Contract permit application form, Oct 2001

NYC 9/11 Public Portal Document

s g,H~~ York Cay APPUCAT7ON FOR CONTRACT PE MTT • of Tr2nspotn4oe • a ofPermit Maaataomt and Construction Control I (REV.8-98)FRfONT

PERMIT NUMBER: Pmm[:TTEE (IBM) #: 12 410 CONTRACT #: R of - P -FM 2

BOROUGH: b9M ❑B DQ ❑x ❑s Dc ❑BNEc ❑QEC ❑B C ❑REC OCMC# SPONSORING AGE►=., ( jDEP QDDC ❑DOT ❑NYSDEC ❑NYSEDC DD OPARKS ❑scA D ❑PA of NZSNJ

PROJECT ENGIINEEFt NAME: P. . RADNAKRISiINAN P.l,. TELEPHONE #: ( - 7I)j ) 595- S NAME OF CONTRACTOR: g E NSA M tN N [ONt(ZoLTELEPEONE #: (118) 53I -2-b0 BUSINESS ADDRESS:12g1B RALPu AV 4UC F, ZCC L'i 4 hl.4 1 1 23(0 RESIDENT ENGINEER NAME: TELEPHONE #: (

PROJECT DESCRIPTION: 13u~Let14ç (roc VP ACTQVIT%ES -co (ZEMOVE OEf3RtS CROM LO A SC o(- S. T... CONTRACT START DATE: 5 1 i5 IDZ CONTRACT COMPLETION DATE: 9I 12-I O Z

TYPE OF PAVEMENT: ROADTW: SIDE LE:

TYPE OF P CT(S) REQUESTED (Check All Applicable): 0111-MAJOR INSTALLATION-SE 0126-TEST PITS, CORES OR BORING CRANE/SHOVEL ON STREET 0112-RAPID TRANSIT CONSTRUCTION 0132-INSTALL FENCE 0205-PLACE SHANTI/TRAILER ON 0113-REPAIR TATER 0135-FINAL RESTORATION STREET 0114-REPAIR SERER 0136-DEP-l~.7OR INSTATLATIONS- 0208-TEMPORARY PEDESTRIAN TIIILK 0115-REPAIR TFR/SEWER TOLTER 0211-TEMPORARY ROADWAY CLOSING 0116-FUEL OIL LINE 0137-DEP-MAJOR IDSTALLATIONS- 0214-PLACE CONTAINER ON STREET 0118-RESET,REPAIR OR REPLACE SERER 0215-TEMPORARY SIDEWALK CLOSING CURB 0201-PLACE MA' TAL ON STREET 0401-REPAIR SIDEWALK 0119-PAVE STREET 0202-CROSSING SIDEWALK 0402-CONSTRUCT NEW SIDEWALK 0120-TREE PIT 0203-PLACE CRANE/SHOVEL ON 0403-REPLACE SIDEREtLK 0121-CONSTRUCT OR ALTER MANHOLE STREET VENTILATORS AND/OR CASTING 0204-PLACE FQUIPAENT OTHER THAN OTHER TYPE OF PERMIT:

Of STREET L AR WORK WORE FPOr STREET TO STREET FEET START E®

rR.rrc STT7L:.:IONi:

!TIC

•TI_

SPECIAL STIPULATIONS:

OCMC APPROVAL BY: DATE: 1Ii0RE LOCATIONS ON REVERSE THE P T TO BE GRANTED SUBJECT TO THE FOLLOWING CONDITIONS: THE APPLICANT AGR=S TO COMPLY WITS ALL LAWS AND RULES OF THE DEPARTI-M T AND OTHER APPLICABLE LARS AND RULES. NO PMOCT SBALL BE ISSUED UNLESS THE APPLICANT HAS ON FILE ALL INSURANCE(BONDS).

APPROVED FOR TSE COMHISSIONER BY: SUBMITTED BY: DATE:

DATE: SIGNED BY: k AOTBORIZED RFPRF.SFSTTATIVF. OF APPLICANT

NYC-WTC 000111840