Contract permit application form, Oct 2001

NYC 9/11 Public Portal Document

York City APPLIC.A770N FOR CONTRACT PER1'fIT otTr2 porrion oter®t Manntcmnt and Construction Control ME.1 (REV.8-98)FRONT

rEP,b=T NUMBER:

PEI MQTTEE (LBW #: 12 4 T 0 CONTRACT #:

BOROUGH: EM OB OQ Ox Os OtEC OBNEC OQEC OBXEC OREC OCMC# SPONSORfTG A CT: EZDEP ODDC DDOT ONYSDEC ONYSEDC 0Em OPARKS OSCA O2lCA OPA of NTLNJ

PROJECT ENGIZiEER NAME: R. RIibHAKR~SKNAN P . TEIEPH #: (7I ) 4S - 'Tim 1 S NAME OF CONMACTCa:.: gEN'SRMiO KURZ #: (718)531 -2400

BUSINESS ADDRESS: 124 AyE4u. R~OokE.-rN hl. `I 1 i 23(e RESIDENT ENGINEER NAME: TELEPHONE t: (

PROJECT DESCR'IPTION:CSu%e.nl GCEn1•4JP AG-t I - 'C -o REMOVE OEBRIS FROM (OE•LASS C 0c Wr • CONTRACT START DATE: 1 l5 I O Z CONTRACT Co ETION DATE: 91 17- I O 2.

TYPE OF PAVEMENT: ROADW)LY: TYPE OF PERMCT(S) REQOESTE) (Check All Applicable): ❑111-MAJOR II(S TT.ATIoN-SEWER 0126-TEST PITS, CORES OR BORING CRANE/SHOVEL ON STREET 0112-RAPID TRANSIT CONSTRUCTION D132-IZTSTALL FENCE D205-PLACE SHANTY/TRAIT ON 0113-REPAIR WATER 0135-FDAL RESTORATION STREET 0114-REPAIR SEWER ❑136-DEN-MAJOR INSTRLLLATIONS- 0208-TEMPORART PEDESTRIAN VZI.K 0115-REPAIR WLTZR/SEWER TV= ❑211-TEMPORARY ROADWAY CLOSING 0116-FUEL OIL LINE 0137-DEP-MAJOR IMTSTALLATIONS- D214-PLACE CONTAINER ON STREET 0118-RESET,REPAIR OR RE LACE SEWER 0215-TEMPORARY SIDEWALK CLOSING CURB ❑201-PLACE ' IL ON STREET ❑401-REPAIR SIDEWALK 0119-PAVE STREET 0202-CROSSING SIDEWALK ❑402-CONSTRIICT NEW SIDEWALK 0120-TREE PIT D203-PL ANE/SHOVEL ON ❑403-REPLACE SIDEWALK 0121-CONSTRUCT OR ALTER MANHOLE STREET VENTUATORS AND/OR CASTING ❑204-PLACE EQUIPHENT OTHER THAN OTHER TYPE OF PERMIT: L+NEAR WORK BE os STREET FR@f STREET TO STREET FEES STZRT E®

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SPECIAL STIPOLATIOUS:

00O3APPROVAL BY: DATE: MOPE LOCATIONS ON REVERSE TEE PERMIT TO BE GRA"ITID SUBJECT TO TEE FOLLOWING CONDITIONS: TEE APP, .ICANT AGREES TO COMIPY WITH ALL LAOS AND RULES OF FBI DEPARTMENT AND OTHER APPLICABLE LAWS AND ROLES. NO PERMIT SHALL BE ISSUID UNLESS TEE APPLICANT SEAS ON FILE ALL INSURANCE(BONDS).

APPROVED FOR THE COMMISSIONER BY: SUBMITTED BY: DATE:

DATE SIGNED BY: 2, ~" 9~- TEL # ( )

NYC-WTC 000111837