HomeMy WebLinkAbout20190622 ECS Psychological Services Application **HANDWRITTEN APPLICATIONS WILL NOT BE ACCEPTED**
[FOR OFFICE USE1
t t 0 Gzi , CITY OF SARATOGA SPRINGS (Application#)
p PLANNING BOARD
t f A •i: 0
Cr' El (Date received)
'-'-') C'',/c7 .itS4 ''' City Hall -474 Broadway
Saratoga Springs, New York 12866-2296
' ; `' Tel:518-587-3550 fax:518-580-9480
ORATED �,
http://www.saratoga-springs.org
APPLICATION FOR: (Rev: 03/2018)
SITE PLAN REVIEW
(INCLUDING PUD)
***Application Check List-All submissions must include completed application check list and all required
items.
Project Name:
ECS Psychological Services
Property Address/Location:
210 Church Street
165.50-3-8 OMB-2
Tax Parcel #: Zoning District:
(for example: /6552-4-37)
Physician Office
PPro osed Use:
Date special use permit granted (if any): Date zoning variance granted (if any):
Is property located within (check all that apply)?: -listoric District f krchitectural Review District
500' of a State Park, city boundary, or county/state highway
APPLICANT(S)* OWNER(S) (/f not applicant) ATTORNEY/AGENT
Name
ECS Psychological Services Rucinski Hall Architecture
Address
210 Church Street 134 Dix Ave
Saratoga Springs NY 12866 Glens Falls NY 12801
Phone
518-580-0520 518-741 -0268
dr.christopher-sisk@ecspsychological.com eph a l n ca .rr.co rn
Email y p
Identify primary contact person: Applicant 'Owner ✓Agent
*An applicant must be the property owner, lessee, or one with an option to lease or purchase the property in question.
City of Saratoga Springs-Site Plan Review Application 1
Application Fee: A check for the total amount below payable to: "Commissioner of Finance" MUST accompany this
application.
Sketch Plan - $300 $
Final Site Plan Approval
Residential - $300 plus $180/unit $
Non-Residential - $600 plus$120/I,000 SQ. FT. $
Modification
Residential - $300 $
Non-Residential - $500 $
500
Total $
500
Submission Deadline—Check City's website (www.saratoga-springs.org) for application deadlines and meeting dates.
Does any City officer, employee or family member thereof have a financial interest (as defined by General Municipal Law
Section 809) in this application? YES _ NO_/_. If YES, a statement disclosing the name, residence, nature and
extent of this interest must be filed wit t is application.
I, the undersigned owner, leasee or purchaser under contract for the property, hereby request Site Plan Review by the
Planning Board for the identified property above. I agree to meet all requirements under Section 240-7.2 of the Zoning
Ordinance of the City of Saratoga Springs.
Furthermore, I hereby authorize members of the Planning Board and designated City staff to enter the property
associated with this application for purposes of conducting any necessary site inspections relating to this application.
Digitally signed by Erin Christopher Sisk
Erin Christopher Sisk sDsNy@Egriicsn ayCcl ShhoriopceoSmmisa,kilcoCspyhcehro-ogicl Serces,o=ECS
20 June
2
Applicant Signature: Date:2019.06.20 14:33:21-04'00' Date:
If applicant is not current owner, owner must also sign.
Owner Signature: Date:
City of Saratoga Springs-Site Plan Review Application 2