Contract permit application form, Oct 2001

NYC 9/11 Public Portal Document

s ~ 2,6`eRYorkChy APPLICATION FOR CONTRACT PF,RMTT it ottrsasporut on • of Per sit Ma®eeaw t and Constraction Control Lfl.l (REV.8-98)FRONT

'PERMIT NUMBER: P T (THM# 124 TO CONTRACT :Rol' - BOROUGH: IM OB OQ OX Os DC DBNEC OREC OCMC# OQEC OBXEC SPONSORING )GENCT: ]~DEP DDDC DDOT ONYSDEC DNYSEDC DHPD DPARKS OSCA Dr r OPA of NYLNJ

PROJECT ENG NAME: R.RADHh1KRtS1lNAN P.G TELEPHONE #: (7I )'~gs-37 18

NAME OF CONTRACTOR: BENTAMIN KURZ soN CoNt&OLTELXP9ONE #: ( 718) 53i -2.Q06 j BUSINESS ADDRESS:t,~.j•IQR(jt f' 4 AVct4((€ R iZccKL-I r'i ~N —i i '23(o RESIDENT ENGINEER NAME: TELEPHONE #: (

PROJECT DESCRIPTION: 3LL L i l( 4lcnN .P -co i1EMoVE O RS G'Ro" LOLA C C%-~i r —i.. CONTRACT START DATE: S I '5 lo 2- CONTRACT CO2SLETION DATE: C) I i - 102. TYPE OF PAVEMENT: ROAD;W:

TYPE OF PERMIT(S) REQUESTED (Check All Applicable): ❑111-MA3OR n7STALTAZ'ION-SERER 0126-TEST PITS, CORES OR BORING CRANE/SHOVEL ON STREET 0112-RAPID TRANSIT CONSTRUCTION C]132-INSTALL FENCE 0205 -PLACE SHANTY/TRAILTA ON 0113-REPAIR W= 0135-FINAL RESTORATION STREET 0114-REPAIR SE O136-DEP-MAJOR INST7 A1TONS- 0208-T~ORARY PEDESTRIAN WALK ❑115-REPAIR STATER/SEWER SALTER ❑211-' ORARr ROADWAY CLOSING 0116 -FOIL OIL LI 0137-DEP-l~JOR INSTALLASIONS- 0214-PLACE CONTAIIER ON STREET 0118-RESET,REPAIR OR REPLACE SERER D215-T~ORARY SIDEWALP. CLOSING CURB 0201 -PLACE !Dc' 'RIOT. ON STREET 0401-REPAIR SIDEWALK 0119-PAVE STREET 0202-CROSSING SIDEWALK ❑402-CONSTRUCT NEW SIDEWALK 0120 -TREE PIT 0203 -PLACE CRANE/SHOVEL ON ❑403-REPLACE SIDEWALK 9121-CONSTRUCT OR AL HOLE STREET VENTILATORS AND/OR CASTING 0204-PLACE EQUIPl~NT OTHER THAN

OTHER TYPE OF PERMIT:

ON STREET L'trGAR WORK WORK FR "' TO STREET FELS STBR2' E8D

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SPECIL STIPOLATIONS

OCMC APPROVAL BY: DATE: ❑MORE LOCATIONS ON REVERSE

THE P T TO BE GRANTED SUBJECT' TO TEE FOLLOWING CONDITIONS: THE APPLICANT AGREES TO COMPLY RITE ALL LAWS AND RULES OF TEE DEPABE IT AND OTHER APPLICABLE LAWS AND RULES. NO PWMXT SHALL BE ISSUED UNLESS TIM APPLICANT HAS ON FILE ALL INSURANCE(BONDS). -

APPROVED FOR TEE COMMISSIONER BY: SVB)ETTTD BY: DATE

DATE: SIGNED BY: r . 2 u --A- ~ TEL.# ( ) AUrNoN1ZED REPRESENTATTPE OF APPLICANT

NYC-WTC 000111838