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5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? b. Consistent with the adopted comprehensive plan? NO YES 6. Is the proposed action consistent with the predominant character of the existing built or natural landscape? 7. Is the site of the proposed action located in, or does it adjoin, a state listed Critical Environmental Area? NO YES If Yes, identify: ________________________________________________________________________________ ✔ NO YES 8. a. Will the proposed action result in a substantial increase in traffic above present levels? ✔ b. Are public transportation services available at or near the site of the proposed action? ✔ c. Are any pedestrian accommodations or bicycle routes available on or near the site of the proposed action? 9. Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements, describe design features and technologies: _____________________________________________________________________________________________ _____________________________________________________________________________________________ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No, describe method for providing potable water: _________________________________________ _____________________________________________________________________________________________ 11. Will the proposed action connect to existing wastewater utilities? NO YES If No, describe method for providing wastewater treatment: ______________________________________ _____________________________________________________________________________________________ 12. a. Does the project site contain, or is it substantially contiguous to, a building, archaeological site, or district NO YES which is listed on the National or State Register of Historic Places, or that has been determined by the Commissioner of the NYS Office of Parks, Recreation and Historic Preservation to be eligible for listing on the ✔ State Register of Historic Places? ✔ b. Is the project site, or any portion of it, located in or adjacent to an area designated as sensitive for archaeological sites on the NY State Historic Preservation Office (SHPO) archaeological site inventory? 13. a. Does any portion of the site of the proposed action, or lands adjoining the proposed action, contain NO YES wetlands or other waterbodies regulated by a federal, state or local agency? ✔ b. Would the proposed action physically alter, or encroach into, any existing wetland or waterbody? ✔ If Yes, identify the wetland or waterbody and extent of alterations in square feet or acres: _____________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Page 2 of 3