HomeMy WebLinkAboutSP-23-020 - Supplemental - 1117 Shelburne Road (3)
575 Dorset Street South Burlington, VT 05403 tel 802.846.4106 fax 802.846.4101 www.sburl.com
Application Number SP-______-__________
(office use only) APPLICATION FOR SITE PLAN REVIEW
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. PROJECT STREET ADDRESS:
2. OWNER(S) OF RECORD (Name(s) as shown on deed, mailing address, phone)
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:
6. TAX PARCEL ID # (can be obtained at Assessor’s Office):
7. PROJECT DESCRIPTION
a. General project description (explain what you want approval for):
b. Existing Uses on Property (including description and size of each separate use):
2 Site Plan Application Form. Rev. 01-2020
c. Proposed Uses on property (include description and size of each new use and existing uses to remain):
d: Are Transfer of Development Rights (TDRs) being utilized? Yes No
If yes, please identify how many and from which parcel (street address)
e. Total building square footage on property (proposed buildings and existing buildings to remain):
f. Height of building & number of floors (proposed buildings and existing buildings to remain, specify if
basement and mezzanine):
g. Number of residential units (if applicable, new units and existing units to remain):
h. Number of employees (existing and proposed, note office versus non-office employees):
i. Type of existing or proposed encumbrances on property (easements, covenants, leases, rights of way, etc.)
j. Other (list any other information pertinent to this application not specifically requested above, please note
if Overlay Districts are applicable):
8. LOT COVERAGE (ALL information MUST be provided. For Planned Unit Developments involving multiple
parcels, attach additional sheets)
Total Parcel Size: acres / sq. ft.
3 Site Plan Application Form. Rev. 01-2020
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. NATURAL RESOURCE INFORMATION
a. Are there any Natural Resources (as defined in the Land Development Regulations Article 12) on the
subject property?
Yes No
b. If yes, is the proposed development encroaching into any of these natural resources (list area of resource
encroachment by type)
c. If yes, please submit the following with this application:
i. A site specific or GIS based natural resource mapping or delineation of the entire property as required by
Table 12-01.
ii. Response to the standards described in the relevant section of Article 12 for the impacted Natural
Resource (applicant is strongly encouraged to have a resource expert respond to these criteria).
10. AREA DISTURBED DURING CONSTRUCTION: ___________________SQ. FT. *
*Projects must follow the City’s specifications for erosion control in Article 16 of the Land Development
Regulations. Projects disturbing more than one (1) acre require a permit from the Vermont Department of
Environmental Conservation.
8. COST ESTIMATES
a. New Building or Addition, including initial fit-up (if initial fit-up cost not available, contact Department
staff): $
b. Landscaping: $
c. Other site improvements (please list with cost):
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9.ESTIMATED TRAFFIC
a.Land Use Code(s) Used, Independent Variables, Calculations:
(attach additional sheets as necessary)
b.P.M. Peak hour for entire property (In and out):
10.PEAK HOURS OF OPERATION:
11.PEAK DAYS OF OPERATION:
12.ESTIMATED PROJECT CONSTRUCTION SCHEDULE AND DATE OF COMPLETION:
13.SITE PLAN AND FEE A site plan shall be submitted which shows the information required by the City’s Land
Development Regulations. All application materials listed in LDR Appendix E, with plans provided as individual
sheets and named to include sheet number and latest revision date, must be submitted digitally. An application
fee shall be paid to the City at the time of submitting the application in accordance with the City’s fee schedule.
NOTE: NOTIFICATION of ADJOINING PROPERTY OWNERS: Notification of adjoining property owners, in
accordance with 24 V.S.A. §4464(a) and Section 17.06(B) of the South Burlington Land Development
Regulations, is the responsibility of the applicant. After deeming an application complete, the Administrative
Officer will provide the applicant with a draft meeting agendas or public hearing notice and sample certificate of
service. The sworn certificate of service shall be returned to the City prior to the start of any public hearing.
I hereby certify that all the information requested as part of this application has been submitted and is accurate
to the best of my knowledge.
SIGNATURE OF APPLICANT DATE OF SUBMISSION
SIGNATURE OF PROPERTY OWNER PRINTED NAME OF PROPERTY OWNER
___________________________________________________________________________
Do not write below this line
I have reviewed this site plan application and have taken the following action:
Date of Complete Application:
Date Issued Decision: or Date Referred to Development Review Board:
4/28/2023
5 Site Plan Application Form. Rev. 01-2020
_______________________________________________________
Administrative Officer Date
The applicant or permittee retains the obligation to identify, apply for, and obtain relevant state permits for this
project. Call (802) 879-5676 to speak with the regional Permit Specialist.