NYC 9/11 Public Portal Document
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SPQNSOPD AGENCY: MDEP ODDC ODOT ONTSDEC ONYSEOC DD Dscx ON3'A OPA of NrAW
PROJECT ENGINEER NAME: DHAKam_4414sw4P.1: TELPEONE 1: (7l8) SQ -~iiSs
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NAME OF C V7RACTOR: $2r1Pam i M K , rz 6.19 A
n Conk r°1~EIEPEORTE #: (118) 531- ZQ 00
BUSIINESSADDRESS: 17LIQr R-,1—L. d..e - l._ i .._ . .N I
RESIDENT ENGD~ER NAME:
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PROJECT DESCRIPTION: LW
CONIItACT START DATE:
CORT3RACT CMdMETICV DATE: q 112 )0
TYPE OF PAV129m: ROADM1UIY: SILERLTZ:
TYPE OF PTE CT(S) REQUESTED Check All
Applicable):
D111-MAJOR INSTALL 2XON_ 0126-TEST PITS, COPES OR BORING CRAPE/SHOVEL ON STREET
1l2-RAPID TRANSIT CONSTRUCTION 0132-INSr. FENCE
0113-REPAIR Sal'CER D205-FLACE SIDIN1Y/2panER ON
D135-m RESTORATION
0114-REPAIIt SEM D136-DER-MAJOR INSTAL ATICUS- 0208- ORARr PzDzs nIAN SRALK
D115-REPAIR R/sE
D116-FUEL OIL LZNE C2U- opj A X CLOSIIM
0137-IEP-MAJOR IN5TsrI.ATrCuS- 0214-PLACE CONMMM ON STREET
0118-RESET,REPAIR OR rjMLA= s 8215-TENO?ORARY SIDEW.LK CLOSING
CURB
0119-PAVE STREET
D201-PLACE MArProIAL ON £Ewan 0401-EMMZ t SE .L1C
0202-CROSSDii SESD .L(C D402-OWSTRUCT NEW SIDER4.L1C
0120-TREE PIT 0203-PLACE CRAIRE/SHOVE(. ON
0 121-CONSTRUCT OR ALTER MANBOLE O403-IMPIACE SEEThLK
S72MET VENTILATORS
AND/OR CASTING 19204-PLACE EQDIPlO:NT OTHER THAN
OTHER TYPE OF PERMIT:'
Cs STurr
FEES STJi2 M
42 ANN S-', N sAt.t ` Ww~t~M 5T J 19149-/o2, 9/ii,/o
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SPECIAL Ssaasar "s:
O APPROVAL BY
DATE:
OMORE LOCATIONS ON REVERSE
TM PERRY TO BE GRANTED SpsJEC: TO THE
Yo27Ap'ING CONDITIONS:
TIM APPLICANT AONPPS TO COASLY PETE ALL.
NO PP]QQT SHALL BE ISSOED UAL SS TEE LAPS AND ROLES OF THE DEPA RT AND OTHER APPLI.w 2 LAPS AND ROLLS.
APPLICANT BAS ON FILE ALL IINSOSGNCE(BONDS).
APPROVED FOR TEE CCl84SStotaR BY:
SUBlQTI~ BY: 4 1C `7
1 cV A C\ DATE :
DATE: SIGNED BT:L LMCLA TEL (F (? 18 ) SR s -3 657
NYC-WTC 000111806
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