NYC 9/11 Public Portal Document
Y ~ APPLICA77ON FOR CONTRACT PERMIT
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PERtit1 (Ii #: 124 TO CONTRACT #: R or - R £M2
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SPONSORING AGENCY: RDEP ODDC ODOT ONYSDEC ONYSEDC OHPn OPARES Osc . OMM OPA of NYLNJ
PROJECT ENGIZNEER NAME: R. R A D W A K R~ S RNAN P. (:. TELEPHONE #: (7 (13 ) 5 9 5- 7( S
NAME OF CONTRACTOR: BENSAMiN KUQZPSHN coN (owt&oL EPEONE #: (11 )S3i -2800
BUSINESS ADDRESS: 12.416 "L P 4 AVEOLL P, Roc L-i r4 r(. 4 1 1 23(0
RESIDENT ENGINEER 2A2g: PHONE #: (
PROJECT txT~~tNoR ( CAO.uP AC.TNVtT%ES 10 REMOVE Del .t$ G'ROM
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CONTRACT START DATE: 5 1 i5 I0 Z - CONTRACT COMPLETION DATE: 9 f [ 2-10 2-
TYPE OP PAVEMENT: ROADW : L SIDEid(IS.:
• TYPE Or PERHIT(S) REQUESTED (Check All Applicable) :
0111 .7OR INSTAll IION-SERER 0126 -TEST PITS; CORES OR BORING CRAM/SHOVEL ON STREET
0112-RAPID TRANSIT CONSTRUCTION 1 ❑132=INSTALL FENCE 0205-PLACE SHANTY/TRAILER ON
j 0113 -REPAIR. iaLTER `~ r ❑135-FINAL RESTORATION STREET
0114-REPAIR SEWER - D136-DEP-3OR INSTALLATIONS- 0208 -TEMPORARY PEDESTRIAN W1LK
❑115-REPAIR'W /SERER ¼ AXER 0211-TEMPORARY ROADWAY CLOSING
0116'FUEL+OIL LINE ^ D137-DEP-MWOR ENSTAr.L IONS- D214-PLACE CONTAINER ON STREET
0118-RESET,REPAIR OR REPLACE- SERER O215-TEMPORARY SIDEWALK CLOSING
CURB 0201 -PLACE MAMEPIAL ON STREET ❑401-REPAIR. SIDESAIK
❑119TRAVE STREET • 9202-CROSSING SIDEWALK 0402-CONSTRUCT NEW SIDEWALK
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0120 -TREE PIT t 17203-PLACE CRANE/SHOVEL ON 0403-REPILACE SIDEWALK
0121-CONSTRUCT OR ALTER MANHOLE STEO T • VENTILATORS
NAND/OR CASTING j
0204-PLACE EQUIPMElTT OTHER THAN
OTHER TYPE OF PERMIT:
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OC?iC APPROVAL BY: DATE: DMMORE LOCATIONS ON REVERSE
TBE PERMIT TO BE GRANTED SUBJECT TO T5E FOLLOWING CONDITIONS:
TIM AP=C+NT Al .ESS TO COMPLY WITS ALL LAWS AND RUNES OF YES DEPARTMENT AND OTffi t APPLICABLE LAWS AND
RULES.
NO 2 T SHALL BE ISSUED UNLESS TEE APPLICANT HAS ON FILE ALL INSURANCE(BONDS).
APPROVED FOR THE CO~IISSIONER BY: SUBMITTED BY: DATE:
DATE: SIGNED BY:
NYC-WTC 000111834
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