Contract permit application form, Oct 2001

NYC 9/11 Public Portal Document

`,,ffc YorkCay APPLICA77ON FOR CONTRACT PERMIT S 'lDep=.-w. of Trlasportmon ~~ of Pmt Mgt *nd Coosunetion Control bOl (REV.8-98)FRORT

PERMIT NUMBER. PERlITTEE (IBIS #: 12 17O CONTRACT #: R f)r -

BOROUGH: M OB ❑Q ❑x ❑S ❑MEC ❑BNEC ❑QEC ❑=C ❑REC OCMC# SPONSORING AGENCY: DEP DDDC ODOT ❑NTSDEC ❑NYSEDC DHPD D s SCA DA ❑PA of NYSNJ PROJECT ENGINEER NAME: R(i D KA K R ~ S H N A N ~ P. G _ TELEPHONE #: (7113 ) '' Q S --'7 (B 1 NAME of CONTRACTOR: BEtJSAM 10 Kt1t2ZAHN LON CDW?ROLTEIEPHONE #: (l18) 5~(-2gOO BUSINESS ADDRESS: 12.+-16 RP L P H Aw-r(t P,,ZOOKL-I M N .1 1 123(2 P15 DENT ENGINEER NAME: TELEPHONE #: (

PROJECT DESCRIPTION: l3utLntnl(, txT~Rtoa GCEAtj.yP ACTtUt -rtES -co i3EMoVE De6Rts cROM LO.LA C OS-~G)TL. CONTRACT START DATE: 51 t5loz CONTRACT COMPLETION DATE: O}' I I-IO2

TYPE O£ PAVE ENT: ROADWAY: SIDEi4►LE TYPE OF PtB T(S) REQUESTED (Check All Applicable): 0111-2Q1.7oR INSTALLATION-SEWER o126-TEST PITS, CORES OR BORING GRAN/SHOVEL ON STREET 0112-RAPID TRANSIT CONSTRUCTION 0132-INSTALL FENCE 0205-PLACE SHANTY/TRAIT ON 0113-REPAIR WATER D135-FIZAL RESTORATION STREET 0114-REPAIR SEWER 0136-DEP-MAJOR INSTALLATIONS- 0208-TEISOPART PEDESTRIAN Sa1LE 0115-REPAIR r/SERER SATER D211-TEMZ?ORABP ROADWAY CLOSING 0116-FUEL OIL LINE 0137-DEP-MAJOR INSTALL TIONS- 0214-PLACE CONTAINER ON STREET 0118-RESET,REPAIR OR REPLACE SEWER 0215-TEMPORARY SIDEWALK CLOSING CURB 0201-PLACE !9i LAL ON STREET 0401-REPAM SIDEWALK 0119-PAVE STREET 0202-CROSSING SIDECALK 0402-CONSTRUCT NEW SIDEFRhLB 0120. m PIT 0203-PLACE CRANE/SHOVEL, ON 0403-REPLACE SIDEWALK 0121-CONSTRUCT OR ALTER MANHOLE STREET VENTILATORS APED/OR CASTING 0204-PLACE EQUIPMEIIT OTHER THAN t OTH R TYPE OF PERMIT:

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OGRK APPROVAL BY: DATE: " ❑MORE LOCATIONS ON REVERSE TBE PTA T TO BE l'RANTED SUBJECT' TO THE FOLLOWING CONDITIONS: TSE APPLICANT ACdNEES TO COMPLY WITH ALL TARS AND RULES OF THE DEPARTMENT AND OTHER APPLICABLE LAPS Alm RULES. NO PERHIT SHALL BE ISSUED UNLESS TEE APPLICANT HAS ON FILE ALL INSURANCE(BONDS). -

APPROVED FOR THE COMMISSIONER BY: SUBMITTED BY: DATE:

DATE: SIGNED BY:

NYC-WTC 000111835