HomeMy WebLinkAboutJ - 06 CNH Trailer Park RenewalTOWN OF CORTLANDVILLE
OFFICE OF CODE ENFORCEMENT
Desiree Campbell
RAYMOND G. THORPE MUNICIPAL BUILDING
3577 TERRACE RD
CORTLAND, N.Y. 13045
OFFICE: 607-756-7490
CELL: 607-423-6009
Memorandum
11/14/2023
Kristin Rocco-Pettrella
Town Clerk
Re: CNH Trailer Park
3610 Kingsley Ave
Cortland, NY 13045
Dear Kristin,
On August 17, 2023, Code Officer, Desiree Campbell, inspected the above noted park. No
violations were noted at this time.
The Code Department received a renewal application for mobile home park permit on
November 13, 2023.
A re -inspection was made at the trailer park on November 14, 2023, to confirm no violations
have been made within this time gap period.
No violations were noted on November 14, 2023. It is my recommendation to grant permit
renewal for the above noted property.
Sincerely,
Desiree Campbell
Any
NYS Code Officer
Town of Cortlandville
TOWN OF CORTLANDVILLE
1 RAYMOND G. THORPE MUNICIPAL BUILDING
„a3577 TERRACE ROAD
PHONE: 607-756-5725 FAX: 607-7S6-4659
CWWW.CORTLANDVILLE.ORG
NO,
TO: The Town Cle k, of the Town of Cortlandville, Cortland County, NY
l J am'} ; CfI tfi of /)u, Anvq�- A"A"'4,vIVY iz zg-
(Name of Operator) (Address of Operator)
Hereby makes application for permission to establish, construct or maintain a Mobile Home Park for the
year 20 d<
Park Location: 3610 KinRlsev Ave. Tax Map #: 96.09-04-14.000
Name of Park: CNH Trailer Park
Such premises are owned by:
a, ofIq 4,0kij,", AAN131 1i l
(Name of Owner) (Address of Owner)
Phone #:. Sir, -SW— GAD Email: lw-r. 4—e- eyTvfi.'ht, C.u`k6✓
Partner's name if partnership exists: J
On -Site Park Manager: ,.7 " Phone #: (p67,
The proposed/existing park will provide Park Units for the location of jZ,
Annual Fee: $5.00 per Park Unit Total Amount Due: $
(Note: The Minimum fee charged is $25.00 per year)
mobile homes.
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 location of streets, and fire hydrants.
Dated: // , 20 ,25 .
(Applicant)
For Office Use:
Amount Received $ Cash Check 9
Date Paid: Received By:
(9/201 s)
Certificate ®f AtIreal,a°uon Of Exemption
c�__Ni;_ from New `fork Strafe Workers' Compensation and/or
Disability and Paid Family Leave Benefits Insurance Coverage
"This form cannot be used to waive the workers' conapens(ataon rights or obligations of any paarty. **
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):
Bret Peek
22 Kraft Ave
Albany, NY 12205-5420
PHONE: 518-365-0817 F EIN: 7tXXXX5651
Workers' Comnernsation Exemption Statement:
Business Applying For:
Health Permit or License
From: NYS Dept of Health
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 owned by one individual and is not a corporation. Other than the owner, there are no employees, day labor, leased
employees, borrowed employees, part-time employees, unpaid volunteers (including family members) or subcontractors.
Disability and Paid Family Leave Benefits Exemption Statement:
The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY
DISABILITY AND PAID FAMILY LE"E BENEFITS INSURANCE COVERAGE for the following reason:
The business MUST be either: 1) 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, Bret Peek, am the Sole Proprietor 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 furnish proof of that coverage on forms approved
by the Chair of the Workers' Compensation Board to the government entity listed above.
SIGN I Signsrtur : Date:
-HE RE
E1 cinpflon Cer lflcnte Number
2 3 R131-07Gr30
C�`��dmarf 21v% 20/223
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CE-200 01/2018