Asbestos inspection report application, 59 [name] Manhattan, undated

NYC 9/11 Public Portal Document

Page 1 of NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION FOR OFFICE PURPOSE ONLY ASBESTOS INSPECTION REPORT Tfiq r g AW. ONLY TYPEWRITTEN I t`OTE:ASBESTOS INSPECTION REPORT SHALL BE SUBMITTED APPLlCATIOI(WJLL „ BEACCEPTED • TO NYC DEP NOT LESS THAN ONE WEEK IN ADVANCE OF 1. START OF THE WORK (ABATEMENT ACTIVITIES) ISEE ITEM 27)

1. FACILITY' ' ZIP 2. ADDRESS 59 Maiden Lane BORO Manhattan CODE 16(148

AKA n/a 3. BLOCK Fi 7 4. LOT # 1

5. 'TYPE OF FACILITY office bldg NAME OF BUILDING 59 Maiden I ane Acc I P 6. APPROXIMATE AGE OF BUILDING 40 YEARS OLD

7. DESCRIPTION OF PROPOSED WORK (e.g. Removing and replacing Old Boller, DemollshIng Building, Replacing Plumbing In Bul ding, Installing Fire Sprinklers, Major Alterations, ACM Removal only)

II. BUILDING OWNER B. NAME 59 Maiden Lane Ass.L.P 9FORTHISPROJECOT Anne Holker

10. TEL. # ( 212 ) 619-6930 FAX# ( 212 ) 619-6933

11. ADDRESS 250 Broadway suit 3001 CITY NY STATE NY ZIP 10007

III. GENERAL CONTRACTOR 12. NAME Grisdale Ball Inc. TEL.#( 718 ) 609-1400

IV. ASBESTOS ABATEMENT CONTRACTOR 14. CONTACT PERSON 13. NAME Grisdale Ball Inc. FOR THIS PROJECT Stanislaw Fic

15. FEDERAL EMPLOYER IDENTIFICATION # 16. TEL. # 718 1 609-1400 FAX# ( 718 ) 609-1500 17.ADDRESS40-29 27th street CITY Long Island City STATE NY ZIP 11101

V. THIRD PARTY AIR MONITOR 18.NAME Glomar Corp. 19. TEL.# ( 914 ) 345-1170

20.ADDRESS 35 East Main street CITY Elmsford STATE NY ZIP 10523

VI_ LABORATORY FOR SAMPLE ANALYSIS 21. NAME Scientific Lab.Inc 22. NYSDOHELAP# 11480

VII-ASBESTOS PORTION OF PREMISES BEING ABATED/ALTERED/DEMOLISHED 9's ASRFSTr1S r`nVrAr-n STRIICTI1RFfSt BEING WORKED ON ceiling (Boiler, Ceilings, Pipes, Storage Tanks, Plenum Ducts, Decking, Ceiling Tiles, etc.)

24.STARTING DATE FOR THIS PORTION OF WORK 01 /10 / 02 PROJECTED COMPLETION DATE 02 /15 /Ji2._

ASBESTOS WORK SCHEDULE ❑ DAY 0 EVENING ❑ NIGHT ❑x WEEKENDS ® WEEKDAYS (eam.spm) (5pm-12am) (12am-eam)

25. TOTAL AMOUNT OF ASBESTOS CONTAINING MATERIAL (ACM) WHICH IS FRIABLE, OR MAY BECOME FRIABLE DURING ABATEMENT /ALTERATION/DEMOLITION (ESTIMATED) 15 ,750 SQUARE FEET, AND/OR LINEAR FEET ON PIPE

26. ASBESTOS HAULER NYS DEC 1A-371 ATC PERMIT # TEL. # ( 631 ) 924-5050 COMPANY NAME DISPOSALSITE(S) Meadowfill Landfill Route #2 box 68

% \ i ii i 27. FILING FEE SCHEDULE ' ' )?7; FOR PROJECT DISTURBING: ~\; EII ING FEE IS 1000 Linear Feet or more or 1000 Square Feet or more of friable ACM ...........................!.i 1 ....... $1200 At least 260 Linear Feet and less than 1000 Linear Feet or ! • / rrL~ At least 160 Square Feet and less than 1000 Square Feet of friable ACM ......................:.....:...........:............:: :1.....:;.:-.. ........... $800 At least 100 Linear Feet and less than 260 Linear Feet or I ' r 1 `~ I J . 1 At least 50 Square Feet and less than 160 Square Feet of friable ACM ..........................ti....~1.......J....; ,:,: ..;.,,.;...,..... . / '.:•.,J...........$400 More than 25 Linear Feet and less than 100 Linear Feet or Cam,-, • More than 10 Square Feet and less than 50 Square Feet of friable ACM ......-'.. i..............$200 Circle appropriate Filing Fee and write it In Item 1. Complete this report and submit it to: \/ ~~; ' j \~` A) The NYC Buildings Department with application for permit and filing fee. Check should be made'pa~ab'e tol Nl C pepartment of Buildings. It no Dept. of Buildings permit is required complete this report and submit to: B) The NYC DEP Asbestos Control Program with filing fee. Check should be made payable to NYC Department of Environmental Protection. ----------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------- Type of Facility - Hospital, Theater, Warehouse, Commercial Office Spaces. Apartment Building, etc. ACM - Asbestos Containing Material means Material Containing Greater Than 1% Asbestos Form Handling Do not detach any sheets. Insert carbon paper between the 4 pages and complete this aide, told this sheet and the tab FORM ACP 7 over the perforation so that all original entries are made on the white page. Reverse the carbon paper appropriately. 2194

ACPFPt' tOl'! NYC-WTC 000093141