Contract permit application for pavement work, Sept 2002

NYC 9/11 Public Portal Document

ewYorkcty APPLICATION FOR CONTRACT PERMIT of Trsnsporc~tion •w • ofPet•itht M:mREment and Comaoetion Control U.2 (REV.8-98) FRONT

PERMIT NUMBER: PF~TM(Isw#: 1 1 5 -7 FS CONTRACT #: Qoc - 9-etAA BOROUGH: fl M OB OQ OX OS OMEC OBNEC OQEC OBXEC OPEC OCMC# SPONSORING GE CT: ODEP QDDC ODOT ONYSDEC ONYSEDC [JHPD OPARFCS ❑SCA O OPA of NYLNJ PROJECT ENGINEER NATSE:Q~ 2r P.r>1..~A lcRisx .1 ( P. C . aONE #: (1 6 6) sC'(5 - 3718

NAME OF CONTRACTOR: F\C'r.owl REMGDIAT(Onl .tNl( t ASeeCon1're0LTEL PHONE #: ( (o ) 7 3 t -3000 BUSINESS ADDRESS: 3010 -t 3ueaS AvCn+us WA %74 3 RESIDENT ENGIIEER NAM: TELEPHONE #: ( )

PROJECT DESCRIPTION:,:AIL-bti.l(r tli"(E(210(Z LEAN-uP AC-r J /c €S 'Tp ►ZEMDye 'nEP,;LtS CQi & COLLAYC o CONTRACT START DATE: __ 5 1 15102. CONTRACT COMPLETION DATE: 9112102 TYPE OF PAVEMENT: ROAD : SIDEWALK: TYPE OF PIN T(S) REQUESTED (Check Al]. Applicable): 0111-MAJOR INSTALLATION-SERER 0126-TEST PITS, CORES OR BORING CRANE/SHOVEL. ON STREET 0112-RAPID TRANSIT CONSTRUCTION 0132-INSTALL PENCE 0205-PLACE SHANTY/TRAILER ON 0113-REPAIR WLTERR 0135-FINAL RESTORATION STREET 0114-REPAIR SEWER 0136-DEP-NA7oR INSTAT•I TIONS- 0208-TEl4PCRARY PEDESTRIAN FIHLE 0115-REPAIR W XE,R/SEWER NA= 0211-TF.l21ORARY ROAD Y CLOSING 0116 -FUEL OIL LINE ❑137-DEP-29(.70R INSTALLATIQNS- 0214-PLACE CONTAINER ON STREET 0118-RESET,REPAIR OR REPLACE SEWER ❑215-TEMPORARY SIDE?ThLK CLOSING CURB 0201-PLACE MA' IAL ON STREET D401-REPAIR SIDEWALK 0119-PAVE STREET 0202-CROSSING SIDEWALK 0402-CONSTRUCT NEW SIDEWALK ❑120-TREE PIT 0203-PLACE CRANE/SHOVES. ON 0403-REPLACE SIDEWALK 0121-CONSTRUCT OR ALTER MANHOLE STREET VENTILATORS AND/OR CASTING 0204-PLACE EQUIPMENT OTHER THAN OTHER TYPE OF PEST:

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SPEC:LIL STIPULATIONS

OCRs APPROVAL BY: DATE: []MOPE LOCATIONS ON REVERSE TEl PERMIT TO BE GRANTED SUBJECT TO TEE FOLLOWING CONDITIOLs: THE APPLICANT AGRRES TO OOHPLY WITH ALL LARS AND RULES OF THE DEPARTMENT AND OTHER APPLICABLE TARS AND RULES. NO PERMIT SHALL BE ISSUED UNLESS THE APPLICANT HAS ON FILE ALL INSURANCE(BONDS).

APPROVED TOR THE COMMISSIONER BY: SUBMITTED BY: DATE:

DATE: SIGNED BY: I'- Il2 1~ TEL.# ( ) A 01-t - _ :yFEESENTATIVE OF APPLICANT

NYC-WTC 000111866