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Home My WebLink About096.09-04-10.000 04/2021O&Oo al l r �osT�ay p di \`Nf yOtS' 1ia�.r:/ih -82= TOWN OF CORTLANDVILLE 3577 Terrace Road, Cortland NY 13045 607-756-7490 BUILDING PERMIT APPLICATION Fee Paid;$tiq .or) Permit No. & 1 goy Application Date: 0-1 J0m1Qo00 Tax Map No.c%(o.0A!-U'-/-J0, nno Name of Property Owner:Co r +VirJ 1.4+ iNkl��Ft honeq:(q(S7 7Sf�-U97Ss Mailing Address& Email Address:1CQ4 Statc 9-+ 13 Gor+to.nd,Ny 13nu Sarrabek�imdrvrl2prno„�.c�w,l Application is Hereby Made to (construct, add, modify, etc.) %falr GIUVvr /G(P mciliS h at (address 1"11b 1-110, \ 1>viyc (oxtlGr�cl.hl�i 130� IS Number of Family Units 'A- Basement? N n Area (SF) q?)O First Floor Area (SF! q4)O Second Floor Area (SF) C Total Area above Second Floor (SF) n Size of Buildins (4 -A —1 n 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: l P11n[i\I F-P"� 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 Cortiandville, New York. Certificate of Occupancy is required upon occupying the premises. The undersigned grants the Town Building Inspector permission to enter upon the premises at all reasonable tim a purpose of vrtaking nece ry inspections. Inspections require 24- hour notice by the applican . � er it Approve _ 2S 2®2!` l APP Signature of Applicant Permit Disapproved Yi ✓� C 'atureG2�ector Date: /� / t 1� 4 dam' )2 76 Mi Signature of Cortlandville Town Clerk TOWN OF CORTLANDVILLE r 607-756-7490 Building Permit # D21-04 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 old sinale wide at CMHP at lot 178 Penauin 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: 05/03/2022 4- �.,4 W `-r Issuing Officer: Desiree Campbell/ Kevin McMahon o`oATUNo��.� TOWN OF CORTLANDVILLE WYO607-756-7490 yEQ. 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 # D21-04 Type of Permit: Demolition Issued on: 05/03/2021 Completed on: 05/21/2021 Description of work: demo and removal of old single wide at CMHP at lot 178 Penguin Drive by owner By Order of Ktt C ""V� NYS Code Enforcement Officers: Desiree Campbell & Kevin McMahon 7/24/2020 INS 1 TNT.png HISCOX HISCOX INSURANCE COMPANY INC. (A Stock Company) 104 Sout i Michigan Avenue, Swta WO, Chicago. Ilhnos GW3 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 Poliopy. Policy No UDC44114026-CGL-20 I Named Insured. I Yravns Towers Address j 747 State Route 41 Homer. NY 13077 Policy period. Form of Business. Each Occunence Limit: From. I May 12. 2020 I To I May Q. 2021 At 12,01 A M (Standard Time) at the address shown shove. Damage to Premrsas Rented to You Limit. Medical Expense Limit. Personal & Advemsing Inryry Lint. General Aggregate Limit ProlucS'Compieted Operations Aggregate Llrnit Supplemental Business Personal Property Floater I so Coverage Limit. Supplemental Busnness Personal Property Fioste* j Not Applicable Coverage DeducbWe: All Premises You Own, Rent or Occupy Premises Number: i 11 Address: State Route 41 1743 Homer, NY 13077 Total Premium: I $ Spode Attachments: I See attached Fors and Endorsements Schedule. CGL D001 01 10 InnAsdes copyrighted materiel of Insurance Services Office. Inc w.m :ts perm,swom ® ISO Properties, tm , 2000 Pape i https:/lmail.google.comlmaiVWOI?tab=nn&ogbl#inboxlQgrcJHsbdJgpgdhMZPCPtGpBrJ WwGXsIQPL?projector--i &messagePartld=0.2 ill 7/24/2020 INS 2 TNT.png A,, H ISCOX HISCOX INSURANCE COMPANY INC. (A Stock Company) encourage courage- 104 South WNW Avenue, Suite 600, Chicago, IWinon 60603 .aw WWI by vnEaEcv.euy e... wmr tw oev..tia..e evs ws�ym O�spwa erww..e.v..a s.o.,«r.we. �.rwe �«e. afxu.. .� r®+aw er vwrnn � nrve.ruer. 3 Wat-- PreWent Secretary Authorized Representative COL 0001 01 to Indudes Copyrighted n BWW of tnwxenca Services Off". Ins.. with se pwrtestrion. O ISO Propsrlee. Inc.. 2000 Page 2 https://mail.google.com/maiVu/0/?tab=rm&ogbURnbox/OgrcJHsbdJgpgdhMZPCPIGpBrJ WwGXSIOPL?projector-1 &messagePartld=0.1 1/1 7/24/2020 W9 TNT.png Form W-9 Request for Taxpayer 'II-- - pMsr2plgj Identiflcatlon Number and Certificatlon te�eaN�iRvvdiw�sarr ww M. 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Do not sand to the IRS. a Fxempbk (Coda apply wily to stun aa11w, raj tdn44sb: sot YrmKpvr an page 3k 6ampt RTlaemdfWael Eumpton ham fATCA rcpa W Cade P anA l OtwtxthwWoor4w pvtrmwm.m.+e..f.e•ar.,ra1 a Am Vxteow,sate% and apt. M ewer not) Soo eulnncLICIM Regi ses rmrw and Adam sdaMa(opowall 0 cite, slotssn02ar coda T tut aciarxanxtiea(q twAffpaaaa9 Ili� Taxpayer Identification Number (TIN) Enter yaw TIN in the appropriate bon The TN provided most match the name given on Lew 1 to avoid I Isoew secuiM rxan,ofr backup withhd&g. For individuals. this is generally your social seanry munbor (SSM. Hmvever, for a p resident arwn, safe proprietor, or Assregardod entity, ses the Instructions for Pan I, later. For other 3 - 7 ontifies, ItIsVow ernpleyor Identification mamba(EIM. If you do not hover o numbw, cab Now to got a 71N, late. or Nolw.It Ow account Is In more than ono name, coo the Instructions for fire, 1. Abe see VRW Name end I Errrobmr kkrdmcaum,-wz- Mmrior To Gale IMr Regums(er far guidelirm on whose Manbor to enter. T -I I Cert)fleatlon I I I Under penaabs of papfy. I certy that: . 1. The numberrham on this form Is my comet taxpayer Identigeatlmt number (or I ern we" for a number to be issued to mar end 2.1 wn net subject to backup wnhhof ft becmaw: (a) I am exempt from backup vdWxkkV , or (b) I havo rat been nettled by the Internal Revenue Smvico VFIS) that I am subject to bacup withlec g as a result of n fahme to report all Interest ordivlderds, or (c) the IRS has ratified no that I ern no longer sub{actto backup withhok fi ng; o nd 3.1 Can a U.S. citizen or other U.B. person (defined belowr and 4. The FATCA cod*) entered on Nis form (J wh Indcabg drt I nm exempt from FATCA reporting Is cored Certification Insbuctlons. Yw Cana cross ow item 2 above 0 you have been notated by the IIiS that you m afrenty subject to backup wigVddeg be®ao ym have faded to report at interest and drrdoWs on yow tax reem For rest estate transactors, am 2 does net apply. For mortgage Interest paid. acgvsxbn ornWMoranmt of saarod prepnty, uanuCitbn of debt. contrOwDons to M kKkYk%al ret4anmri wrmgmnmt Ow old generally. payments OR=titan Interest and drndeends, yw ue not reputed to sign the cemfratlan, but you man provide yvweoreetT01. See tM tsincTlors (err Pad a, later. Sign tLprNed Hera U.S. paean►(�,�.,y,��Cj')/j>/ General Instructions Section references ors to the Internal Revenue Coda Unless othawiw noted. Future developments. Far the latent Information abort dmdopm" rotated to Form Wand Its Instructions, Mch as legclation masted after they were published. go to www.4sgov/Fortn)59. Purpose of Form An Individual or mtdy (Form W-9 rerimtor) who Is mupued to No an information retwn with the IRS amt obtaki yow carnet taxpayer kimtificabon comber (TIN) which may be yof social secvity mm%or (".Sly), hdrvidual tapayer Identification nlxrber MM. adoption taxpayerkianb5catiorn reamer (A11M. or employer Identification mwnbo (EIN), to report on on Information retum the wmnmt paid to you. or other amount espoortable on an Infarnation return. Exwnpies of Wormation rotwm indudo, but oe not On i to, the foCow4V. • Fenn 1099-INT (stores) earned or pokQ Cat Not 1g2T1x one► MOL, 1a, aDa.D • Form 1099-M (dividends. Y ckxT V those from stocks or mutual hmft) • Forth 1099-MISC (vadas types of trams. prbss. awards. or grass • Form 1099-B (stock or mutual ford sales and certain ohm lrusaetions by brokers) • Form 1091(fv (proceads from real estate trarsactfars) • Fern 109M (merchant card and third party network transactions) • Form 1090 (Iwme mortgagn interest).1098-E (slWmt lam idamt). 1098-T (0ition) • Form 1099-C (canceled debt) • Form 1039-A (acquistion or noaneloment o1 sepeed property) Use Form W-0 a* if you are a US. person (including a resident don). to provide yaw correct TIN. tl yea do not mhun Form W-9 to lire mquaster Wth a TIN, youmiph! be subject to backup wt B. Sea %Vhat b backup wiftft g. Isfor. rum W-9 gift. I62e19) https://mai).goog)e.com/maiVu/0/?tab=rm&ogbl#inbox/QgrcJ HsbdJgpgdhMZPCPtGpBrJ WwGXsIQPL?projector-1 &messagePartld=0.3 111