Contract permit application form, Oct 2001

NYC 9/11 Public Portal Document

flew York aty APPLICATION FOR CONTRACT PE~MTT w— f tof itMana ration w • a of PaxoR Manummt and Coasaoctian Control 01 OREV.8-98)FRONT

PERMIT NUMBER: PERHITTEE (IBlD #: 124 7 O CONTRACT #:

BOROUGH: I§M Os OQ OX OS Dc OBNEC OQEC OBXEC DREC OCMC# SPONSORING AGENCY: DEP DDDC ODOT ONYSDEC ONYSEDC OPARKS OSCA DN OPA of NYLNJ

PROJECT ENGII : R HONE #: (7113 ) j 1S- 2 7 ( 8 . NAME O£ CONTRACTOR: g NSA M tt4 K u R ZRF ( ci .oi.TEIEPBONE #: (-1 1 ) 5 3 i -'LQ OD BBSINEss ADDREss:124 P iPu Avv4Lte P,IZaOKIH .t ni. 1 i 23te RESIDENT ENGINEER NAME: TELEPHONE #: C )

PROJECT DESCRIPTION: 3u,Le (J~t~P ç eAN UP AG- JyV'iL To REMOVE DB RS GROM `o A`S CONTRACT START DATE: S I esi Io-. 4 T CONTRACT COY~LETION DATE: ) I ( 2- I o 2 TYPE OF PAVEMENT: ROADWAY: SIDEWALK:

TYPE O£ PEMIT(S) REQUESTM (Check All Applicable): 0111-1 JOR INSTALLLATYoN-SES ER 0126 -TEST PITS, CORES OR BORING CRANE/SHOVEL ON STREET 0112-RAPID TRANSIT CONSTRUCTION 0132-INSTALL FENCE 0205-PLACE SHANTY/TRAILER ON 0113-REPAIR WATER 0135-FDDiL RESTORATION STREET 0114 -REPAIR SEi?ER D136-DEP-MAJOR INSTATLATEONS- ❑208-TElTPORARY PEDESTRIAN WALK 0115-REPAIR l /SERER TEUMR D211-TEKPORARY ROADWAY CLOSING 0116 -FUEL OIL LINE 0137-DEP-MAJOR INSTALLATTONS- 0214-PLACE CONTAINER ON STREET 0118-BESET,REPAIR OR BINLACE SERM 0215 -TEMPORARY SIDEWALK CLOSING CURB 0201-PLACE M TERIAL ON STREET D401- AIR SIDEWALK 0119-PAVE STREET 0202-CROSSING SIDEWALK 0402 -CONSTRUCT NEW SIDEWALK 0120-TREE PIT 0203-PLACE CRANE/SHOVEL ON ❑403-REPLACE SIDEWALK 0121-CONSTRUCT OR ALTER MANHOLE STREET VEITTI_LATORS AND/OR CASTING 0204-PLACE EQUIPh= OTHER THAN

OTHER TYPE OF PERMIT: L AP. S7ORF 8011: ON STREET ER@! STREET TO STREET EEET STBRT EM

5 nli;1` n1 11 ~ i1.~s -r . Lt_ 2~(~ PAF!C

S-_ MrA- -Z IONS:

fIP~x IONS :

Rx_ ^Errw-:oSs: '

SPEcIa-. STIPULATIONS: J

OCMC APPROVAL BY: DATE: ❑MORE LOCATIONS ON REVERSE

THE PERMIT TO BE GRANT SOB.JEC: TO TEE FOLLOWING CONDITIONS: THE APPLICANT AGREES TO CONY WITH ALL LAWS AND RULES OF THE DEPART)~NT AND OTHER APPLICABLE LAWS AND ROLES. NO PHR1IT SHALL BE ISSUED ONLP..SS TEE APPLICANT HAS ON FILE ALL INSURANCE(BONDS).

APPROVED FOR TEE COMIESSIONER BY: SUBMITTED BY: DATE:

DATE: SIGNED BY: ' , , (" ______ TEL. # ( AUTHORIZED REPRESENTATIVE OF APPLICANT

NYC-WTC 000111839