Contract permit application form, Oct 2001

NYC 9/11 Public Portal Document

c ~ENewYorltCSty APPLTCATTON FOR CONTRACT PERIYITT of irmsportaton of Permit Men rent and Co~trnction Control M•IIl (REV.8-98)FRONT

PERMIT NUMBER: PE MITTEE (IBN #: 124 TO CONTRACT #: R or• • p, cM 2

BOROUGH: M OB OQ OX OS Dc OBNEC OQEC OBXEC OREC OCMC# SPONSORING AGI CY: 1DEP ❑DDC ODOT ONYSDEC ONYSEDC OHPD OPARES OSCA OMIT. OPA of NYLNJ

PROJECT ENGnmm m : R. R A D H f-n K a y s t-I N A N P, (. TELEPHONE #: (7 )

NAME OF CONTRACTOR: SEN'SAM,N KUaZBFlM t S. ON CONt2OL=zEPHONE #: (11 e) 531 -ZQOO BIIsnmss ADDREss:124B RgLPtA Ayer(ut P,~OO .Lfr4 N.4 1 i 23(0 RESIDENT ENGINEER NAME: TELEPHONE #: ( )

PROJECT DESCRIPTION:_3u«e~rJ( (~<<nri-~P AG , r~GS co ilEMOVE DEC~aus G•ROM Lbl.lA 4 —~i,• CONTRACT START DATE: 1 ,5 10 Z CONTRACT COMPLETION DATE: C) I( I ..102.

TYPE OF PAVEMENT: ROADWAY: TYPE OF PERMITS) REQUESTED (Check All Applicable): D111-IOLJOR INS LLATION-SEWER 0126-TEST PITS, CORES OR BORING CRAZE/SHOVEL ON STREET 0112-RAPID TRANSIT CONSTRUCTION 0132-INSTALL FENCE 0205-PLACE SHANTY/TRAILER ON 0113-REPAIR WA TER 0135-FIAL RESTORATION STREET 0114-REPAIR SEWER 0136-DEP-MAJOR INSTALLATIONS- ❑208-TELPORARY PEDESTRIAN WMLK ❑115-REPAIRR'WATER/SEWER VULU R 0211-T +RARI ROADWAY CLOSING ❑116-FUEL OIL LAZE 0137-DEP-IWOR INSTALTATIONS- 0214-PLACE CONTAINER ON STREET 0118-RESET,REPAnt OR REPLACE SEWER 0215-TEMPORARY SIDEWALK CLOSING CURB 0201-PLACE EOTERTAL ON STREET 04 01- AIR SIDEWALK 0119-PAVE STREET 0202-CROSSING SIDEWALK 0402-CONSTRUCT NEW SIDEWALK 0120-TREE PIT 0203-PLACE CRANE/SHOVES. ON 0403-REPLACE SIDEWALK 0121-CONSTRUCT OR ALTER HANEOLE STREET VENTILATORS AND/OR CASTING 0204-PLACE EQUIPMENT OTHER THAN

OTHER TYPE OF PE .MIT: J WORK WORE ON STRE-ST FR0V STR£1T TO STREET FEET START END

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SPECIAL STIPULATIONS: 1

OCHC APPROVAL BY: DATE: DORE LOCATIONS ON REVERSE

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

APPROVED FOR THE COMILSSIONER BY: SUBMITTED BY: DATE:

DATE: SIGNED BY: /'- • TEL. # ( ) AUTBOPSZFD REPPESENTATIVE OF APPLICANT

NYC-WTC 000111846