WTC debris clean-up application form, June 2002

NYC 9/11 Public Portal Document

THE CITY OF NEW YORK LANDMARKS PRESERVATION COMMISSION PtoM.I,p I CENTRE STREET, 9TH FLOOR, NEW YORK, NEW YORK, 10007 .r ern TEL: (212) 669- 7700 FAX: (212) 669-7960

APPLICATION FORM FOR WORK ON DESIGNATED PROPERTIES F-2 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 number below. Please print or type all items. If not applicable, mark N.A.

Stall

C DOCKET f DATE REC9 DATE CERT. AS COMPLETE BLDG. DEPT. • & DATE STAFF

0 INDIVIDUAL 0 SCENIC ❑ INTERIOR .YPE OF DESITENATTON HISTORIC DISTRICT

PMW 0 CNE 0 C OF A ❑ REPORT TION OTHER WORK TYPE

3 Nassau ADDRESS FLOOR OR APARTMENT Exterior DESIGNATED PROPERTY Manhattan (OJ T L2- 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 (II oppicable) PHONE ldayl CO-OP SHAREHOLDER ADDRESS APT N CRY, STATE. ZIP CODE NIA ARCHITECT/ NAME. TITLE & FIRM If applicable) PHONE loos) ENGINEER If applicable ADDRESS CITY, STATE. ZIP CODE

Benjamin Kurzban and Son Control, Inc. (718) 531-2900 CONTRACTOR NAME. TITLE & FIRM (B opWcoble) PHONE (day) If applicable 1248 Ralph Avenue Brooklyn, New York 11236 ADDRESS CITY, STATE. ZIP CODE

PERSON FILING _NYC Department of Environmental Protection (718) 595-3718 APPLICATION NAME TITLE & FIRM (a oaahcoblel PHONE (day) e.g. Expedlto. Attorney. Maroging Agent etc. 59-17 Junction Boulevard, 8th Floor Corona. NPw Ynrk 11368 ADDRESS CITY, STATE. ZIP ODE

ARE YOU APPLYING TO ANY OF THE FOLLOWING? 0 Buildings Department 0 City Planning Commission 0 Board of Standards & Appeals

I am the owner of the above listed property. lam 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 for work on or Inc cooperative or condominium building, u f l rd1, R OWNERS NAME and TITLE (please type or pd01 +ld Co PHONE (clay) the 'owner Is the Co-op Board or Condominium Association. An officer of the Co-op Board or Condominium COMPANY TION. ORGAM Association must sign this appl cation. Please consult the Instructions for Filing euJ ~11 ` X6.38 for additional Information. ADDITES

TYC DEP / X602 SIGNATURE Note: Section 25-317 of the Administrative Code of the City of New York makes d a punishable offense to willfully make false statements on this application. Tres oroo

NYC-WTC 000093917