Contract permit application form, Oct 2001

NYC 9/11 Public Portal Document

s F —M— T etr York aty APPUCATTON FOR CONTRACT PF.'RMTT of Tramportapon W of Paget Maaaft!ntat and Construction Control .1 (REV.8-98)FROWT

PERMIT NUMER: P 1 (IBM) #: I2-4 TO CONTRACT #: OF - R QAZ

BOROUGH: Mj OB OQ DX Os OBNEC OQEC DBnC DREG OCMC# DC

SPONSORING AGENCY: DMTA OPA of NYLNJ RDEP ODDC ODOT ONYSDEC ❑NYSEDC OHPD OPARES OSCA

PROJECT ENGINEER NAME: R. RADHfaKR)SMNAN P.G. TELEPHOKE #: (718 ) SQ $-~'7 1 8 - r n }} NAME OF CONTRACTOR: _ENTAM10 KUt2ZF.Hn1 L 7N (ON120LTESEPRONE #: (-118) 53i -2-QOO

BUSINESS ADDRESS:tlLe PI~t. p N Avet4Lxt CC -L-I nt tJ. q I

RESIDENT ENGINEER NAME: TELEPHONE #: ( )

PROJECT DESCRIPTION:C3t.D, ExT~OR IEHN uP ACT%\It•T 1 ES TO REMOVE De[~Rt5 GROlA C..O .t.ADSCo4'TSt=c.. • CONTRACT START DATE: 51 Is Io2.. CONTRACT 0010IETION DATE: n l I0 2 z TYPE OF PAVEMENT: ROADWAY: SIDEWALK:

TYPE OF PERMIT(S) REOQESTED (Check Al.]. Applicable): 0111-MAJOR INSTALLA ION-SE1aER 0126-TEST PITS, CORES OR BORING CRANE/SHOVEL ON STREET 0112-RAPID TRANSIT CONSTRUCTION 0132-INSTALL FENCE 0205-PLACE SHANTY/T A=M ON 0113-REPAIR W1TER 0135-FI2AL RESTORATION STREET 0114-REPAIR SEWER 0136-DEP-MAJOR INSTAT.T.ATIONS- 0208-TEMPORARY PEDESTRIAN W1LK 0115-REPAIR WATER/SEWER WATER 0211-TMPORARY ROADWAY CLOSING 0116-FUEL OIL LINE O137-DEP-MANOR INSTALLATTONS- 0214-PLACE CONTAINER ON STREET ❑118-RESET,REPAIR OR REPLACE SEWER D215-TEMPORARY SIDEWALK CLOSING CURB 0201-PLACE MATERIAL ON STREET 0401-REPAIR SIDEWALK 0119-PAVE STREET 0202-CROSSING SIDEWALK 0402-OONSTRUCT NEW SIDEWALK ❑120-TREE PIT 0203-PLACE CRANE/SHOVEL ON 0403-REPLACE SIDEWALK 0121-CONSTRUCT OR ALTER MANHOLE STREET VENTILATORS AND/OR CASTING 0204-PLACE EQUIPMENT OTHER THAN OTHER TYPE OF PERMIT:

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SPECra STIPOLATIONS:

OCIM APPROVAL BY: DATE: ❑MORE LOCATIONS ON REVERSE

THE PTA T TO BE GRANTED SUBJECT TO TEE FOLLOWING CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL TARS AND RULES OF THE DEPARTMENT AND OTHER APPLICABLE LAWS AND RULES. NO PERMIT SHALL HE ISSUED UNLESS TEE APPLICANT HAS ON FILE ALL INSURANCE(BONDS). - ..

APPROVED FOR THE COMA SSIONER BY: SUBEITT ED BY: ________________________DATE:_____________

DATE: SIGNED BY: PL ' /"- ~L(/11VVL— TEL. # ( ) AUTHORIZED REPRESENTATIVE OF APPLICANT

NYC-WTC 000111842