HomeMy WebLinkAboutSD-20-24 SP-20-029 - Supplemental - 0510 Shelburne Road (21)
575 Dorset Street South Burlington, VT 05403 tel 802.846.4106 fax 802.846.4101 www.sburl.com
Permit Number SP-______-__________ (office use only)
APPLICATION FOR SITE PLAN REVIEW
□ Administrative □ Development Review Board
All information requested on this application must be completed in full. Failure to provide the requested
information either on this application form or on the site plan will result in your application being rejected and a
delay in the review before the Development Review Board.
1. OWNER(S) OF RECORD (Name(s) as shown on deed, mailing address, and phone):
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
2. LOCATION OF LAST RECORDED DEED(S) (Book and page #): __________________
3. APPLICANT (Name, mailing address, phone): ___________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
4. CONTACT PERSON (person who will receive all correspondence from Staff. Include name,
address, phone):____________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
4a. CONTACT EMAIL ADDRESS: _________________________________________________________
5. PROJECT STREET ADDRESS: _________________________________________________________________
6. TAX PARCEL ID # (can be obtained at Assessor’s Office): __________________________________________
7. PROJECT DESCRIPTION
a. General project description (explain what you want approval for):
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
2 Site Plan Application Form. Rev. 5-2018
__________________________________________________________________________________________
b. Existing Uses on Property (including description and size of each separate use):
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
c. Proposed Uses on property (include description and size of each new use and existing uses to remain):
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
d. Total building square footage on property (proposed buildings and existing buildings to remain):
__________________________________________________________________________________________
__________________________________________________________________________________________
e. Height of building & number of floors (proposed buildings and existing buildings to remain, specify if
basement and mezzanine): ____________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
f. Number of residential units (if applicable, new units and existing units to remain):
__________________________________________________________________________________________
g. Number of employees (existing and proposed, note office versus non-office employees):
__________________________________________________________________________________________
__________________________________________________________________________________________
h. Other (list any other information pertinent to this application not specifically requested above, please note
if Overlay Districts are applicable): ______________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
3 Site Plan Application Form. Rev. 5-2018
8. LOT COVERAGE Total Parcel Size: _____________Sq. Ft.
a. Building: Existing ________ % / _____________sq. ft.
Proposed _________% / _____________sq. ft.
b. Overall impervious coverage (building, parking, outside storage, etc)
Existing ________% / _____________sq. ft.
Proposed ________% / _____________sq. ft.
c. Front setback non-building coverage (along each street, commercial properties only)
Existing ________% / _____________sq. ft.
Proposed ________% / _____________sq. ft.
d. Total area to be disturbed during construction (sq. ft.) ______________*
* Projects disturbing more than one-half acre of land must follow the City’s specifications for erosion control in
Article 16 of the Land Development Regulations. Projects disturbing more than one acre require a permit
from the Vermont Department of Environmental Conservation.
9. COST ESTIMATES
a. New Building or Addition, including initial fit-up (if initial fit-up cost not available, contact Planning & Zoning
staff): $ ____________________
b. Landscaping: $____________________
c. Other site improvements (please list with cost): _______________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
10. ESTIMATED TRAFFIC
a. P.M. Peak hour for entire property (In and out):____________________________________
11. PEAK HOURS OF OPERATION: _________________________________________________
12. PEAK DAYS OF OPERATION: __________________________________________________
13. ESTIMATED PROJECT COMPLETION DATE: ______________________________________
14. SITE PLAN AND FEE A site plan shall be submitted which shows the information required by the City’s Land
Development Regulations. Three (3) regular size copies, one reduced copy (11" x 17"), and one digital (PDF-
format) copy of the site plan must be submitted. A site plan application fee shall be paid to the City at the time
of submitting the site plan application in accordance with the city’s fee schedule.