Contract permit application form, Oct 2001

NYC 9/11 Public Portal Document

a aE- York CSty APPLTCATTON FOR CONTRACT PF,kMTT of TranspoltzIIan of Pammt Maanaaoeat and Construction Control M11 (PEP.8-98)F1ONT

PERMIT NUMBER: PE~TTEE (IBM) #: 124 70 CONTRACT if : (~ or - R BOROUGH: ISM OB OQ ❑X Ds DC ❑BNEC ❑QEC ❑BXEC OREC OCMC# SPONSORING AGENCY: 5ZDEP QDDC ODOT ONYSDEC ONYSEDC DD DPAP1s QscA DA OPA of NTSNJ

PROJECT ENGII NAME:. RI'\ D N A K R ~ S r1 N A N TELEPHONE 4:: (718 ) 5 9 5 -Z7 ( S

NAME OF CONTRACTOR: BcNSAMIN K1.1Q2P.F ZSO►JCnw AoITTIEPHONE if : (1

BUSINESS ADDRESS:1246 RRIPu Ayct tt Cc .L-I(1 N.J i i '23fo RESIDENT ENGINEER NAME: TELEPHONE if: (

PROJECT DESCRIPTION:(3u~Lei F--1 L- txT OR Cte`nJ UP nCT,'II -T'I S To REMOVE DE(s2iS F2oM LOLLA H ' C • CONTRACT START DATE: S 1 1'5O2. CONTRACT COMPLETION DATE: g' F2 I O 2

TYPE OF PAVEMENT: ROADWIIAY: TYPE OF PERMITS) REOUESTED (Check All Applicable): 0111-MAJOR INSTALLATION-SEWER 0126-TEST PITS, CORES OR BORING CRANE/SHOVEL ON S T 0112-RAPID TRANSIT CONSTRUCTION 0132-INSTALL FENCE 0205-PLACE SHANTY/TPATTi'R ON 0113-REPAIR WATER 0135-FINAL RESTORATION STREET 0114-REPAIR SERER 0136-DEP-MA7OR INSTALLATIONS- ❑208-TEMPORARY PEDESTRIAN WALK 0115-REPAIR WATER/SEWER WATER 0211-7 ORARY ROADWAY CLOSING 0116-FUEL OIL LINE 0137-DEP-MAJOR INSTALLATIONS- 0214-PLACE CONTAIMR ON STREET 0118-RESET,REPAIR OR REPLACE SEWER 0215-TEMPORARY SIDEWALK CLOSING CURB 0201-PLACE MATFRTET. ON STREET ❑401-REPAIR SIDEWALK 0119-PAVE STREET 0202-CROSSING SIDEWALK 0402-CONSTRUCT NEW SIDEWALK 0120-TREE PIT 0203-PLACE CRANE/SHOVEL ON 0403-REPLACE SIDEWALK 0121-CONSTRUCT OR ALTER MANHOLE STREET - VENTILATORS AND/OR CASTING 0204-PLACE EQULP1~2NT OTHER THAN OTHER TYPE OF PERMIT: X AR aolm aoas on STRZET teat! STREET TO STREET FEES ST .BE E®

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SPECIAL STIPDLATZONS:

OCMC APPROVAL BY: DATE: ' ORE LOCATIONS ON REVERSE THE PERNST TO BE GRANTED SUBJECT TO TEE FOLLOWING CONDITIONS: THE APPLICANT ) S TO COLT WITH ALL LAWS AND RIILES OF TEM DEPARTMENT AND OTE412 APPLICABLE LAPS AND ROLES. NO PERMIT SSAIL BE ISSU IINLESS TEE APPLICANT WAS ON FILE ALL INSURANcE(BONDS).

APPROVED FOR THE COMMISSIONER BY: SUBMITTED BY:

DATE SIGNED BY: • Q ,-J `~`~ TEL. # ( ) AUTBOAIZID REPRESENTATIVE OF APPLICANT

NYC-WTC 000111841