WTC debris clean-up application form, June 2002

NYC 9/11 Public Portal Document

THE CITY OF NEW YORK LANDMARKS PRESERVATION COMMISSION 1 CENTRE STREET, 9TH FLOOR, NEW YORK, NEW YORK, 10007 ►~ ~m 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 enter the number below. Please print or type all items. If not applicable, mark N.A.

stair use OntJ

PC DOCKET # DATE RECD DATE CERT. AS COMPLETE BLDG. DEPT. C & DATE STAFF

❑ INDMDUAL 0 SCENIC 0 INTERIOR .YPE OF DE5KNA1ION HISTORIC DISTRICT

PMW ❑ CNE O C OF A 0 REPORT ACTION OTHER WORK TWE

DESIGNATED ADDRESS 3 Nassau APARTMENT Exterior CP1lF) PROPERTY Manhattan (o5 BOROUGH BLOCK LOT ZONING DETAILED DESCRIPTION Removal of debris (cleaning) 5 from the collapse of the WTC OFPROPOSED WORK from exterior building surfaces as per scope of work Use back of form it necessary previously reviewed and approved by NYCLPC.

COST OF PROJECT WARNING LETTER / NOV # NIA TENANT/LESSEE/ NAME. TITLE & FULM (if opp)Cable) PHONE (day) CO-OP SHAREHOLDER ADDRESS APT C CI Y, STATE, ZIP CODE

NIA ARCHITECT/ NAME, TITLE & FIRM (if applicable) PHONE(dol ENGINEER If applicable ADDRESS CITY. STATE, ZIP CODE

Benjamin Kurzban and Son Control, Inc. (718) 531-2900 CONTRACTOR NAME. TITLE & FIRM (If applicable) 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 fit applicable) PHONE (day) e.g. EKpeditor,Affa c. Managing Agent, etc. 59-17 Junction Boulevard, 8th Floor Corona NPw York 11368 ADDRESS CITY, surf, ZIP . ODE

ARE YOU APPLYING TO ANY OF THE FOLLOWING? O Buildings Department ❑ City Planning Commission ❑ 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 thebest OWNER ' tT ofm~y~ knoowledge.~ (~ For applications for work on or in a LA I I' r I R h R -W -( 1 V (1 o cooperathe or condominium building, OWNERS NAME and TITLE (please )VP0 or pra;f PHONE (day) the 'owner is the Co-op Board or Condominium Association. An of icer of the Co-op Board or Condominium COMPANY C TLION . (If applicable)( AssodftonmustI s n Lr I/_ Pb conaulT the ngstruction ffor FFilig e IO CK'C /~tr e (l Q v V for additional Information. ADDIT CIT'l STATE ~/~ NYC DEP i for owner 1'7'5'7O SIGNATURE UREOFOwNB 1ATE

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. Per TIFF

NYC-WTC 000093928