NYC 9/11 Public Portal Document
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~ y coy ,, NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
Asbestos Control Program
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59-17 Junction Boulevard, 8" Floor. Carona. NY 11368-5107
ASBESTOS PROJECT NOTIFICATION
Building Dept. or TRU No
FOR OFFICIAL USE ONLY
I BE (ASBESTOS INSPECTION REPORT)
(see fee ulel
When submitting this form at the NYC Deportment of Buildings, the original form and three (3) copies with original
signatures are required. Submittal at the NYCDEP requires one copy of the form with original signatures. This
form must be submitted to the NYC DEP not less than one week in advance of the start of abatement activities .
1. FACILITY
2. Address 47 Ann St Borough Manhattan Zip —
AKA 3. Block 92 4. Lot
1 7
5. Type of Facility 6. Name of Building
II. BUILDING OWNER
7. Name 47 Ann St As sociates LLC 8. Contact Person
9.Tei.# (212) 706-3030 Fax#
10. Address - City State Zip
III. GENERAL CONTRACTOR
11. Name Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name Benjamin Kurzban & Son Control _13. Contact Person Louie lannioo
14. Federal Employer ID. 15. Tei. # (718) 531-2900 Fax #(718)2091808
16. Address 21 48 Ralph Avenue City Brooklyn State NY Zip 11236 __
V. THIRD PARTY AIR MONITOR
17. Name Warren & Panza 18. Contact Person
19. Federal Employer ID. # ___
_P I 20. Tel. # (212) 922-0077 Fax # (212) 922-0630 _
21. Address 228 East 45th St City New York State NY` Zip f 10017
22. Sample Analysis Laboratory _~ __ 23. NYS DOH ELAP #
VI. PROJECT INFORMATION
24. Starting date for this portion of work _ 4i123JO Z Projected completion date
Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Friday ❑ Saturday ❑ Sunday
Shift from: _____ ❑ am ❑ pm to ❑ am ❑ pm
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If other,
specify
Access to inspect the premises must be provided during the work schedule indicated in this item
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RECVEO
JUN 2 0 2002
25. Total amount of asbestos-containing material to be abated during this work ~1 "BAtINt cD
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Square Feet, and/or 0 Linear Feet
2/2001
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NYC-WTC 000119460
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