Contract permit application form, Oct 2001

NYC 9/11 Public Portal Document

s :Uq : ttR•YorkC32y APPLICATION FOR CONTRACT PF,UMIT of Ti • of Peat Manaem it and Co on Control M11 (REV.8-98)FRORT

PERMIT NUMBER: PERMITTEE (IHW #: 114 TO CONTRACT #: _ BOROUGH: OM DB DQ Ox ❑S Dc DBNEC DQEC OBXEC OREC 0a4C# SPONSORING )GENCY: WDEP DDDC DDOT DNYSDEC DNYSEDC DHPD DPARKS ❑SCA D•M OPA of NYLNJ PROJECT ENGIt AME: R. RDNAKR~5NNA N P.(:. TELEPHONE #: (718 ) ( S NAME OF CONTRACTOR: p t E NTA PA 10 K U R ZBHnl cSO 4 HONE #: ( - I 1 g) S k i - -2-Q OO

BUSINESS ADDRESS:I .46Rglp ( Ay t4i&L OCK.LHM 0 1 ( •23(J,

RESIDENT ENGINEER NAME: TELEPHONE #: ( )

PROJECT DESCBIPTIOH: a crib tXT Rkoc ACTt~11TICS - CO iZ6MOVE OEC3RIS GROM G.Ol.CA) C O- WZ.• CONTRACT START DATE: 5 1 t5 10Z CONTRACT COMELBTION DATE: ') it - I 02.

TYPE OF PAVEMENT: ROADAAY: SIDEWALK: TYPE OF PSRlCT(S) REQDESTED (Check All Applicable): 0l11-MA3OR INSTALLA'*ON-SENOR 13126-TEST PITS, CORES OR BORING CRANE/SHOVEL ON STREET 0112-RAPID TRANSIT CONSTRUCTION 0132-INSTALL FENCE 0205-PLACE SHANTY/TPJJ.I D ON O113-REPAIR iNPTER 0135 -FIN L RESTORATION STREET 0114 -REPAIR SERER 0136-DEP-B42OR IRSTALI.A TOtNS- D208-TRIMN)RARY PEDESTRIAN WALK 0115-REPAIR iIILTER/SEINER WLTER 0211 -TEMPORARY ROADWAY CLOSING 0116-FUEL OIL LINE D137-DEP-MAJOR INSTALLMIONS- 0214-PLACE CONTAINER ON STREO;T 0118-RESET ,REPAIR OR REPLACE SEINER 0215-TEMPORARY SIDERAIK CLOSING CURB 0201-PLACE hUU IAL ON STREET 0401 -REPAIR SIDF~LK 0119-PAVE STREET 0202-CROSSING SIDERAL 0402 -CONSTRUCT NEW SIDEWALK 0120-TREE PIT 0203-PLACE CRANE/SHOVES, ON ❑403-RF'PI.ACEE SIDEi41LK 0121-CONSTRUCT OR ALTER MANHOLE STREET VENTILATORS AND/OR CASTING 0204-PLACE EQUUI R4T OTHER THAN

OTHER TYPE OF PERMIT:

OK STitLR •X-= WORK WORE FROM. STREET TO STREET JEEET START Z=

..0 fIP :.L:Oss:

TIC

SPECIA:. STIP[Jl.IdXOSS:

OCIC APPROVAL BY: DATE: ❑MORE LOCATIONS ON REVERSE

TEE PERMIT TO BE GRANTED SUBJECT_ TO TEE FOLLOPING CONDITIONS: TEE APPLICANT A(72EES TO COMPLY WITH ALL LAWS AND ROLES OF TEE DEPARTMENT AND OTHER APPLICABLE LAWS AND RULES. NO PERMIT SHALL BE ISSUED UN..Ess TEE APPLICANT HAS ON FILE ALL INSURANCE(BONDS).

APPROVED FOR THE COMMISSIONER BY: SUBMITTED BY: DATE:

DATE: SIGNED BY: AUTHORIZED REPRESENTATIVE OF APPLICANT

NYC-WTC 000111843