Contract permit application form, Oct 2001

NYC 9/11 Public Portal Document

s ~~t_ York Qty A PPL ICA 77ON FOR CONTRA CT mt of Transportation • ofPast Manaecamt and Coteso action Coot of M1 (RE7_8-98)FRONT

PERMIT NUMBER: PERMITTER(LBtn #: 124 TO CONTRACT #: R or• - BOROUGH: tM OB OQ OX OS ON€C OBNEC OQEC OBXEC DEC OCMC# SPONSORfIG AGENCY: RDEP ODDC ODOT ONYSDEC ONYSE>C OHPD OPARKS DSc OM M OPA of NYLNJ

PRO.IECTEGI2)EFT2 2atME:R. RAbHAKRtS NAN r P.G. =EpsONE #: 0718 ) 545 r~ NAME OF CONTRACTOR: g E N'SAM 1N KUQ ZgF1a r'' S.7N CpN'f2OL73:LEPHONE #: (7 t e) S3 i -Z-god . BUSINESS ADDRESS:IZ46 RPLPN Ayct-(tx .L`/N 14.1 1 1 23(,

RESIDENT ENGINEER NAME: TELEPHONE #: ( )

PROJECT DESCRTtrrrON: IL l(t Gx -r o EAN.OP AGTt'tT'E5 To i>EMoVE Deppts CROPA LOLLAV C c- wT . CONTRACT START DATE: c I IS IOZ CONTRACT COMPT'ETION DATE: g II JO 2

TYPE OF PAVEMENT: ROADSAY: SIDEWALK:

TYPE OF PERMIT(S) REOUESTED (Check All Applicable): 0111-MAJOR INSTALLATION-SERER o126-TEST PITS, CORES OR BORING CRANE/SHOVEL ON STREET 0112-RAPID TRANSIT CONSTRUCTION 0132-IZTSTALL PENCE 0205-PLACE SHANTY/TRAILER SHANTY/TRAILER ON 0113-REPAIR AATER ❑135-FINAL RESTORATION STREET 0114-REPAIR SE D136-DEP-MAJOR I21STALLATIONS- ❑208- RBR4 PEDESTRIAN SALK ,` ❑115-REPAIR TOTER/SERER N!ATER 0211-TEMPORARY ROADWAY CLOSING D116-FUEL OIL LINE 0137-DER-MAJOR INSTALLATrONS- 0214-PLACE CONIAfl ON STREET ❑118-RESET,REPAIR OR REPLACE SEWER 0215-TEMPORARY SIDEWALK CLOSING CURB 0201-PLACE MATERIAL ON STREET D401- AIR SIDEWALK 0119-PAVE STREET E1202-CROSSING SIDEWALK 0402-CONSTRUCT NEW SIDEWALK 0120-TREE PIT 0203-PLACE CRANE/SHOVEL. ON D403-REPLACE SIDEWALK 0121-CONSTRUCT OR ALTER MANHOLE STREET VENTILATORS AND/OR CASTING 0204-PLACE EQUIPMENT OTHER THAN

OTHER TYPE OF PERMIT:

ON STRL"I -m'a FORK FORK 1`ROl4 SSREET TO STREET REFS SMI= E=

'S3 ai 1 °J c:m'C" 1l PJSDIC

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SPECIAL STIPULATIONS

OCMC APPROVAL BY: DATE:_ DoRE LOCATIONS ON REVERSE THE PERMIT TO BE GRANTED SUBJECT. TO THE FOLLOWING CONDITIONS: THE APPLICANT A S TO COMPLY WITH ALL LAWS AND RULES OF THE DEPARTHENT AND OTHER APPLICABLE LAWS AND RULES. NO PE T SBALL BE ISSUED UNLESS THE APPLICANT HAS ON FILE ALL INSURANCE(BONDS).

APPROVED FOR THE CO)`4SISSIONER BY: SUBMITTED BY: DATE:

1!I DATE: GNED BY: SIGNED ✓L ' r~ TEL. # ( ) AUTHORIZED REPRESENTATIVE OF APPLICANT

NYC-WTC 000111845