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 ►~ n 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.

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

o INDMDUAL 13 SCENIC 0 INTERIOR WE OF DESlblNA1ION HISTORIC DISTRICT

PMW ❑ CNE 0 C OF A El REPORT ACTION OTHER WORK TYPE

(o3 Ng550.0 VLef Exterior (RI F) ADDRESS FLOOR OR APARTMENT DESIGNATED PROPERTY Manhattan (5 BOROUGH BLOCK LOT ZONING DETAILED Removal of debris (cleaning) 9 from the collapse of the WTC OFPROPOSEDWORK 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 & FIRM (If applicable) 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 applicable) PHONE (clay) 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 (it applcablel PHONE (days e.g. EKpedifoi,Aftomey Manog ng Agent, 59-17 Junction Boulevard, 8th Floor Corona NPw York 11368 etc. ADDRESS CITY, STATE, ZIP . ODE

ARE YOU APPLYING TO ANY OF THE FOLLOWING? ❑ 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 the best of my knowledge. OWNER l (~ For applications for work on or In a L/L I I ~ a h R ( cooperative or condominium building, OWNERS NAME and TITLE (please)ype or print PHONE (dot) the 'owner is the Co-op Board or Condominium Association. An ofilcer of the Coop Board or Condominium COMPANY. C TION. ON (N apppcable) ~t / /~ Please consul theingstructions for Filing J.h n fITI~_ /r _ V Q v V for add9bnal information. ADOITE Cif'f ETA

NYC DEP /t t11ca for owner J~ SIGNATURE sNATUREOF 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. P. QRQ

NYC-WTC 000093928