Fire Suppression System Installation Request, WTC

NYC 9/11 Public Portal Document

Work Permit Application I I Internal Use THE CITY OF NEI^YORK^H ■ • ' Rease File 2 Copies 100451761 __ Application Must Be Typewritten dept, of bldgs. I DEPARTMENT OF BUILOINQS

1 Filing Status X| Initial Permit I I Renewal------ - I Umited \ \ Job Numbtr

Expected Job Start Date

2 Location Borougt^ d H. k dt. O. H Block Low 1 BIN C.B.No. House No(5). 5 Street Name ll}oA.£d T/tadp Cpyitpn Apt/Condo No(s}.

Special Place Name Ftoor(s)

3 Type of Permit No Work Permh New Building Afteration Equipment Work Demolition & Removal Rumbing Boiler Standpipe Fuel Burning I I I Foundation/Earthwork B Sign I Fire Alarm

Al I Earthwork Only Construction Equipment Fuel Storage X Fire Suppression System □ For Foundation/Earthwork Permits, provide area of site; sq. fL Sprinkler Mechanical/HVAC I Curb Cut Describe:

4 AppllcanVContractor I I The following information represents a change to the original permit application. Last Nema SAIA First Name M.l. BusinessName SE^JTI^/EL rjliE CONTROL Business Phone (2J 2“594‘~05^0 INC. Address 1^5 E. 109 th. St.___________ City Metv Vofik, state NV ZIP J 00 2 9 LicenseType; Ejg 7 Lie. No. 230 C XI I shall pertorm the responsibilitiQS required ot a Superintendent ot Construction tor this job.

5 Filing Representative Complete if different from applicant Last Name QpRYSKO __________________________________ First Name ANDREW M.l. Business Name । Business Phone ( 212 ) 677 — 1940

Addrsss 500-C GRAND ST., SUITE 12 E City NYC State NY ZIP 10002

6 Insurance Compensation insurance has been secured in accordance with the requirements of the Workman's Compensation Law as follows:

X| Insurartce Certiticates/Policies on file with the Department ol Buddings I | Insurance Certificates/Policies submitted with this application insurance Company CNA Certifieate/Poliey No. 1 01 055770 Expiration Date ] 2—93

7 Statements and Signatures I hereby state that the above information is correct and complete to the best of my Applicant Name HC-nTLy SCLtd knowledge. Title PA.&.6 ♦

Falsification of any statement is a misdemeanor under Section 26-124 of the Signature Dote Administrative Code and is punishable by a fine or imprisonment, or both. 6-/5-9! It is unlawful to give to a city employee, or for a city employee to accept, any benefit, monetary or otherwise, either as a gratuity for properly performing the Job or in exchange for special consideration. Violation is punishable by imprisonment or fine or both.

Rexiste 1-90 PW-2

NYC-WTC_000166101