HomeMy WebLinkAbout20190418 Old Saratoga Square Revised application page 3 R ue t xtension of c ; n proval
• `Identify date of original DRC approval: Current expiration date: Org. App. No.
0 Describe why this extension. is necessary and whether any significant changes have occurred either on the site or in the neighborhood.
SPQR Environmental Assessment Form
O Applicants proposing the following must complete "Part I" of the SEQR Short Environmental Assessment Form (available here:
htt AL_w.dec.n . ov docs eits e' o erations p df/ leaf
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• Construction or expansion of a multi-family residential structure (4 units .4-)
• Construction or expansion (exceeding 4,000 sq. ft. gross floor area) of a principal or accessory non-residential structure
- Telecommunications facility, radio antennae, satellite dishes
- Demolition
Disclosure
Does any City officer, employee or family member thereof have a financial interest (as defined by General Municipal Law
Section 809) in this application?
,, ® No iliYes - If yes, a statement disclosing the name, residence, nature, and extent of this interest must be filed with this
/1"0/1 V application.
Certification
l/ate, the property owner(s), or purchasers}/lessee(s) under contract, of the land in question, hereby request an appearance
before the Design Review Commission.
By the signature(s) attached hereto, I/we certify that the information provided within this application and accompanying
documentation is, to the best of my/our knowledge, true and accurate. l/we further understand that intentionally providing
false or misleading information is grounds for immediate denial of this application.
l/we hereby authorize the members of the Design Review Commission and designated City staff to enter the property
associated with this application for purposes of conducting any necessary site inspections relating to this application.
Furthermore, l/ire agree to meet all requirements under.Article VII for Historic Review or Article VIII for Architectural
Review the d :: Code of the City of toga S.''rin:sem
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CIC"-'1911 a/t"'"' / - /7 Date:
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Date:
(applicant signature)
If applicant is not the currently the owner of the property, the current owner must also sign.
Owner Signature Date:
Owner Signature: Date:
Revised 01/2019