HomeMy WebLinkAboutCEDAR Program RequestNew York State
NEWYORI( Department (Emergency Department of Stale
ov oxiuxny. Division of Building Standards and Codes
of State Management 9
One Commerce Plaza
99 Washington Avenue, Suite 1160
Albany, NY 12231-0001
Email: CEDARQdos.ny.gov
Code Enforcement Disaster Assistance Response
EMPLOYER RELEASE FORM
The below named individual has applied to participate in the New York State Code Enforcement Disaster
Assistance Response (CEDAR) program. CEDAR provides volunteer Code Enforcement Officials, Building
Safety Inspectors, and Registered Design Professionals that conduct rapid safety assessments on
buildings that have been damaged as a result of a disaster. The information this program provides to
impacted communities Is Invaluable in the recovery phase following such an event. The data collected
can be used to speed up the application process for financial assistance, and assist in the decision
making process to allow residents and building owners to return to their homes and businesses. The
program is available to all communities within Newyork State, The CEDAR volunteers are provided with
workman's compensation and are indemnified by New York State while deployed.
By signing this Employer Release Form you are indicating that you will support the individual's
participation in the CEDAR program. This includes their occasional training, drills, and more importantly,
responding to assist a community that is in need following a disaster.
Thank you for your support.
Print Employee's Name: {I wA) 1 /1, /'.x11 A
Supervisor's signature:
Print Supervisor's Title: IAR]nw,� 01,&g Date:
2,11.2021
New York State
Department of State
sNr�WnvOaK lDepartrnent l Emergency Division offtllding Standards and Codes
mvoarvaar. of State Management One Commerce Plata
99 Washington Avenue, Suite 1160
Albany, NY 1223L-0001
CEDAR Application
Personal Information
Street Address 1047 Route 90
Town/Village/City lCortland
State INew York Zip Code 13045
County lCortland
Email Address k—Memahon@cortiandville.org
Work phone no. 607-756-7490
Home phone no.
Mobile phone no. I607-745-0004
Employer Information
Employer JTown of Cortlandville
Street Address 3577 Terrace Road
---
.. ------ - ..........J
Town/Vlllage/City Cortland
NOW
Send to: CEDAR@dos.ny.gov
Include Employer Release Form
PRINT NAME KeVln MCMahon
NYCEO/BSI INY0347605 J to# (NY or CE)
DBSC Use Only
CEO / BSI Certification
ICS 700.a
ICS 100.b
License Number verified
Approve
Disapprove
Reason for disapproval:
YES NO
State New York Zip Code 13045
Date IAMRESPONDING profile created
Check all that apply
CEO Q✓ BSI El Architects Engineer
Complete the NYS Education Department License number only if you selected either Architect or Engineer
NYS Education Department License Number L Nytg--
Date ICS 700.a completed L— —
Date transcript request submitted to FEMA J
Date IC5100,b completed ICS INFORMATIONS Please email a copy of your certificates to: cEDARodos.nygov
I have decades of building experience and a former owner of a custom design build firm here In Upalate NY.
Please add skills, While In business we built both commerdal and residential projects I have multiple aoeredltallons and awards
from NAHB, was President for 10 years of the local Home Builders Association, and first In our local BOCES to
training or start their Hall of Fame as a Building Trades Graduate In 1974.1 was responsible for bringing our Home Builders
knowledge that group Into the Skilled Trades Diversity Council based out of Ithaca, NY and helped the local laborers and other
you feel would unions team up to promote the Trades to Incoming students I have since retired my business and have been a
benefit the full time Code Officer for over 10 years. I currently work for a total of four municipalities here in Cortland County:
program Town of Cortlandville, Town of Virgil, Town of Homer and Village of Homer. Thanks for your consideration.
05/19/2021