. _ Nc&. k N. c. e ' e
-k ' eltf
Brief Description of Proposed Action: 0 N -e4'
ru re,tioU9e bviLd ins cod vse -For cr e,,,i4 y.k associA_ted
co okr 15 ffcfi vii-ies.
Telephone:S/�_.7 ,i € y Name of Applicant or Sponsor: E-Mail:! !` G m, . ' ..yl
4N /r• 1,v . CC
Address:
(it/ • (NO o & P State: Zip Code:
City/PO: � ���p�{
C2L(ep n c b v r ivy tds-0. NO YES
Y local law,ordinance,
1.Does the proposed al�tion on involve the legislative adoption of a plan,
administrative rule,or regulation?
If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that
j
/`
may be affected in the municipality and proceed to Part 2. If no,continue to question 2.
2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES
If Yes list ency(s)name and permit or approval:
, ag
PL 60,1A i , t, /30 ci r d x
3.a.Total acreage of the site of the proposed action? acres
b.Total acreage to be physically disturbed?
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? —
4. Check all land uses that occur on,adjoining and near the tri epos Commercial R(Residential(suburban)
a Urban 0 Rural(non-agriculture)
❑Forest a Agriculture ❑Aquatic 0 Other(specify):
❑Parkland
Page 1 of 4
5. Is the proposed action, NO v
a.A permitted use under the zoning regulations? J<
b.Consistent with the adopted comprehensive plan? NO YES
6. Is the proposed action consistent with the predominant character of the existing built or natural
landscape?
7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? YES N/A
NO YES
If Yes,identify:
8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES
b.Are public transportation service(s)available at or near the site of the proposed action? x
c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? X.
YES
9.Does the proposed action meet or exceed the state energy code requirements?
If the proposed action will exceed requirements,describe design features and technologies:
10. Will the proposed action connect to an existing public/private water supply? NO® S
NO YES
If Yes,does the existing system have capacity to provide service.
If No,describe method for providing potable water: x
11.Will the proposed action connect to existing wastewater utilities?
NO YES
If Yes,does the existing system have capacity to provide service? ❑NO jg.YES x
If No,describe method for providing wastewater treatment: -
12. a.Does the site contain a structure that is listed on either the State or National Register of Historic
NO YES
Places?
b.Is the proposed action located in an archeological sensitive area? X
NO YES
13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain
wetlands or other waterbodies regulated by a federal,state or local agency? X
b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? X
If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres:
14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply:
g
❑ Shoreline 0 Forest
❑A riculturaUgrasslands ❑Early mid-successional
0 Wetland !$Urban ❑Suburban
NO YES
15.Does the site of the proposed action contain any species of animal,or associated habitats,listed
by the State or Federal government as threatened or endangered? X
NO YES
16.Is the project site located in the 100 year flood plain?
17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES
If Yes, O YES
a.Will storm water discharges flow to adjacent properties? pf
b.Will storm water discharges be directed to established conveyance systems(rumen N and storm drains)?
If Yes,briefly describe: � rr
W.:.LL CcAJ-vPC't- LeAc Nr^i -iv 111:11w el
Page 2 of 4
18.Does the proposed action include construction or other activities that result in the impoundment of
NO YES
water or other liquids(e.g.retention pond,waste lagoon,dam)?
If Yes,explain purpose and size: X
19.Has the site of the proposed action or an adjoining property been the location of an active or closed
NO YES
solid waste management facility?
If Yes,describe:
20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES
completed)for hazardous waste? Y
If Yes,describe: /`
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE Date: C�C�OF �3 U 3
Applicantlspgi?sorname: �N • /' - L
CC
Signature: �� --
Part 2-Impact Assessment. The Lead Agency nedsin Part responsible for
other materi`asesubmitted by�he project sponsor the ofollowing
questions in Part 2 using the information
otherwise available to the reviewer. When
the answering le andontext of thesp the reviewer proposed action?"
be guided by the concept"Have my
responses been reasonable considering
No,or Moderate
small to large
impact impact
may may
occur occur
1. Will the proposed action create a material conflict with an adopted land use plan or zoning
regulations?
2. Will the proposed action result in a change in the use or intensity of use of land?
3. the Will th proposed action impair the character or quality of the existing community?
4. Will the proposed action have an impact on the environmental characteristics that caused the
establishment of a Critical Environmental Area(CEA)?
5. Will the proposed action result in an adverse change in
thelewa existing level of traffic or
affect existing infrastructure for mass transit,biking or Y- --
6. Will the proposed action cause an increase in the use of energy and it fails to incorporate
reasonably available energy conservation or renewable energy opportunities? -_
7. Will a.the public/private ate water impact existing: -_
a.public/private water supplies?
b.public/private wastewater treatment utilities?
8. Will the proposed action impair the character or quality of important historic,archaeological,
architectural or aesthetic resources?
a
9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands,
waterbodies,groundwater,air quality,flora and fauna)?
Page 3 of 4
No,or Moderate
small to large
impact impact
may may
occur occur
10. Will the proposed action result in an increase in the potential for erosion, flooding or drainage -�
problems? __
]l I. Will the proposed action create a hazard to environmental resources or human health?
question i - in Determination Part 2 haasa significance.ed modelrate to large Agency
mpact may for the
if there spa need to explain why avparticular
euestinn if P r that
Part of the
d,in proposed action detail,may or impact,including any measures or design elements that have complete Part 3.d by
Part 3 should,n ouffi avoid d
may project sponsor be i nvocant.EalhCpo ential impact should belassessedtcons dering is setting prob bility of occurr ng,impact
may or will eve si ili ', P
duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and
cumulative impacts.
o Check this box if you have determined,based on the information and analysis above,and any supporting documentation,
that the proposed action may result in one or more potentially large or significant adverse impacts and an
environmental impact statement is required.
❑ 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.
Date
Name of Lead Agency
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)
Page 4 of 4
Site Plan Review Revised June 2009
Signature Page
Thispage 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:
a cj • c
Designates: �}n'/liw i 4G(-1
As agent regarding: Variance-_Site Plan Subdivision
r Section _�_Block 4 Lot
For Tax Map No.: a mss- Booky s yZ Page Date
Deed Ref- enc-:6t<-R�— DATE: ;
OWNER SIGNATURE: � - -----
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:
Designates:
As agent regarding: Variance Site Plan Subdivision
Section Block Lot
For Tax Map No.: Page Date
Deed Reference: Book
DATE:
OWNER SIGNATURE:
IL 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 Plan Department Fees for
$1,000 without notification to the applicant services will be charged
directly to the applicant. Fees for engineering review
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
purpose of reviewing the application submitted.
properties for the pure approval
4. OTHER PERMIT RESPONSIBILITIES: Other pedanss may responsibility be uir to con any tiionitional alteration a activity subsequent to app
by the Zoning Board or Planning Board. It is the app
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.instructions AGREEMENT TO PROVIDE agree to the submission
equirements, the undersigned, have thoroughly read
acknowledge no construction activities shallll understand the commenced
that the application, plans and supporting materials are a true and complete
instructions for submission and agree
prior to issuance of a valid existing I certify and that all work will be performed in accordance with the
approved and of the existing conditions and the work proposed,
approved plans and in conformance with local zoning regulations.
necessary. I also ulnderstand that prior to
beoreq required the provide an as-bust survey by
agents,will obtain a certificate of occupancy as necessary-
a licensed land surveyor of all newly constructed facilities prior to issuance of a certificate of occupancy
I have read and agree to the above.
o�f fi. �2a(3
�_L.. ti. .; .� . i��� '�� e w i c-_ Date signed
Signature[Applicant]
Print Name[Applicant]
Signature[Agent] Print Name[Agent]
Date signed
Town of Queensbury Planning Office• 742 Bay Road •Queensbury,NY 12804 • 518-761-8220 11
North High Realty Holdings, Inc.
Narrative in response to Site Plan Review Revised June 2009
Page 7 ,letter V
The project proposed for review furthers or is consistent
with the vision, goals and policies in the Town' s
plan. By making the best use of an existing
structure
comprehensive p been a part of Queensbury' s history
structure that has long growth greenery surrounding the
and by not disturbing old g + s long range vision
site, the project ensures that Queensbury
for the area will continue.
PLANT LIST
KEY
A
B
C
QTY. COMMON NAME SIZE
3
1
2
NEON FLASH SPIREA 12"- 15" ht.
EMERALD GREEN ARBORVITAE 36" ht.
GLOBE ARBORVITAE 12" - 15" ht.
D 1 LIME HYDRANGEA 12" - 15" ht.
E 1 UPRIGHT YEW 36" ht.
MATERIALS LIST
MATERIAL
COLOR
Vertical Vinyl Siding
White
Asphalt Shingles
Harbor Blue
Vinyl Replacement Windows
White
Insulated Exterior Doors
TBD
1
L I G H T I N G RAB
WP2FC FULL CUT-OFF INSTALLATION INSTRUCTIONS
.44.001.
Thank you for buying RAB Lighting fixtures. Our goal is to design the best quality products to get the lob done right.
We'd like to hear your comments. a ll the Marketing Department at 888-RAB-1000, or email: marketing @rablighting.com
IMPORTANT NCE.
READ CAREFULLY BEFORE INSTALLING FIXTURE. RETAIN INSTRUCTIONS FOR FUTU ab eEFEREodes.
RAB fixtures must be wired required for safety. Wallpacks are for Electrical
Code
shoduldpnot be used in areas
Proper grounding is req
with limited ventilation or high-ambientFebefore installing Installation a maintaining f zture.y a qualified electrician
.
WARNING: Make certain power is OF
MOUNTING LOCATION
Use the Drilling Template on the inside back Mount fixture on a wall with lens facing down as n
surface of the housing to at tsatla
ntido an r sL dt r
ab w a a
horizontal uP r tiont DO elT
junction boxes or for more secure Ins
bolt housing to mounting surface using locations mount in a way that would entrap heat.
noted below.
1. Swing open door by loosening two screws. WIRING
Remove reflector and lift door off hinges.
HID ONLY CAUTION: 125°C supply wire required
2. Prepare the housing for use by knocking out the - Not useraddition dwelling d T10 2 ulsee a d s
umpapkly e
appropriate holes. supply connections inside the junction box.
3. Line up the housing in desired location and All QT units are factory wired for 120V except those
mount securely. factory ordered with a 277V Photocell (/PC2).
4. Complete the wiring to the supply wires and If other voltages are required. remove reflector and
ground (see wiring instructions). rewire for the appropriate voltage.
5. Replace the reflector, install the lampand slide ro riate voltage fixture lead to
door onto hinges. Swing close door and tighten 1 the HOT supppplead.
the two screws.
6. To insure weatherproof seal make sure all holes 2. Connect the COM" fixture lead to the COMMON
(mounting, plugs, conduit, etc.) are sealed with 3 Fixture ground screw must be connected to
weatherproof silicone sealant.
Lag Bolt Locations supply ground.
4
q o o °I 4 All unused leads must be capped and insulated.
Q W 7
TOP a o (t)LINE • BLACK
I o,� (-)COMMON ♦ WHITE LIGHT
o �� O 111 FIXTURE
• GROUND • GROUND
r Drilling Template
L I G H T I N G RpiB.
Luminaire
Date : 25 Nov 2013 IES Filename : t20376a.ies
Description : WP2FCH150
Title : FULL CUT OFF WALL PACKS WITH SEMI-SPECULAR REFLECTOR AND CLEAR
Enter the descnp`.ie here FLAT GLASS LENS
Desc : ONE 150 WATT MK LAMP LUMEN RATING=
Light Loss Factor : 1.00
For : ANDY LIUCCI Number of Lamps 1
By : ASKCO ELECTRIC SUPPLY
Lamp Lumens : 11500 Ims
Luminaire Watts : 150 W
16 32 Arrangement Magnification: 100°.%o
0 feet
Scale:
45 -- -
I
I
I
I
30 Iojel.-
. I Ai 4 idyl i Iiiii 11-.1:1611N4 10= 4IL I
tri gall)
11 - ■
I
'quilleil i
-45
-45 -30 -15 0 15 30 45
. . _ •.•_-_ -:::5-2013 Ltgrt n;Ana.',575 r: I Cakulafons based on IESt1A meMois and mcomlenoatans i Results sensed rom content of Mot ometnc riles