Contract permit application for pavement work, Sept 2002

NYC 9/11 Public Portal Document

1 APPLICA770N FOR CONTRACT PFRAf1T s ~iewYorkCRy o(Transpotfadon o(Permoit Manoonn of and Conseaetion Control !C.1 (REV.8-98)FRONT

PERMITTEE (IBrO #: CONTRACT a: ZI nr -R Enr7 ! BOROUGH: SIM ❑B ❑Q ❑x Os Dc ❑BNEC OQEC OBXEC OREC OCMC# SPONSORING AGENCY: 91DEP ODDC ❑DOT ONYSDEC ONYSEDC OD ❑PARRS ❑SEA Oh ❑PA of NY4W

PROJECT ENGINEER NAME: 'R . ZI AA H AK R i Sl-IN Ala "Q E ¶T =soNE #: (1 ) S9 5 - _9'7 18 NAME of COIT1TtACTOR:Ae}ieylRehnp_G`ia4ien'T,nc IF~be►'Gort+'' HONE #: ( ) 181-3000 BUSINESS ADDRESS: J 3pIb ~i urnS Avenue I Wan N.`I 11783 RESIDENT ENGINEER NAME: TELEPHONE •: (

PROTECT DESCRIPTION: kIinn Px4erbr ('.IPAntin 4o Re-vrlrcue 1--6s Cron LwallOPS of W)G CONTRACT START DATE: S is IA Z CONTRACT COMPLETION DATE: 9)1Z 2

TYPE OF PAVEMENT: ROADW : SIDEWALK: TYPE OF PERMITS) REQUESTED (Check Al]. Applicable) : 0111-MAJOR INSTAL A•ION-SERER 0126-TEST PITS, CORES OR BORING CRANE/SHOVEL ON STREET 0112-RAPID TRANSIT CONSTRUCTION 0132-INSTALL FENCE 0205-PLACE SHANTY/TRAILER ON 0113-REPAIR W= D135-P L RESTORATION STREET ❑114-REPAIR SEWER D136-DEP-MAJOR INST7 LASTONS- 0208-TEMPORARY PEDESTRIAN 'BALK 0115-REPAIR 1 /SIWER _ TER 0211-TEMEORARY RAADWAX CLOSING 011 -FUEL OIL LINE 0137-DEP-MA.TOR INSTALLATIONS- 0214-PLACE CONTAINER ON STREET 0118-RESET, REPAIR OR REFLA= SEWER 0215-TEMPORARY SIDEWALK CLOSING CORE 0201-PLACE bM31RIAL ON STREET ❑401-REPAIR SIDEWALK 0119-PAVE STREET 0202-CROSSING SIDEWALK 0402-CONSTRUCT NEW' SIDEWALK 0120-TREE PIT 0203-PLACE CRANE/SHOVEL ON 0403-REPL7CE SIDEWALK 0121-CONSTRUCT OR ALTER MANHOLE STREET VENTILATORS AND/OR CASTING 0204-PLACE EQUIP T OTHER THAN OTHER TYPE OF PERMIT: s WORK WORK ON sTRZTr E1 t STREET TO STREET FEET START III)

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SPECIAL STIPULATIONS:

OCNC APPROVAL BY: DATE: ' 5oRE LOCATIONS ON REVERSE

THY PERYST TO BE GRANTED SUBJECT TO TBE FOLLOWING CONDITIdNS: THE APPLICANT AGREES TO COMPLY WITS ALL SAWS Alm RULES OF TNT DEPARTMENT AND OTBER APPLICABLE LAWS Alm RULES. NO PERMIT SHALL BE ISSUED UNLESS TEE APPLICANT HAS ON FILE ALL INSURANCE(BONDS).

APPROVED FOR THE COMISSIONER BY: SUBMITTED BY: DATE:

DATE: SIGNED BY: /. . PL c) '- -- TEL. # ( AUTsO_RIZED REPRESENTATIVE OF APPLICANT

NYC-WTC 000111869