NYC 9/11 Public Portal Document
_.ONe1~YorkCay APPLIC,A770W FOR CONTRACT PERMIT
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PERMIT Nt1 ER: -L 5c
PEMETTEE(IBO#: CONTRACT #: F?OC - RcM3
BOROUGH: RM Os OQ OX Os Dc OBNEc OQEC OBxEC OREC OC 4C#
SPONSORING ).GENCY: ®DEP ODDC ODOT ONYSDEC ONYSEDC OHPD OPARKS OSCA OMTA DPA of NTLN:T
PROJECT ENGINEER NAME:R, '~gpHAKR~SN/dAN P.%. TELEPHONE #: ('l('L•) SC(5-~'7t43
NAME OF CONTRACPORTR0 ASDcSTOS Zt iMDVAL CO . TELEPHONE #: (Z; '2 ) /(,1-4IOO
BUSINESS ADDRESS: ALI- 2 O t2) 90% -IT {135Co
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RESIDENT ENGINEER NAME: TELEPHONE #. ( )
PROJECT DESCRIPTION: _ _ _ _b l /J - E'X`T R C(cp.4uP /aGTlvyrtES TO REMovc ,RtS FROAA
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CONTRACT START DATE: '5 2. BI 102 CONTRACT CO_*0 IETION DATE: 9 /2 502
TYPE OF PAVEM NT: ROADWAY: SIDEWALK•
TYPE OF PE MXT(S) REQUESTED (Check All Applicable) :
0111-MAJOR INS LL TION-SEWER 0126-TEST PITS, CORES OR BORING CRANE/SHOVEL ON STREET
0112-RAPID TRANSIT CONSTRUCTION 0132-INSTALL FENCE 0205-PLACE SHANTY/TRAIIER ON
0113-REPAIR WATER 0135-ET2 L RESTORATION STREET
0114-REPAIR SEWER D136-DEP-2A<TOR INSTALLATIONS- D208-TEMPORARY PEDESTRIAN SNiLdc
10115-REPAIR .'(ER/SEWER IEU!ER 0211-TEMPORARY ROADWAY CLOSING
D116-FUEL OIL LUTE 0137-DEP-MAJOR INSTALLATIONS- 0214-PLACE CONTAI2WR ON STREET
0118-RESET,PEPAIR OR REPLACE SLNZR 0215-TEMPORARY SIDEWALK CLOSING
f CURB 0201-PLACE MATERIAL ON STREET 0401-REPAIR SIDEWALK
0119-PAVE STREET 0202-CROSSING SIDEWALK 0402-CONSTRUCT NEW SIDEWALK
0120-TREE PIT 0203-PLACE CRANE/SHOVEL ON ❑403-REPLACE SIDEWALK
/ D122-CONSTRUCT OR STREET
ALTER 2ANROLE VENTILATORS
AND/OR CASTING 0204-PLACE EQUIPMENT OTHER THAN
1 OTHER TYPE OF PERMIT:
ON STREET FROH TR AR WORK WORK
TO STREET TFE]T S28IG END
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SPECIAL STIPOS.ATIONS:
OCMC APPROVAL BY: DATE: ❑MORE LOCATIONS ON REVERSE
THE PERMIT TO BE GRANTED SUBJECT TO THE FOLLOWING CONDITIOItS:
THE APPLICANT AGREES TO CONEY WITH ALL LAWS AND RULES OF TEE DEPARTMENT- AND OTHER APPLICABLE LABS AND RULES.
NO PERMIT SHALL BE ISSUED 0N:2SS THE APPLICANT HAS ON FILE ALL INSURANCE(BONDS).
APPROVED FOR THE COMMISSIONER BY: SUBMITTED BY: DATE:
DATE: SIGNED BY: 'C. ' rt C2: TEL. ft ( )
AUTSORIZED REPRESENTATIVE OF APPLICANT
NYC-WTC 000111850
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