Application FILL
[Your Name]
19 Cedarwood Drive
Queensbury NY, 12804
518-955-6767
VanceCohen @yahoo.com
March 12, 2014
Craig Brown
Planning and Zoning Department
Town of Queensbury
742 Bay Road
Queensbury NY 12804
Dear Craig Brown:
This letter is to inform you of the changes that I have made to my property located on 1159-1161 State Route
9 Queensbury New York. I had prior approval for plans 3-2007 dated August 27, 2007. Up to this date I have
complied with the rules and regulations set forth in the plans that were previously approved. I have been
continually working on this project due to the cost of renovations.This project is an ongoing project that will
take several years to complete. I expect this project to take me till November 2015 before it is completed in
full. To this date I have removed stumps along the back side of the property. Also, I have laid gravel on my
parking area to prevent from any holes or uneven grounds.
When this project is complete the building will be removed and the property will meet all required
code approvals. To meet the current complaint of the gravel extending onto the neighboring property, when
weather is permitted the gravel will be raked back to be in compliance.
Sincerely,
V / N
[Your Name] f�� fAr tscAp 4_ !A
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• Site Plan Review Revised June 2009
General Information
c� F ' 3
Tax Parcel ID: . t '\� L. __
Zoning District: \'c Q
Current Use: Cam\- c oc es S C - Wit. Ricti n
Proposed Use: 4i \.- Co a o T C‘.(`' q
-cam►:Z is --t,
Location of project: \%,\ A- MD t �`� qcOre R. VITS . 11/4-4
Applicant Name \► .0 Address: n Qua drw&
Home Phone
5a-455 6-1!_Lit 7-1 CeII (0.-R (koicka x.tt
s It-)k'd
Work Phone Fax
E-Mail: Vt
Agent's Name: t Address: tkiiPr
Home Phone Cell:
Work Phone Fax
E-mail
Owner's Name: , Address 419, Gov Is ettoa.
Home Phone r Cell
na
_Tol-07,0s Fax Let_ r" �C
Work Phone 5k Z 14-1 (35-t 1
E-mail K901 e PN6\.
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 1 Type Existing sq.ft. Proposed Total sq. ft.
Addition sq. ft. _
A. Building footprint
,7r(v0 S NSIQ
B. Detached Garage /V N %A N/A
C. Accessory Structure(s) /
D. Paved, gravel or other hard surfaced area
c)05� ( O 1 (33
E. Porches/ Decks
32v U 320
F. Other
G. Total Non-Permeable [Add A-F]
1z979 1 .7110
H. Parcel Area [43,560 sq. ft. /acre]
Z 5-0 3Zl ,✓ -- Z s 03z,
I. Percentage of Impermeable Area of Site [I=G/H]
(V 370
Setback Requirements
Area Required Existing Proposed
Front [1] `v Z14,q 4
Front [2] J
Shoreline
Side Yard [1] 5 v 11 Z Z Z N/4
- Sv, Zvvh�N
Side Yard [2]
Rear Yard [1] �7 /4
Rear Yard [2]
Travel Corridor
Height [max] '
Permeability �j
a
No. of parking spaces 3 n
V i
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? N O
2. If the parcel has previous approvals, list application number(s): J "200-1
3. Does this project require coverage under the NYS DEC Stormwater Pollution Prevention Program?
N� 4�I
4. Estimated project duration: Start Date p I��� End Date ( t ( \S
5. Estimated total cost of project ZS�OQO
6. Total area of land disturbance for project: ,5-10.0,tpS
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 �a sq. ft.
Existing Floor Area ,DtoOS sq. ft. [see above definition]
Proposed Additional Floor Area eD 14 ei sq. ft.
Proposed Total Floor Area cDg(12.. sq. ft.
Total Allowable Floor Area — Z1 ' Area x '2.2 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. • c'
B. The proposed project complies with all other requirements of this Chapter,including the site plan revie 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. e-`7
C. The site plan encourages pedestrian activity internally and,if practicab e,to and from the site with pedestrian paths or sidewalks connected to
adjacent areas. Q,
� S
D. The site plan must conform t Chapter 136 Sewage and Sewage Disposal, Chapter 147 Stormwater Management Local Law, and other
applicable local laws. Yt,5
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. .es
F. The establishment,maintenance and operation of the proposed use will not create public hazar s 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 a 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 proo at 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 ev n 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 move . Pedestrian connections between adjacent sites
shall be provided to encourage pedestrian use. e 5
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. 5
K. The water supply and sewage disposal facilities will be adequate and will meet all applicabl d cu nt requirements set forth by Department
of Health regulations and Chapter 136 of the Town Code. e.S
L. The adequacy, type and arrangement of trees, shrubs and other suitable plantings, landsc ping and screening shall effectively provide a
visual and/or noise buffer between the applicants and adjoining la s, including maximum retention of existing vegetation and
maintenance,including replacement of dead or deceased plants. e.S
M. Fire lanes,emergency zones,and fire hydrants will be adequate and eet the needs and requirements of emergency service providers. 'J c,
Jam...
N. The design of structures, roadways and landscaping in areas s eptible to ponding, flooding and/or erosion will minimize or avoid'such
impacts to the maximum extent practicable. Ni..-, v
O. The site plan conforms to the design standards,lands`aping standards and performance standards of this chapter. \(.t.,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
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
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 L.-
appropriate, on standard 24" x 36" sheets, with continuation on 8%" 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. If the applicant is
not the record owner,a letter of authorization shall be required from the owner
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. C.i//
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.
H The location,height,size,materials,and design of all proposed signs.
I The location of all present and proposed utility systems including:
1. Sewage or septic system; L 1
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 L,5[
.�
(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 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 (febti-
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.
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 (._S
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
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;
A/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;
A
3. Maximum seating capacity,where applicable;and
4. Number of parking spaces existing and required for the intended use.
P 1. Floor Plans. r
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 L-5
5
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. A/4
R Plans for disposal of construction and demolition waste,either on-site or at an approved disposal facility.
S Plans for snow removal,including location(s)of on-site snow storage. L-5
T An Environmental Assessment Form("EAF"),as required by the SEQRA regulations,with Part 1 completed by the Applicant shall be j ,J
submitted as part of the application. If the proposed project requires a special use permit and an EAF has been submitted in t '
conjunction with a special use permit application,a duplicate EAF is not required for the site plan application.. 5 C 6t R-
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
reviewing an application (and for SEQRA compliance) all proposed uses on a single parcel or on contiguous parcels shall be �(! t'xl
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.
Town of Queensbury Planning Office- 742 Bay Road• Queensbury, NY 12804. 518-761-8220 7
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Pre-Submission Conference Form 1179-4-0401
1. Tax Map ID •
2. Zoning Classification 17;C ( J C L 3. Code Reference for Review: t`eCcOe tW- C94-- 3? �G.T fcc-U(vi'eiG}t k
4. Ordinance Reference#: I -7 a_ ?__ -IO ea.Cjec f f S 4�
5. Pre-Submission Meeting Notes; Outstanding Items To ,Addressed Include:
Deed Yes No
General Information complete ✓Yes No
Site Development Data Complete ,1�/plil ( Yes
Setback Requirements Complete I luzA<<{c-sn Yes No rl
Additional Project Information Complete Yes No
*Coverage under DEC SWPPP Rrotirarn •(3 bE-3 Yes ' No
FAR Worksheet complete /AA Yes �10
Standards addressed Yes �/No_ , /II 0/N
Checklist items addressed ' Yes Na
Environmental Form completed Yes No
Signature Page completed . Yes No
• c) Gig 41, COP/ (-1 �—` Sr L" /
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*Applicant must provide office with Notice of Intent(NOI); SWPPP Acceptance Foma„DEC letter issuing permit number;
Notice of Termination (NOT) ( '
Staff Representative: /5 r�c cx MR Cc-
�iliopg- n� � �
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Applicant/Agent: AA EC c•(CG W L).FCec d 'C /
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ors-cc sc i pItcn
Date: .dc_ �r !�'J�c✓� �di�S
4't7 ►a2, 1 ,ryep .k4cl�
Town of Queensbury Planning Office. 742 Bay Road• ueensbury, NY 12804 • 518-761-8220 j 8
r_,] , / - — I . l A- — --- — -
Site Plan Review Revised June 2009
1448.4(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 Esponsor)�.3 . ,��(�� �y �
1. A `IVV\\c Q�l/'�ii+1 I MfT {!i'1:t (11<1J LC l Cli 1 140;ti1-
3. PROJECT LOCATION: �p. ,(
Municipality 'r1'r?`... -S 11,`�:'' County
4. PRECISE LOCATION(Street address and road intersections,prominent landmarks,etc.,or provide map!
\\. C\.4 1i t ec..k , c
5. IS PROPOSED ACTI
❑New pension ❑Modiflcatlon/alteration
6. DESCRIBE PROJECT BRIEFLY: p,-.,
'12.fa cyle_ c 0 � T .i` k(-
7. AMOUNT OF D y re
AFFECTED:
Initially hh 1 acs Ultimately ( acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
t��ST.� ❑No If No,desulbe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
❑Residential ❑Industrial t Commercial ❑Agriculture 0 Park/Forest/Open space 0 Other
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL,
STATE OR LOCAL)?
❑Yes lektilo If yes,list agency(s)and permit/approvals
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
Yes ❑No If yes,list agency name and permit/approval
s 1 am�. P 1� r - mac -c 3 7- d ? lam aN r
.
t2. AS A RESULT OF PROPOSED ACTION WIL (STING PERMIT/APPROV- • QUIRE MODIFICATION?
❑Yes •166NNo
I CERTIFY THAT 1\n�'ORMATION -.' IDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE �f!
Applicant/sponsor name: ' ' . ` n Date: 11 " 1 t'(
t
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
Town of Queensbury Planning Office. 742 Bay Road • Queensbury, NY 12804• 518-761-8220
Site Plan Review Revised June 2009
• PART II—ENVIRONMENTAL ASSESSMENT(To be completed by Agency)
A. DOES ACTION Ili/Aiwa)ANY TYPE I THRESHOLD IN 6 NYCRR PART 617.4? If yes,coordinate the review process and use the FULL EAF.
1111
❑Yes No
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNUSTED ACTIONS IN 6 NYCRR,PART 617.6? If No.a negative declaration
may be supers red by another involved agency.
❑Yes Ell No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,it legible)
Cl. 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_
u!r!
CS. Long term,short term,cumulative,or other effects not identified in C1-CS?Explain briefly.
'V
C7. Other impacts(Including changes in use of either quantity or type of energy)?Explain briefly.
N
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA?
❑yesrNo
E. IS THERE,OR IS THERE UKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
❑Yes g o 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)seeing(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 Title of Responsible Officer
Signature of Responsible Officer in Lead Agency Signature of Pre parer(If different from responsible espornrbk officer)
Date
2
Town of Queensbury Planning Office- 742 Bay Road • Queensbury, NY 12804 • 518-761-8220 10
%
d
•d
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:
Designates:
As agent regarding: Variance Site Plan Subdivision
For Tax Map No.: Section Block Lot
Deed Reference: Book Page Date
OWNER SIGNATURE: DATE:
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 applicants 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 Oar and in conformance with local zoning regulations. I acknowledge that prior to occupying the facilities proposed, I or my
agents,will 'stain : certificate of occupancy as necessary. I also understand that I/we may be required to provide an as-built survey by
a licensed :nd ■, eyor of- ewly constructed facilities prior to issuance of a certificate of occupancy
I have r-ad - •ree to the above.
Q •-1 CA__CG _,—) //pi ,
it-/
Signature Ii•-nt Print Name [Applicant] Date signed
9 [ ] [ �P l 9
Si• •- - [Agent] Print Name[Agent] Date signed
Town of Queensbury Planning Office- 742 Bay Road • Queensbury, NY 12804• 518-761-8220 11
. TYPE: DEE
DOCUMENT 4 2347
WARREN COUNTY CLERK RETT: 2249 $2'000.00
RECORDING COVER SHEET 0/17!20¢3 132:34:00 P.M.
- RECEIPT:_3960 - -_~ .
CARYL-M LARK
WARREN COUNTY CLERK
EXP. INITIALS �:�� 1311 PAGE: 87
VOL.:. DE LIBER:
No. of PAGES
' . ADDTL. FEE
ADDTL. NAMES
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TOWN 3.4,_t_i2 ■ 4 CAM * r-
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* p.a.
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* CO
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Grantor/Mortgagor/Lessor: Donald J. Daniels
Grantee/Mortgagee/Lessee: Mitchell A. Cohen
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RECORDED BY: ((�(Y�1�1() ,'�k i (1�� '�'C't(, - / RECORDING STAMP
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RETURN TO: Bruce O. Lipinski /
Bartlett, Pontiff, Stewart&Rhodes, P.C. / � p �
One Washington Street / LIBERf� 1 1 0 A.1 '
Glens Falls, NY 12801 /
/ 1 PAGE__ , AND EXAMINED
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/ 03 MAR 17 PM 2: 34
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Upon recording, this page becomes a /
part of the document ($3.00) / p E C U R O E 0
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WARRANTY DEED WITH LIEN COVENANT
DATE OF DEED: March/If, 2003
GRANTOR: Donald J. Daniels
1 Gilmore Drive
Queensbury,NY 12804
GRANTEE: Mitchell A. Cohen
3047 Goggins Road
Lake George,NY 12845
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Go THIS WARRANTY DEED made between Grantor and Grantee on the deed date stated
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above WITNESSES THAT GRANTOR in consideration of
One Dollar($1.00)
lawful money of the United States and other good and valuable consideration,paid by Grantee,
DOES HEREBY GRANT AND RELEASE UNTO GRANTEE and his assigns forever
all that property located at:
1161 State Route 9
Town of Queensbury
County of Warren
State of New York
TAX MAP #: 295.8-1-2
(THE PROPERTY IS DESCRIBED MORE FULLY IN SCHEDULE "A" ATTACHED)
THIS GRANT IS MADE:
TOGETHER with the appurtenances and all the estate and rights of the Grantor in and to said
premises.
TO HAVE AND TO HOLD the premises granted by this Warranty Deed unto the Grantee
and his assigns forever.
AND THE GRANTOR COVENANTS as follows:
FIRST: That Grantee shall QUIETLY ENJOY said premises;
SECOND: That Grantor will forever WARRANT the title to said premises;
THIRD: That this conveyance is made subject to the trust fund provisions of section thirteen
of the lien law.
If there are more than one Grantor or Grantee,the words "Grantor" and "Grantee" used in this
deed includes them.
IN WITNESS OF THIS CONVEYANCE, Grantor has executed this WARRANTY ,-y
DEED on the deed date stated above.
IN PRESENCE OF
Donald J. Daniels
STATE OF NEW YORK )
) ss..
COUNTY OF WARREN )
On the /7 day of March in the year 2003, before me, the undersigned, a Notary Public in
and for said State, personally appeared,DONALD J.DANIELS personally known to me or proved
to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within
instrument and acknowledged to me that he executed the same in his capacity, and that by his signature
on the instrument,the individual,or the person upon behalf of which the individual acted,executed the
instrument.
Notary Public
BRUCE G.CARR
NOTARY PUBLIC,STATE OF NEW YORK
WARREN COUNTY 14808919
COMMISSION EXPIRES OCTOBER 31,2006
SCHEDULE "A"
ALL THAT TRACT,PIECE OR PARCEL OF LAND, situate in the Town of
Queensbury, Warren County,New York, and more particularly described as follows:
COMMENCING at a point on the westerly side of New York State Highway Route#9,
which point is marked by an iron pin found in the ground; running thence S. 59° 33' W., 119.22 feet;
running thence N. 34° 15' 30" W., 200 feet to a point; running thence N. 59° 33'E., 120 feet more or
less to the westerly side of New York State Highway Route#9; running thence along the westerly side
of New York State Highway Route#9 S. 30° 48'E. 200 feet to the place of point of beginning.
BEING the same premises conveyed from William H. Perkins to Donald J. Daniels by
Warranty Deed dated October 24, 1988 and recorded in the Warren County Clerk's Office on
December 19, 1988 Book 737 at Page 225.
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