NYC 9/11 Public Portal Document
' l
THE CITY OF NEW YORK LANDMARKS PRESERVATION COMMISSION'
O I CENTRE STREET,9TH FLOOR,NEW YORK,NEW YORK,10007 ;f' ,.
TEL: (212)669-7700 FAX:(212)669-7960
APPLICATION FORM
FOR WORK ON DESIGNATED PROPERTIES
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This application will not be deemed complete until it is so certified by the Landmarks
Preservation Commission. An application consists of an application form and the materials
necessary to describe the project fully. If being submitted in response to a Warning Letter or
Notice of Violation, please enterthe numberbelow.
Please print or type all items. If not applicable, mark N.A.
DOCKET i DATE RECD DATE CERT. AS COMPLETE BLDG. DEPT. ♦ & DATE STAFF
0 INDIVIDUAL 0 SCENIC 0 INTERIOR
fFE OF DESiGNAItON HISTORIC DISTRICT
PMW 0 CNE 0 C OF A 0 REPORT
ACTION OTHER WORK TYPE
Exterior
ADDRESS FLOOR OR APARTMENT
DESIGNATED
PROPERTY Manhattan
BOROUGH BLOCK LOT ZONING
DETAILED
DESCRIPTION Removal of debris (cleaning) from the collapse of the WTC
OF PROPOSED WORK from exterior building surfaces as per scope of work
Use back of form if necessary
previously reviewed and approved by NYCLPC.
COST OF PROJECT WARNING LETTER / NOV #
NIA
TENANT/LESSEE/ NAME. TITLE & FIRM (If opOlcoble) PHONE (day)
CO-OP SHAREHOLDER
ADDRESS APT # CITY, STATE. ZIP CODE
NIA
ARCHITECT/ NAME, TITLE & FIRM (If applicable) PHONE (do)
ENGINEER
If applicable
ADDRESS CITY, STATE. ZIP CODE
Benjamin Kurzban and Son Control, Inc. (718) 531-2900
CONTRACTOR NAME, TITLE & FIRM (If opplicoble) PHONE (day)
If applicable 1248 Ralph Avenue Brooklyn, New York 11236
ADDRESS CIIV, STATE, ZIP CODE
PERSON FILING NYC Department of Environmental Protection (718) 595-3718
APPLICATION NAME. TITLE & FIRM (if coolicable) PHONE (day)
e.g. Expeditor. Attorney.
ManagIng Agent, etc. 59-17 Junction Boulevard, 8th Fi or C rnna. New York 11368
ADDRESS ZIP
CITY STATE. ODE
ARE YOU APPLYING TO ANY OF THE FOLLOWING?
❑ Buildings Department ❑ City Planning Commission El Board of Standards & Appeals
I am the owner of the above listed property. I am familiar with the work proposed to be carried out on
my property and give my permission for this application to be filed. The information entered is correct
and complete, to the best of my knowledge.
OWNER
For applications br work on or In a
cooperative or condominium building, OWNER'S NAME and TITLE (please type or print) PHONE (day)
the 'owner' is the Co-op Board or
Condominium Association. An officer of
the Co-op Board or Condominium COMPANY: CORPORATION, ORGANIZATION (it appliicable)
Association must sign this application.
Please consult the Instructions for Filing
for additional Information. ADDRESS CITY. STATE. ZIP CODE
NYC DEP for owner
SIGNATURE SIGNATURE OF OWNER - - -- ---- - - ---- - - - DATE - - - - -
Note: Section 25.317 of the Administrative Code of the City of New York makes it a punishable offense to willfully make false statements on this application.
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NYC-WTC 000093887
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