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HomeMy WebLinkAboutI - 11 Landmark Mobile Home Park Permit Renewalr'— i I DEC - 1 2022 TOWN OF CORTLANDv7i LLE RAYMOND G. THORPE MUNICIPAL BUILDING 3577 TERRACE ROAD CORTLAND, NEW YORK 13045 PHONE: 607-756-5725 FAX: 607-756-4659 WEBSITE: WWW.CORTLANDVILLE.ORG NO. RENEWAL APPLICATION FOR MOBILE HOME PARK PERMIT TO: The Town Clerk of the Town of Cortlandvillee, Cortland County, NY C1v �HP / l.�—�' of �(9 ✓1'///�/�: Dr ��/o©, go��ey�er (Name of Operator) (Address of Operator) �!,7 t/ Hereby makes application for permission to establish, construct or maintain a Mobile Home Park for the year 20 '13 . Park Location: 1030-1038 Route 13 Tax Map #: 96.09-04-09.000 Name of Park: Landmark Mobile Home Park Such premises are owned by: GN; �hr►�S L LC of q0 ✓�11y4Pr A-,-"`yvo' /�vvbc;'�".h i f�;�o7t (Name of Owner) (Address of Owner) Phone#: 59 S - 7d/ "06OA EmaiL,Jeu✓hrn;�_9S ���I�p�P' erYlY.Ga.a� v a Partner's name if partnership exists: On -Site Park Manager: I� �� ' r`^' 2� f- Phone #: S-g 17q Lf _q The proposed/existing park will provide Park Units for the location of 7 mobile homes. ainia75.7i Ti�'ee: $.�i.�Q pc1' Pdi1C vTuit Toial A.iouui Due: (Note: The Minimum fee charged is $25.00 per year) Filed herewith is a complete plan to scale showing the layout of the mobile home park, the location, size and areas of each mobile home unit, the locatio o treets, and fire hydrants. Dated: I l b -1 . 20 R R. (Applicant) For Office Use: Amount Received $ Cash Check # Date Paid: Received By: (9/2018) qNE'W Workers' Certificate of Attestation of Exemption TRIK Compensation from New York State Workers' Compensation and/or Board Disability and Paid Family Leave Benefits Insurance Coverage "This form cannot be used to waive the workers I compensation: rights or obligations of any party." The applicant may use this Certificate of Attestation of Exemption ONLY to show a government entity that New York State specific workers' compensation and/or disability and paid family leave benefits insurance is not required. The applicant may NOT use this form to show another business or that business's insurance carrier that such insurance is not required. Please provide this form to the government entity from which you are requesting a permit, license or contract. This Certificate will not be accepted by government officials one year after the date printed on the form. In the Application of (Legal Entity Name and Address): CNY MHPS, LLC 90 Airpark Dr Ste 400 Rochester, NY 14624-5732 PHONE: 585-721-0602 FEIN: XXXXX5085 Workers' Comnensation Exemntion Statement: Business Applying For: Mobile Home Park Permit From: Town of Cortlandville The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE SPECIFIC WORKERS' COMPENSATION INSURANCE COVERAGE for the following reason: The business is a LLC, LLP, PLLP or a RLLP; OR is a partnership under the laws of New York State and is not a corporation. Other than the partners or members, there are no employees, day labor, leased employees, borrowed employees, part-time employees, unpaid volunteers (including family members) or subcontractors. Partners / Members: Brian Cook, Jeff Cook Disability and Paid Familv Leave Benefits Exemodon Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY DISABILITY AND PAID FAMILY LEAVE BENEFITS INSURANCE COVERAGE for the following reason: The business MUST be either: I) owned by one individual; OR 2) is a partnership (including LLC, LLP, PLLP, RLLP, or LP) under the laws of New York State and is not a corporation; OR 3) is a one or two person owned corporation, with those individuals owning all of the stock and holding all offices of the corporation (in a two person owned corporation each individual must be an officer and own at least one share of stock); OR 4) is a business with no NYS location. In addition, the business does not require disability and paid family leave benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in New York State. (Independent contractors are not considered to be employees under the Disability and Paid Family Leave Benefits Law) I, Brian Cook, am the Member with the above -named legal entity. I affirm that due to my position with the above -named business I have the knowledge, information and authority to make this Certificate of Attestation of Exemption. I hereby affirm that the statements made herein are true, that I have not made any materially false statements and I make this Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that I understand that any false statement, representation or concealment will subject me to felony criminal prosecution, including jail and civil liability in accordance with the Workers' Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the government entity listed above I also hereby affirm that if circumstances change so that workers' compensation insurance and/or disability and paid family leave benefits coverage is required, the above -named legal entity will immediately acquire appropriate New York State specific workers' compensation insurance and/or disability and paid family leave benefits coverage and also immediately famish proof of that coverage on forms approved by the Chair of the Workers' Compensation Board to the government entity listed above. SIGN HERE I Signature:�� Exemption Certificate Number 2022-077602 Date: %l (0�-3 f ?a Received November 17, 2022 NYS Workers' Compensation Board CE-200 01/2018 i J _, `1.1 !J ll�,y►� �• . �+'"r°� a-- _ - - i' - Key o Eswes -- - -'i�' ,I� �. - 1A 19 2 LLand 1054 NYS-13 9DC Cortland, NY 13045 tiry 6ANow Res-owned 155 Home Sites ti 7 Vacant lot 10 ° 6 9 9 .- 9Qa Ss y S GI 1 a P&P means pad an 6 Permit permit Permit -means we v 2 rms are working on Cat DP 5 a 56 getting permit 49-Pa a m � ' _ Corcland Permltz Jefi Relgle is a `'sy working on v d w Jf cQ J 4 Undmark Dr. _ Sag Jay, 4 Penguin Park Owned? - y a o 6 Penguin Park a- 33 Penguin ¢ - - - 43 Penguin 47 Penguln or 147 Penguln? 1$ C - SD Penguin Q. 189 Penguln I 1?e Penguin Town Supervisor Tho tas A. Wiilianu (607) 756-6091 Deputy Supervisors Jay E. Cobb Jeffrey D. Guido Torun Councilmen David J. Donlick Gregory K. Leach TOWN OF CORTLANDVILLE RAYMOND G. THORPE MUNICIPAL BUILDING MUSTINE. ROCCO-PETRELLA, RMC TOWN CLERK — TAX COLLECTOR — TOWN REGISTRAR 3577 TERRACE ROAD CORTLAND, NEW YORK 13045 townelerh@cordandville.org (607) 756-5725 FAX (607) 756-4659 TDD 1-800-662-1220 November 7, 2022 CNY MHPS, LLC Attn: Mr. Jim Cook 90 Airpark Dr. #400 Rochester, NY 14624 Re: Renewal Application for Mobile Home Park Permit — 2023 Town Attorney Dear Mr. Cook: John A. DelVecchio (607) 758-7520 Enclosed, please find the renewal application for a Mobile Home Park Permit in Town ClerkiColleetor the Town of Cortlandville for property located at 1030-1038 Route 13 (tax map #96.09- Kristin E. Rocco-PetreUa 04-09.000) known as Landmark Mobile Home Park, as well as a copy of Chapter 151 of (607) 756-5725 the Code of the Town of Cortlandville. Lorry HighwayDra h sttp't. As you are aware, the Mobile Home Park Permit for this location is valid for the Larry J. Dmck (607) 756-8241 year 2022 and must be renewed annually. Per Town Code the application for the renewal of a trailer park permit must be submitted to the Town Clerk on or before Town Justice December 1" each year. Robert J. DeMarco Moy Beth Mathey (607)756-2352 In addition to the applications, please provide valid proof of insurance, an Town Assessor David W. Briggs (607) 756-7306 Town Historian NickAlteri (607) 756-6091 Carle Enforcement Officer Desiree Campbell Kevin McMahon (607) 756-7490 Planning & Zoning Bruce Weber (607) 756-7052 Water & Server Supt. Brian Congdon (607) 756-9637 updated site plan, and the appropriate fee. If you should have any questions regarding the permitting process or if I can be of further assistance, please do not hesitate to contact me. Enc. Best regards, Kristin E. Rocco-Petrella, RMC Town Clerk/Collector Town of Cortlandville —The Tovn of Cortlandville is an Equal Opportunity Provider and Employer — Ifyou wish to file a Civil Rights program complaint of discrimination, complete Ure USDA Program Discrimination Complaint Form, found online at h4gn v v.v ncrr reda vnv/cnmmlaint filine cnst.litml, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by Fax (202) 690-7442 or email at rom mm intake(lncda van,