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Home My WebLink About096.09-04-10.000 03/2021b3�aaai�! �zo ; \{ r ,-'i TOWN OF CORTLANDVILLE 3577 Terrace Road, Cortland NY 13045 607-756-7490 BUILDING PERMIT APPLICATION 1� Fee Paid:.lpp ;(P. OD Permit No. M03 Application Date: ) QCQC) Tax Map No.01lo- 09 - OW -10. 000 Name of Property Owner: Cprtland I, statts Mal kjW Phone #: (00-1- "f54'�- K%78 re Mailing Address& Email Address:! stair 12+R ror+fir d.nrr 1304< c�rrrnbi�ikdmc4evel�7�xnk cows Application is Hereby Made to (construct, add, modify, etc.) -Ff o-r t-an wn ! AeyyNoV%Sh Number of Family Units :I - First Floor Area (SF1 -7an at (address) IS9 PCnrlh orwe Cnrklar�d.NY 12,045 Basement? NIn Second Floor Area (SF1 n Area (SF) -1DO Total Area above Second Floor (SF) n Size of Building ) a xlo0 Size of Lot Setbacks: Front Rear Left Side Right Side Sewage Disposal Water Supply Type of Heat Date of Health Department Approval Builder's Name: / avJ/jZk Phone Number: Estimated Cost: OCC Class: Submit drawings showing the location of the building on the lot in relation to the property lines. A set of Building Plans detailing: the foundation, framing, grade and species of lumber, Energy Code Compliance, sheathing, interior walls, stairs, windows and other information that may be necessary to determine compliance with the N.Y.S. Building Codes. All Statements contained herein are true and the work will be performed in the manner set forth in this application in accordance with all codes of the State of New York and all laws, ordinances, codes and regulations of the Town of Cortlandville, New York. Certificate of Occupancy is required upon occupying the premises. The undersigne the Town Building Inspector permission to enter upon the premises at all reasonabl times for th urpose of making necessary inspections. Inspections require 24- hour notice by tlAapplicat. 7h0 P iit Approved V' 0 APR 28 2121 j Signature of Applicant ' Rho �ni 7� Permit Disapproved', ��!- S gnature of Inspector Date: °�� `$3^t0'�OD i6�0na' Signature of Cortlandville Town Clerk TOWN OF CORTLANDVILLE .VFW YOQ+ 607-756-7490 Building Permit # D21-03 Date Issued:5/3/2021 This notice, which must be prominently displayed on the property or premises to which it pertains, indicates that a BUILDING PERMIT Has been issued to: Cortland Estates MHP Permitting: demo and removal of single wide trailer at CMHP lot 159 Penouin Drive by owner At: 1054 Route 13 All work shall be executed in strict compliance with the permit application, approved plans, the NYS Uniform Fire Prevention and Building Code, and all other laws, rules and regulations, which apply. The building permit does not constitute authority to build in violation of any federal, state or local law or other rule or regulation. Special Notes (if anv) : Do not proceed beyond these points until countersigned below by the inspector. Footing before pouring concrete Framing before closina Plumbing before enclosina Insulation inspection Footing before backfill Electrical before enclosing(BY OTHERS) HVAC before enclosina Final lnspection X Permission is hereby granted to proceed with the work as set forth in the specifications, plans, or statements now on file in this department. Any amendments made to the original plans or specifications must be submitted for approval. Permit Expires:0510312022 j/ , /--j_ ,A Issuing Officer: Desiree Campbell/ Kevin McMahon Z TOWN OF CORTLANDVILLE 3 •- ti r pEIV y°Q� 607-756-7490 CERTIFICATE OF COMPLIANCE Having complied with the provisions of the Local Laws of the Town of Cortlandville and the NYS Fire Prevention and Building Codes as per application type: Demolition, The below named permit holder is hereby granted this Certificate of Compliance. Cortland Estates MHP 1054 State Route 13 Cortland, NY 13045 96.09-04-10.000 Building Permit # D21-03 Type of Permit: Demolition Issued on: 05/03/2021 Completed on: 05/21/2021 Description of work: demo and removal of single wide trailer at CMHP lot 159 Penguin Drive by owner By Order of 14 NYS Code Enforcement Officers: Desiree Campbell & Kevin McMahon 7/2412020 INS 1 TNT.png e bdI-03 HISCOX HISCOX INSURANCE COMPANY INC. (A Stock Company) 0t1C4cry�lfs Ccof age 104 South Michigan Avenue, Suite 600. Chicago, li6noa 60603 Commercial General Liability Declarations In return for the payment of the premium, and subject to all the terms of this Policy, we agree with you to provide the Insurance as stated In this Poll r Pokey No ruDC-4484026-CGL-20 Named Insured Trans Towers Address. f 743 State Route 41 Honer, NY 13077 j i Pokey penal. From (.-M_a I To. ay 12 2020 �— _ May 12, 2021 At 12 01 A M (Standard Time) at the address shown above Form of Business: I IndividuallSde Proprietor Each Occurrence Limit $300.p00 Damage to Premises Rented to You Limit $100,000 Any one Premises Medical Expense Limit. I $5,000 Any one person Personal & Advertising Injury Limit. 1 $300,OW Any ono person or otganizabon General Aggregate Limit 15300.000 ProducWCompleted Operations s300,000 Aggregate Limit' Supplemantal Bushiest Personal Property Floater s0 1 Coverage Limit. 1 Supplemental Business Personal Property Floater Not Applicable Coverage Deductible All Premises You Own, Rent or Occupy Premises Number i Address: State Route 41 1743 Homer. NY 13077 Total Premium: S 500.00 Attachments: f See aascned Forms and Endorsements Schedulo. CGL 000101 10 Includes OopyflplMW aralefisl of Insurance Services Office, Inc, with Page 1 fts pam twin . OISO Propertws. Inc., 2WO https:llmail.google.wrrVmaiVuIOI?tab=rm&ogbWRnboxIOgrcJHsbdJgpgdhMZPCPtGpBrJ WwGXsIQ PL?projector- I &messagePartld=0.2 111 7/2412020 W9 TNT.png 1 - _�• Tenn W-9 Request for Taxpayer Give For, to the Identification Number and Certification I requester. Do not MAN eeuwr5eni ► Go to i wevJrs.gcv/FormWD for hstructlmn and the latest Information. send to the IRS. e Nrro(aa dnwrnm yararenr toxralurn}rtannals reoesdanotia Wsdo rnM ��eor rr OLawa ' a ur�rorw�egaoea«auyamro.awra.rveom.r,�,�e ., 3Chock appropriate box lor ledendW tlessibotxn of the porson stall• hane, is entered on the 1. CMUt only cow of the 4 Eumetbn(ceee9 a" only to l}bl fomn9 sNmi ten wta'n vmsaa. not trxfnYka"csse bsmoctbnsonpapo7): dird./dausobpronmeww ❑ ccap—hen ❑scrponw. ❑ pre—hNp ❑Trulel '- .pip{ ^sing5l.rDember ULC Eannpl payee coda V am) C� ❑ UmgsdMbMycwo=V Fidrtnst da=J!kaaonic•Cwrpva•brls.S drt.P..ParNm )► u dots: Ctxxk Cie approprta tax IntM Ye eboro for ono ua ctrsdrXim alhsaYign►rrArMaewrar. Donddrdt Exempicnfrom FATCAroporrsrg !!Case lLCk clas;aed aaas9p'e-narrater U.Caut htWngartlM fmomdr owrnaurtlass ne ornmra ve LlGh Vaft') anDav 11D art b rot Qsagvded fen ere owrr tar U.S. fsdaal tapurpatsc Oairwbe, o abglamanbaLLC itut c hthpegadBd born ere m•rer dqutl crrckar aepropriate box /car taaarxQratbnawowrbr. Wrrtsa lmLrttiKKrt► ninweawsnu.ussaer.rid n eAtlbcrs l.armv. Wa03,rM ^epl.a BufOne)SM Yrbuatbm. Ifieque:a's martr rd adbea(opMrnQ a city, sure, awdEp 6k;4 IUslSaccowe stafibir(�rovelopha l) Rif 'l xigjji Taxpayer Identification Number (TIN) Enter your TIN In the appropriate box. The TIN provided aunt match the name given on rag 1 to avoid I WCnt security nanbor I backup witldwtding. For Irdvlduaks, this la generally your social seetmty number (SSM. However, for a resident alien, safe proprietor. or disregarded an*, sea the Instructions for Pan 1. Loder. For other 3 - '� amhlas, it is your employer Identification number (EIM. a you do not have a nurnber, see How to got a 71M Later. or Nets If the account is in more than ono name, sod the 4c Wctlons for the 1. Also sod Whet Hama and I Employer rwmbw Number To Give the Requester for guidelines on vdese number to enter. M -I Certification I I I Under penalties of pepuy. I eauly that 1. The marraer shown on this forth Is my correct tnrpayor identification amber (a I ann waiting for a number to be issued to me; and 7.1 ann not subject to backup whMwMug because (a) I ern exempt from backup wiNbokfi g, or (b) I have not been notified by the internal Re om o Servica ORS) that I err subject to backup wiestdd"i g as a result of a takes to repot all interest or Qrviderds, or (c) the IRS ism notified me that I om no longer subject to backup wd7MoIQN9: and 0. t em o U.S, citizen or other U.S. person (derided below}, and 4,7Iwn FATCA code(c) Wised an this form (it any) Indicating that I am exempt from FATCA reporting Is correct CaNfkatlon Instructions. You mat cross out Item 2 above if you have been rutlfed by the IRS that you era Currently subject to boclap Witeeldng because you have faded to report al interest and dividends an yap tax return For real estate oansactbns, hem 2 does not apply. For mortgage Interest paid, aepdsllon a aDordasrrat of secured propory, cancellation of debt, mmnbudas to an individual reeremae arrangement ORA), and generally. payments othathn Interest oaf caidends, you we net required to sign the cerblicatbut. but you mat provide your correct Tel. See the Instructions for Pan 0, Laim sign s U-%p1prmee, } Hero r c /% 'i�✓1/ �Gl/1'/lirl/ General instructions Section references are to One Internal Revere Coda uJese otherwise Wed. Futuro dovelWinonts. For the latest Information obout devclopmems related to Form W-9 and its Mabuctiom such m leghlaten reacted afterthey case published. go to www.Is9ov1FamYl9. Purpose of Form An inUivdual or artily (Film W9 rquester) who Is required to Me an I formation return well the IRS mat obtain year correct taxpayer identification number (DM which may be your social security number (SSM. Individual taxpayer klentlfcatian number MM. adoption taxpoyaidemtifeaam number (A7)M. oror~ identification number (EIM. to mpon an on Information return the emount pail to your is after amount reportable on an information return. Examplas of linformatlon returns Include, but are not United to, the folowbng. • Forth 1099•INT (rdarest earned or paid) Cat He. I0231x Data► May Jar, a.DaD • Forth 1099-DN (dwiderds, Including thoso from stocks or mutual funds) • Form I D99•MISC (vodo :s typos of Income, prizes, awards, or grass procods) • Farm 1099-B (stock a mutual fund sa)ea and certain other tronsnctiens by brokers) • Form 1099-S (procood9 from teal assets s transactions) • Form 1099-K (machant cod aid third party network transactions) • Form 1098 (home mortgage Interest).1098-E (student foo n Inmaq. 1098-T MXtlon) • Forth 1099-C (Canceled debt) •Forth 1099-A(acquIsainor abandonment atsaumot proper) Use Form W-9 only if you one a US. person (Inclu" a resides alai), to provide your correct TIN. II you do not return Form W9 to the requester with a TIN, you mtgtt be sabloct to backup wllMokl4ng. Soo ymm is backup witMoldang, War, cam W-9 (err,. IM12016) httpsdlmail.google.cam/maillu/0/?tab=rm&ogbl#inboxIOgrcJHsbdJgpgdhMZPCPLGpBrJWwGXsIQPL?projector-1 &messagePartld=0.3 1/1 7/24/2020 INS 2 TNT.png Al HISCOX HISCOX INSURANCE COMPANY INC. (A Stock Company) encourage courage" 104 south Michigan Avenue. Suite 600. Chw.Wo, Isinola 60603 M WI W by WNEPEgF.M'y Irsr,rxNulw aev.+Ma,..a nr Poi yYrow �v»EM�. arwarx ew 5«nwry wrw voecr .fur nm a. ee arv«�s+e�s «m ripnM ms MeuM� �.w� r OW President CGL 1500101 10 Includes copynghted m tenal of I�arce Services Qtpoa, Inc., with 4S pemass*n ® ISO Properties, Inc., 2000 Page 2 https://mail.google.com/maillu/0l?tab=rm&ogbl#inbox/QgrcJHsbdJgpgdhMZPCPIGpBrJ WwGXsIQPL?projector=l &messagePartld=0.1 111