CITY OF NEW YORK BOARD OF STANDARDS AND APPEALS 40 Rector Street, 9th Floor New York, New York 10006-1705 Phone: (212) 788-8500 Fax: (212) 788-8769 http://www.nyc.gov/html/bsa/ CITY ENVIRONMENTAL QUALITY REVIEW VARIANCE AND SPECIAL PERMIT APPLICATIONS BSA Cal. No. _____________________ CEQR No. _____________________ Place an X in the box to the right of the category that applies to your application. If your project is a Type II, an environmental review is not required. If your project is a Type I, an Environmental Assessment Statement (EAS) is required. If you cannot find an appropriate item on the list, your project is most likely “unlisted” and requires the submission of an EAS. If your application is unlisted or Type I, submit one (1) original and two (2) copies of the completed EAS and one (1) copy in PDF format on a CD. If your application is Type II, submit three (3) copies of the checklist. If you require assistance in completing this form, please call the Board’s CEQR Examiner at (212) 788-8749. PREMISES AFFECTED BY YOUR APPLICATION Street Address ________________________________________ Borough ____________________ Tax Block ____________________________ Tax Lot __________________________ Zoning District ____________________________ PROJECT DESCRIPTION: Identify the action (variance or special permit), ZR section the application is filed under, ZR sections to be waived, if applicable, and a description of the proposal, including use, new construction or rehabilitation, square footage of development, and number of stories of proposed building. American LegalNet, Inc. www.FormsWorkFlow.com GENERAL 1. Any project or action which exceeds 25 percent of any threshold described in items 6-11 and 16 occurring wholly or partially within or substantially contiguous to any publicly-owned or operated parkland, recreation area or designated open space. Type I: EAS required 2. Any unlisted action (unless the action is designed for the preservation of the facility or site) occurring wholly or partially within or substantially contiguous to any historic building, structure, facility, site or district or prehistoric site or that has been proposed by the New York State Board on Historic Preservation for a recommendation to the State Historic Preservation Officer for nomination for inclusion in the National Register, or that is listed on the State Register of Historic Places (The National Register of Historic Places is established by 36 Code of Federal Regulation (CFR) Parts 60 and 63, 1994 (see section 617.17 of this Part). Type I: EAS required 3. Any Unlisted action that exceeds a Type I threshold established by an involved agency pursuant to section 617.14 of this Part. Type I: EAS required 4. Any structure exceeding 100 feet above original ground level in a locality without any zoning regulation pertaining to height. Type I : EAS required 5. Maintenance or repair involving no substantial changes in an existing structure or facility. Type II: No EAS required 6. Interpretations of an existing code, rule or regulation. Type II: No EAS required 7. Minor temporary uses of land having negligible or no permanent effect on the environment. 8. Mapping of existing roads, streets, highways, natural resources, land uses and ownership patterns. Type II: No EAS required Type II: No EAS required NEW CONSTRUCTION 9. Any new office structure which has a minimum of 200,000 square feet of floor area and exceeds permitted floor area under existing zoning by more than 20 percent. 10. Type I: EAS required Activities, other than residential construction, which meet or exceed any of the following thresholds: (a) Parking for 1,000 or more vehicles. Type I: EAS required (b) A facility with more than 240,000 square feet of gross floor area. Type I: EAS required 11. Any new community or public facility containing at least 100,000 square feet of floor area, or the expansion of an existing facility by more than 50 percent of floor area where the total size of the expanded facility exceeds 100,000 square feet of floor area. Type I: EAS required 12. Granting of individual setback and lot line variances. Type II: No EAS required 13. Granting of an area variance(s) for a single-family, two-family or a three-family residence. Type II: No EAS required 14. Construction or expansion of a single-family, a two-family or a three-family residence on an approved lot including provision of necessary utility connections as provided in paragraph (11) and the installation, maintenance and/or upgrade of a drinking water well and a septic system. Type II: No EAS required American LegalNet, Inc. www.FormsWorkFlow.com 15. Construction, expansion or placement of minor accessory/appurtenant residential structures, including garages, carports, patios, decks, swimming pools, tennis courts, satellite dishes, fences, barns, storage sheds or other buildings not changing land use or density. 16. Construction or expansion of a primary or accessory/appurtenant, non-residential structure or facility involving less than 4,000 square feet of gross floor area and not involving a change in zoning or a use variance and consistent with local land use controls, but not radio communication or microwave transmission facilities. Type II: No EAS required Type II: No EAS required EXPANSION, MAINTENANCE, ACCESSORY STRUCTURES 17. Expansion of an existing office facility by more than 50 percent of its floor area, where the total size of the expanded facility exceeds 240,000 square feet of floor area. 18. Expansion of an existing non-residential facility which exceeds the following thresholds: Type I: EAS required (a) Parking for 500 or more vehicles. Type I: EAS required (b) A facility with more than 120,000 square feet of gross floor area. Type I: EAS required 19. Replacement, rehabilitation or construction of a structure or facility, in kind, on the same site, including upgrading buildings to meet building and fire codes unless such a facility meets or exceeds any of the thresholds in section 617.4 of this Part. 20. Maintenance of existing landscaping or natural growth. 21. License, lease and permit renewals, or transfers of ownership thereof, where there will be no material change in permit conditions or the scope of permitted activities. 22. Routine activities of educational institutions, including expansion of existing facilities by less than 10,000 square feet of gross floor area and school closings, but not changes in use related to such closings. Type II: No EAS required Type II: No EAS required Type II: No EAS required Type II: No EAS required AFFIRMATION: I state that I am duly authorized by the fee owner/conditional owner of the said subject premises to make this application to the Board of Standards and Appeals. I have read this application thoroughly. I understand its contents and affirm to the best of my knowledge that the representations made above are true. SIGNATURE Affix seal, if Registered Architect or Professional Engineer. NOTE: This CEQR checklist is not exclusive and lists the Type II actions typically filed at the Board of Standards and Appeals. For further reference, see New York State’s Environmental Quality Review Act (SEQRA), Article 8 of the New York State Environmental Conservation Law, New York State Department of Environmental Conservation’s SEQRA Regulations at 6 N.Y.C.R.R. '617, including 6 N.Y.C.R.R. '617.5 (Type II actions); 6 N.Y.C.R.R. '617.4 (Type I actions); Official Compilation of the Rules of the City of New York, Title 62, Chapter 5, Appendix A, '6.04 (exempt actions) and '6-15(a)(1), (2) (additional New York City Type I thresholds from Executive Order No. 91 of 1977 as amended); Rules of Procedure for City Environmental Quality Review (CEQR), DCP #91-15, September 1991. July 21, 2010 American LegalNet, Inc. www.FormsWorkFlow.com