Landmarks work application form, New York City, 2002

NYC 9/11 Public Portal Document v+CNrMer• :fl L~. . . .. •. ~ ,t...A. ?' -{}.~:•-'•.. , .f;•:!~r~ ~ 'P4 THE CITY OF NEW YORk..LANDMARKS P1 ESER VATION •COMMISSION I CENTRE SfREg-9TR FIAOR NEW YORK. NEW YORK.10007 TEL (212) 669- 7700 FAX: (212) 669-7960 , APPLICATION FORM FOR WORK ON DESIGNATED PROPERTIES F2 This application win not be deemed complete until it is so certified by the Landmarks Preservation Commission. M 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 NA,

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

❑ Wowtou j 0 SCENIC 0 INTERIOR .TEE Of D€SGNAIK)N HISTOI1IC DISTRICT

PMW 0 CNE 0 C Of A 0 REPORT TTON OTHER WORK TYPE

17 ~O H N'S `t' R E L T Exterior ADDRESS FLOOR OR AMTMENT DESIGNATED

PROPERTY Manhattan Cp l [ 30 BOROUGH BLOCK LOT ZONING DETAILED 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 y reviewed and approved by NYCLPC.

COST OF PROJECT WARNING LETTER / NOV # NIA TENANT/LESSEE/ NAIVEE, TITLE & FIRM (E opplicable) PHONE (dayl CO-OP SHAREHOLDER ADDRESS APT x CITY, STATE. ZIP CODE

NIA ARCHITECT! NAIVE, TITLE & FTTM (If applicable) PHONE (day) ENGINEER If applicable ADDRESS CITY, STATE, ZIP CODE

Benjamin Kurzban and Son Control, Inc. (718) 531-2900 CONTRACTOR NAME, TITLE & FIRM (IT oppficoblet PHONE tday) 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 applicable) PHONE (day) e.g. aging Agent, etc. Managing Agent, etc. 59-17 Junction Boulevard, 8th Floo~CQrona New ynrk 11368 ADDRESS Cltt, STATE, ZIP LODE

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 Ro RRh c)F Taus -TEES CF Z> 2~ 9 d0L l ) For applications for wont on or N a cooperative or condominium building. OWNERS NAME and TITLE (please type of pAill) (ii -I PHONE (day) the'ovn of Is the Coop Board or Cothe "a Wm Assodation, An officer of O L 1O H S ' uN r. I I~ ` ,7 -r r~ I V1 T ti'{ C• S t /` L.i'L L r~ l~ (4 me Co-op Board or Condominium COMPANY, CORPORATION, ORGANIZATION (E oppilcoble) Ass cons atIon must sign this appfor fun. Please consort the Instrvellons tar FBMg for additional Intormatlon. Y I —] R OlIESS \ o - ] S T P E E —L y ~ E V) l W `, .~10 }~ T~ N . tZ115!-STATE, P CODE 3 Q - V a,/ r

pp NYC DEP ©- /C IL or owner_ SIGNATURE sIGNATUREOFOWNER

Note: Section 25.3)7 of the Administrative Code of the City of New York makes it a punishable offense to willfully make false statements on this application Q.,.- v%v

NYC-WTC 000094013