Form for submitting an asbestos inspection report to the NYC Department of Buildings as part of a STOS project notification.
NYC-WTC_000099921–000099926Folder label: “65 Nassau St”
OCR status: ok · source: pdftotext
NYC 9/11 Public Portal Document
r wyld' ~' VXWOF ENVIRONMENTAL PROTECTION Asbestos Control Program NYC DP 7 59-17Juncton Boulevard, 8' Floor, Corona, NY 11368-5107
STOS PROJECT NOTIFICATION L Building Dept. or TRU No FOR OFFICIAL USE ONLY I
(ASBESTOS INSPECTION REPORT) l- (Tee fee Schedule) c -i { When submitting this form at the NYC Department of Buildings, the original form and three (3) copies with original sigraturee are required.. Submittal at the NYCDEP requires one copy of the form with original signatures. This form must Cie subm~'ii feM the NYC DEP not less than one week in advance of the start of abatement activities. 1. FACILITY
2. Address 65 Nassau Street Borough Manhattan Zip 10001 AKA N/A 3. Block 65 4. Lot 1 5. Type of Facility Apartments 6. Name of Building N/A II. BUILDING OWNER
7. Name 65 Nassau Owners Corp. 8. Contact Person Scott Jaffe 9. Tel. # (718) 596-1616 Fax # (718) 834-9850
10. Address 65 Nassau Street City NY State NY Zip 11101 III. GENERAL CONTRACTOR 11. Name N/A Tel. # IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name Black Rock Construction Co. 13. Contact Person Tony Brown 14. Federal Employer ID. # - _ _ _ _ _ _ _P 15. Tel. # (718) 297-8361 -- Fax # (718) 746-3023 16. Address 88-15 168th Street # 6C City Jamaica State NY Zip 11432 V. THIRD PARTY AIR MONITOR
17. Name Central Environmental Inc. 18. Contact Person Alim Yerima 19. Federal Employer ID. # -.-.-.-.-.-. P11-.-.-.-. - 20. Tel. # f) 293-8727 _ Fax # i7iL996-4430 ____ 21. Address 91 McClellan Street City Bronx State NY Zip 10452 22. Sample Analysis Laboratory Taylor Environmental 23. NYS DOH ELAP # 11480 VI. PROJECT INFORMATION 24. Starting date for this portion of work 1215/01 Projected completion date 4/5/02
Asbestos work schedule El Monday O Tuesday E) Wednesday El Thursday D Friday D Saturday ❑ Sunday
Shift from: 9:00 __E am Dpm to 5_30 _ Dam Elpm ,\ ~_~- ...i ; , . If other, speciy Must call (718)746-8054 for access to building r ~` `` P~cCEIy~O Access to inspect the premises must be provided during the work schedule indicated In n t — this item. ç
25. Total amount of asbestos-containing material to be abated during this work \ ;i . '; 4& O Square Feet, and/or 0 Linear Feet l R is N. J/ ~4'l * + 75Q ACP7 7F
NYC-WTC 000099921
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