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Newburgh Land Develop App Ac12 2016 1 - Newburgh Land Develop App_AC12_2016 %28Autosaved%29 (1)

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FORM: LDA01
Land Development Application
City of Newburgh, New York, Planning Board
83 Broadway, Newburgh, New York 12550
Phone: (845) 569-7386
www.cityofnewburgh-ny.gov
LDA01 Page 1 of 8 Issue Date: 1/2/2017
GENERAL INFORMATION:
Project Name/
Address:
Project Descriptions
(Brief):
Application for:
Check all that apply
Site Plan: Answer all parts of Form PB01
Subdivision: Answer all parts of Form PB02
Special Use Permit: Answer all parts of Form PB01 and PB03
Special Parking Permit: Answer all parts of Form PB04
Area Variance: Answer all parts of Form ZBA01
Use Variance: Answer all parts of Form ZBA02
Applicant:
Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
Property Information:
Street Address:
City: Newburgh
State:
NY
Zip:
Tax Map Designation:
Section:
Block:
Lot(s):
Section:
Block:
Lot(s):
Section:
Block:
Lot(s):
Zoning District:
FOR INTERNAL USE ONLY
Application Receipt Date:
Index/Appeal Number:
Meeting Date:
Public Hearing:
Fee Paid:
Completed LDA:
Informational:
Part 1 EAF from mapper:
Ownership Affidavits as Required:
Owner ID Type:
Land Development Application
City of Newburgh, New York, Planning Board
123 Grand Street, Newburgh, New York 12550
Phone: (845) 569-7400 Fax: (845) 569-0096
www.cityofnewburgh-ny.gov
LDA01 Page 2 of 8 Issue Date: 1/2/2017
Property Interest of Applicant (check one):
Owner. If the Property is held by a Corporation, must complete a Corporation
Authorization Statement.
Purchaser or holder of an option to purchase. Applicant must attach a copy of
contract.
Holder of a lease on the property. (Applicant must attach copy of lease.)
A verified agent of one (1) of the above.
Property Owner of Record (if different from Applicant):
Note: A copy of the Owner’s Photo Identification should be provided
Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
If the Applicant is other than the Owner, the Owner must submit an Owner’s Proxy
Statement. If the Property is held by a Corporation, the Owner must also complete a
Corporation Authorization Statement.
Person Preparing Plan or Plat:
Name:
Firm:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
List all contiguous holdings in the same ownership:
Section:
Block:
Lot(s):
Section:
Block:
Lot(s):
Section:
Block:
Lot(s):
Land Development Application
City of Newburgh, New York, Planning Board
123 Grand Street, Newburgh, New York 12550
Phone: (845) 569-7400 Fax: (845) 569-0096
www.cityofnewburgh-ny.gov
LDA01 Page 3 of 8 Issue Date: 1/2/2017
The deadline for submitting an application package for an upcoming Technical
Workshop is 12:00 PM on the third Friday of the month.
The deadline for submitting an application package for an upcoming Planning Board
Meeting is 12:00 PM on the Friday AFTER the first Tuesday of the month.
Application packages not received by these deadlines will not be placed on the agendas.
NO EXCEPTIONS.
The following documents are required of all application packages. All documents
must be received prior to the application deadline to be placed on the next agenda.
Completed Informational or Denial Letter from the Zoning Enforcement
Officer in the Building Department. (Request a minimum of 2 weeks prior to
due date)
Completed Land Development Application (Form LDA01 and Forms PB02,
PB03, PB04, ZBA01, or ZBA02 as required)
Short or Full Environmental Assessment Form.
Applicants must complete a SEQRA Form and submit it with their application
package. The appropriate SEQRA Form depends on the project’s location, type,
and size.
• Applications in the East End or Colonial Terraces Historic District MUST
submit a Full Environmental Assessment Form.
• The City requires that you use the DEC’s EAF Mapper Application
(www.dec.ny.gov/eafmapper/) that will generate partially completed EAFs
with data in NYS databases.
Short Environmental Assessment Forms (Short EAF): Use the Short EAF For Type
II Actions listed in 6 NYCRR Section 617.4-5, or Unlisted Actions. Not acceptable
for properties in Historic Districts.
Full Environmental Assessment Form (Full EAF): Use the Full EAF for
applications that exceed any Type I threshold in Part 617.4. Required for properties
in Historic Districts.
Affidavit(s) of Ownership,
Submit affidavit showing ownership, or other status to legally apply for on behalf
of the property. See pages 6-9 of this form, Form PB01.
Land Development Application
City of Newburgh, New York, Planning Board
123 Grand Street, Newburgh, New York 12550
Phone: (845) 569-7400 Fax: (845) 569-0096
www.cityofnewburgh-ny.gov
LDA01 Page 4 of 8 Issue Date: 1/2/2017
For Site Plans/ Special Use Permits Requiring Site Plans: Submit Two (2)
Hardcopies of the Site Plan
The applicant must complete the separate site plan checklist in the Land
Development Application below and include that information in the submitted site
plan.
For Subdivision Plats: Submit one (1) Original Mylar, One (1) Photographic
Mylar, and one (1) Contact Print of Preliminary Plat
The applicant must complete the appropriate subdivision checklist in the Land
Development Application below and include that information in the submitted plat.
All applicants must submit with their application one (1) original mylar, one (1)
photographic mylar at the same scale, and one (1) contact print of the preliminary
or final plat at a standard sheet size of 22” by 34” by 44”.
For Zoning Variances:
Site Context Map: Eleven (11) copies. Please submit eleven (11) copies of a site
context map showing the zoning of the parcel in question, as well as the zoning of
all adjacent properties.
Plot Plan: Eleven (11) copies. If the area variance applied for involves any
expansion of existing buildings or new construction on the site, then the applicant
must submit eleven (11) copies of a complete plot plan of the proposed expansion
drawn to scale with accurate dimensions, showing the location of all existing and
proposed structures on the lot in sufficient detail to enable the zoning board to
determine compliance.
One (1) Digital Copy at 600 dpi/ppi or greater
The applicant must provide a digital copy of Site Plans or Subdivision Plats.
Applications will not be accepted without a digital copy
Coastal Assessment Form (CAF).
A completed CAF is required for properties located inside the City’s Waterfront
Revitalization Area Boundary. Consult the following document to determine
whether subject property falls within this boundary:
http://docs.dos.ny.gov/opd-lwrp/LWRP/Newburgh_C/Index.html
If a CAF is required, the applicant must review Code Chapter 159 at
http://ecode360.com/28160802, complete the CAF, available at
http://www.dos.ny.gov/opd/programs/pdfs/Consistency/FCAF_fillable.pdf
Industrial Pretreatment Program Permit
The City of Newburgh regulates discharges to the sanitary sewer system in order to
comply with effluent limitations dictated by local, state, and federal laws. Article
III of Section 248 of the City Code defines restrictions on wastewater discharged to
the City’s sanitary sewer system: http://ecode360.com/10873704
All sewer discharges, other than sanitary wastes, may require on-site pretreatment
prior to discharge, along with applicable monitoring and reporting. A checklist is
Land Development Application
City of Newburgh, New York, Planning Board
123 Grand Street, Newburgh, New York 12550
Phone: (845) 569-7400 Fax: (845) 569-0096
www.cityofnewburgh-ny.gov
LDA01 Page 5 of 8 Issue Date: 1/2/2017
available from the City’s Engineering Department in order to assess the potential
requirement of an IPP Permit. This must be filled out and signed by a licensed P.E.
and reviewed by the City.
Stormwater Management
The City of Newburgh is responsible for maintaining compliance with the State
Pollution Eliminations Discharge General Permit for Stormwater Discharges from
Construction Activity and the Small Municipal Stormwater Sewer Systems (MS4)
Permit, amongst other local, state, and federal laws as they relate to stormwater
management. Article IV of Section 248 of the City Code defines the requirements
related to stormwater management: http://ecode360.com/10873863
Disturbances of one acre or more require coverage under NY State Pollution
Eliminations Discharge General Permit for Stormwater Discharges from
Construction Activity (those sites under this threshold may be subject to
stormwater requirements as dictated in the City Code and identified by the City’s
Engineering Department, which can be discussed prior to the application with the
engineering department or post application during the workshop process).
Fees. All applications must include the appropriate fee, by check, made payable to “City
of Newburgh”.
Subdivision Fee
Parks, open space, and minor subdivisions: $0.10 per square foot of subdivided area
Lot line change and two-lot subdivision with existing residential structure: $200
Minor subdivision of 4 lots or fewer: $200
Major subdivision of 5 lots or more: $200, plus $50 per lot
Public hearing: $150, plus $50 for obtaining a public hearing notification list from the City
Assessor
Site Plan Fee
Residential (4 or fewer dwelling units): $300
Residential (5 or more dwelling units): $300, plus $150 per unit
Commercial: $1,000, plus $200 per 1,000 square feet of floor area
Variance Fees
Residential Fee: $150.
Commercial Fee: $250.
Recreation fee in lieu of land (at Board's discretion)
For residential site plans (3 and greater): $1,000 for per unit
Special Use Permit Fee
Residential: $150
Commercial: $250
Public Hearing Fee, If Required
$50 for address list + postage + newspaper fee
Escrow Fee for professional services required in review process, if Required
Residential subdivision: $500.
Commercial subdivision: $1,000.
Multifamily residential site plans and special permits: $100 per dwelling unit.
Commercial or other nonresidential site plans and special permits: $1,000, plus $200 per 1,000
square feet of building floor area or part thereof.
Land Development Application
Applicant Affidavit
City of Newburgh, New York, Planning Board
123 Grand Street, Newburgh, New York 12550
Phone: (845) 569-7400 Fax: (845) 569-0096
www.cityofnewburgh-ny.gov
LDA01 Page 6 of 8 Issue Date: 1/2/2017
To Be Completed by Applicant.
On this the day of _______, 20 , before me, ______________ (name of
notary), the undersigned officer, personally appeared ____________________
(name of affiant), known to me (or satisfactorily proven) to be the person(s) whose
name(s) (is or are) subscribed to the within instrument and acknowledged that (he, she or
they), first being duly sworn, deposes and swears that:
I!am!the!owner!of!the!property!located!at:!
I!am!authorized!to!act!on!behalf!of!the!owner!of!the!property!located!
at:!
Street Address:
_________________________________________
City:
Newburgh
State:
NY
Zip:
12550
____________________________!
Signature!of!Affiant!
______________________!
Printed!Name!of!Affiant!
Subscribed and sworn to before me this day of , 20 .
____________________________!
Signature!of!Notary!Public!
______________________!
Printed!Name!of!Notary!
Date!Commission!Expires:! ________!
STATE OF )
) ss. (city/town)
COUNTY OF )
Land Development Application
Owner’s Proxy Statement
City of Newburgh, New York, Planning Board
123 Grand Street, Newburgh, New York 12550
Phone: (845) 569-7400 Fax: (845) 569-0096
www.cityofnewburgh-ny.gov
LDA01 Page 7 of 8 Issue Date: 1/2/2017
To Be Completed By the Owner If Different than Applicant.
A. Property Information:
Street Address:
City:
Newburgh
State:
NY
Zip:
Tax Map
Designation:
Section:
Block:
Lot(s):
B. Property Owner:
Name:
Address:
City:
State:
Zip:
Phone:
C. Applicant: (Party making application on owner’s behalf)
Name:
Address:
City:
State:
Zip:
Phone:
D. Owner Proxy Statement:
I, swear that I am the owner of the subject
property, and, , the – Agent /Corporate Officer
/Contractor / Other _______________ of said owner or owners is duly
authorized to perform said work and to make and file this application; that all statements
contained in the application are true to the best of his/her knowledge and belief; that work
will be performed in the manner set forth in the application and in the plans and
specifications filed therewith.
Owner Signature: Date:
Subscribed and sworn to before me this day of , 20 .
____________________________
Signature of Notary Public
______________________
Printed Name of Notary
Date Commission Expires:
________
Land Development Application
Corporate Authorization Statement
City of Newburgh, New York, Planning Board
123 Grand Street, Newburgh, New York 12550
Phone: (845) 569-7400 Fax: (845) 569-0096
www.cityofnewburgh-ny.gov
LDA01 Page 8 of 8 Issue Date: 1/2/2017
To Be Completed by Corporate Officer is if Corporation is Owner or Applicant.
STATE OF )
) ss. (city/town)
COUNTY OF )
___________________________, being duly sworn deposes and says that he/she is the
_______________________________________________________________________
(title)
________________________________________________________________________
(name of corporation)
a__________________________________________ (enter name of State of
incorporation) corporation, the applicant named the foregoing application and knows the
contents thereof and the same is true to his own knowledge, except as to matters therein
stated to be alleged on information and belief and as to those matters he believes it to be
true. The signature of the applicant and owner also grants consent for City Staff or City
Board or Commission members responsible for of the review or approval of this
application(s) to enter the property of the subject application.
_____________________________________________
Applicant Signature
Date
_____________________________________________
(Print Name Above)
_____________________________________________
Property Owner Signature(s)
Date
_____________________________________________
(Print Name Above)
Sworn to before me
This _________ day of ______________, 20______
_____________________________________________
Notary Public
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