NYC 9/11 Public Portal Document
ASBESTOS PROJECT NOTIFICATION 87ATB OF ►sear
YORtt
DEPARTMENT OF LABOR
Division of Ram & tieaWi
Asbestos Cents! Bureau
BuU 12 ROOM 187
Stan Campus
AOMW, NY 12240
Ciieckonly One tW ofno*adnn below.
Dial- __ Complete all sections and submit 10 calendar days prior to starting date.
Amended Submit amended notification with all sections completed and amended item(s) circled.
Cancelled. Complete Section G andattach copy of initial notification or complete all sections.
B rgamy___ ou must first cell the Program Manager's offic. the of
Conetol Bureau 18-~57•LZ33
return this form
and nB
offorr prier approval emergency thou ate
Date (_/ /_} Time ( 3 Emergency Status coed
Authorized by: (From Asbestos Control Bureau)
a.•~yy ' ~A._ '~ ~V V.
~i~iiCo W4ri'1.~.QA1~l~LiliLLr/li ~'"kG le. ~,` ( I ' . Iii: r l
ProWde all -W wry requested below
-~-~-~-~-~-~- -~-~-~- -
1. FEIN P 11 2. Asbestos Lb. No. 8 0- 01 8
-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.
3. Contractor Name and Address 4. MailIng Address (ifdprew)
l-io7nr,lrwin Pliminotlnn Cn! Samar
195H Central Avenue
Farmlngdale, New York 11735
S. Daly Authorized Representative 6. s ontcactorts)beused
Io es (Uwn arnpdereGoes below/
Nate toot told Name
Asbestos Lic. No. L,J__.1—
Tide VIC8 President
Phone No. (631)752-2898 Name
Asbestos Lm. No. E
7. Parry for Whom Work is Being Performed: Nate The Cooper Group, Inc.
Address 888 Fifth Avenue, New York, NY 10103
I BROnIEE 81TE AtT11R+(:'
Provided 4oramdon.agnssred beiow.for the btdldmp'site eowhiot the ebesms pmfatwill be sambaed.
8. P,niq t, , County New York
Name oflezilding
Room or other specific location Entire Basement. 1st and 2nd floors, roof and facade
street address 23 Thames Street
City, town or village New York, New York 10006
9. Building Information
Current use Commercial Building age
Prior Use Commercial Building size sq. ft.
10. Building Raptosenwtive/site contact Name Chanan Rozenbaum phaye No. t 2l2208-4614
F
NYC-WTC 000134205
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