NYC 9/11 Public Portal Document
APPLI ATION FOR CONTRACT PERMIT
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PROJECT ENGnwm xum: R. RM1DHnKt2tSNw1J}tal t P. L° TFSEPH0IE : (ZIP) SQS-371$
NAME OF CONMACTOR: BENS1RMt N 1LuR2qA►.1 SOrt 1bn1TROL TEIBPHONE #: ( - 71 )_5 ( — 2q OO
SVSIIQESS ADDRESS: I1-4 QRtPH AVE►.ILLE 3QOOIct~JIV P3 \1 - 112$( 0
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PROJECT IMSCMI:PTTCN: .AlLhtui C'NTcf.. .,,6n_. ../1 ..-►. w.. Ac..gt —n.r"
CONTRACT START DATE:_ 1 To' . oTRALT o0MPI2 TSON RASE:
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TYPE OF PAVEMENT: ROiADi1sY: S331ERRIJ :
TYPE OF PEIRET(S) PEONESTED (Cheek All Applicable):
D111-HAJOR fTS lIOV-SEWER - E3126-TEST PITS, CORES OR BORING CRAM/SHOVEL OR STRSE'T
0112-RAPID TRANSIT CONSTRDCTIO7 13132-INSTALL PEKE 13205-PLACE SHARTR/1'AA37A ON
0113-REPA R 14LTER 0135-Ffl L BESTORATIOR STREET
0114-REPAIR SERER D136-DEP-l0).TOR IZ S77ZL SIDS- D2O8- oRARr PEDESTRIAN S01IZ
0115-REPAIit SULTER/SERERR --TER 0211-TEIO?0RARY ROADT CLOSIImG
0116-FUEL OIL LIE 0137-EIEP-HAJOR 3N LLA=CKRs- E 14-PLACE CONTAU ON STREET
[3118-RESET,REPAXR OR FZPLACE SEiiER 0215-TMORARY SIDEWM.Z C .OSD
CURS 0201-PLACE MA .UL ON STREET 0401-IMPAIR ST IJC
0119-PAVE STREET 13202-CROSSDYG SIDzRALR 0402-CONSTRUCT BEET SIDE=
0120-TREE PIT 13203-PLACE CRANE/SHOVEL ON ❑4033MML CE STEPD1LR
13121-CONSTRUCT OR ALTER lANHOLE STREET V
AND/oR CASTING 0204-PLACE EQUI N'T OTHER THAN
OTHER TYPE OF PCT:
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LACATIONs ON REVERSE
TBE P T TO BE QtANTED SUBJECT TO T8E FOLLORING 471®ITIOWS:
TBE APPLIUNT A S TO C0tRLT AITE ALL IAAS AM ROLPS OF 1'8i DEPAAng= 11W OTBER
NO PCT SBALL BE ISSUED VIC.YSS TBE APPLICANT BTS Odi PILE APPLSCABLE TARS AND 9[7f.9C_.
ALL 1J►SORANCL (BO1WS) .
APPROVED FOR THE COTSISSIO03R BY: SUBLCTTED BY: DATE:
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AVTEORIEED REPRESENTATIVE OF APPLICANT
NYC-WTC 000111858
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