Raze Applications Applied for: November 10 - December 5, 2016 · Plumber's Name 34. Plumber's...

18
Raze Applications Applied for: November 10 - December 5, 2016 STATUS DATE ID Address Description of Work PER SUB TYPE DCRA Notice Date ANC Expiration Date SSL ANC Zoning Applicant 11/30/2016 R1700033 1313 IRVING ST NW, WASHINGTON, DC 20010 RAZE BRICK GARAGE Raze December 6, 2016 January 19, 2017 2848 0804 1A RF-1 SHEBA 11/14/2016 R1700028 5708 SHERIER PL NW, WASHINGTON, DC 20016 RAZE A 1.5 STORY SFD Raze December 6, 2016 January 19, 2017 1452 0830 3D R-1-B PRICE 11/15/2016 R1700029 3702 HARRISON ST NW, WASHINGTON, DC 20015 TWO STORY BRICK BUILDING SINGLE FAMILY DWELING Raze December 6, 2016 January 19, 2017 1877 0041 3G R-1-B JAN MARUT 12/5/2016 R1700034 3701 NEW HAMPSHIRE AVE NW TWO STORY MIXED USE BUILDING STORE RESTAURANT Raze December 6, 2016 January 19, 2017 3030 0805 4C FONTANA 11/28/2016 R170031 2812 Georgia AVE NW Two story semi-detached brick dwellling Raze December 6, 2016 January 19, 2017 2886 0330 1B MU-4 BROWN Farideh Anaraki 11/28/2016 R170030 2814 Georgia AVE NW Two story semi-detached brick dwellling Raze Decemer 6, 2016 January 19, 2017 2775 0330 1B MU-R BROWN 11/28/2016 R1700032 331 N ST NE, WASHINGTON, DC 20002 RAZE A TWO STORY BRICK BUILDING Raze December 6, 2016 January 19, 2017 0772 0023 6C PDR-1 CASSIE 331 N JUST LLC 2814 Georgia Ave LLC PETER J LYDON RAM K CHOPRA LAURA M PETAWAY Owner Name 1 of 1 Department of Consumer and Regulatory Affairs(DCRA) 1100 4th St, SW Washington, DC 20024

Transcript of Raze Applications Applied for: November 10 - December 5, 2016 · Plumber's Name 34. Plumber's...

Page 1: Raze Applications Applied for: November 10 - December 5, 2016 · Plumber's Name 34. Plumber's License Number 35. Raze Method (ball, bulldozer, by hand, etc.) I frso I Bulldozer I

Raze Applications Applied for: November 10 - December 5, 2016 STATUS

DATE

ID Address Description of Work PER

SUB

TYPE

DCRA Notice

Date

ANC Expiration

Date

SSL ANC Zoning Applicant

11/30/2016 R1700033 1313 IRVING ST NW, WASHINGTON, DC

20010

RAZE BRICK GARAGE Raze December 6, 2016 January 19, 2017 2848

0804

1A RF-1 SHEBA

11/14/2016 R1700028 5708 SHERIER PL NW, WASHINGTON, DC

20016

RAZE A 1.5 STORY SFD Raze December 6, 2016 January 19, 2017 1452

0830

3D R-1-B PRICE

11/15/2016 R1700029 3702 HARRISON ST NW, WASHINGTON, DC

20015

TWO STORY BRICK BUILDING SINGLE

FAMILY DWELING

Raze December 6, 2016 January 19, 2017 1877

0041

3G R-1-B JAN MARUT

12/5/2016 R1700034 3701 NEW HAMPSHIRE AVE NW TWO STORY MIXED USE BUILDING STORE

RESTAURANT

Raze December 6, 2016 January 19, 2017 3030 0805 4C FONTANA

11/28/2016 R170031 2812 Georgia AVE NW Two story semi-detached brick dwellling Raze December 6, 2016 January 19, 2017 2886 0330 1B MU-4 BROWN Farideh Anaraki

11/28/2016 R170030 2814 Georgia AVE NW Two story semi-detached brick dwellling Raze Decemer 6, 2016 January 19, 2017 2775 0330 1B MU-R BROWN

11/28/2016 R1700032 331 N ST NE, WASHINGTON, DC 20002 RAZE A TWO STORY BRICK BUILDING Raze December 6, 2016 January 19, 2017 0772

0023

6C PDR-1 CASSIE 331 N JUST LLC

2814 Georgia Ave LLC

PETER J LYDON

RAM K CHOPRA

LAURA M PETAWAY

Owner Name

1 of 1 Department of Consumer and Regulatory Affairs(DCRA)

1100 4th St, SW Washington, DC 20024

Page 2: Raze Applications Applied for: November 10 - December 5, 2016 · Plumber's Name 34. Plumber's License Number 35. Raze Method (ball, bulldozer, by hand, etc.) I frso I Bulldozer I

* •* * wr:;:ARr:;: WAS~ I WA5~1NGTON

oc Government of the District of Columbia

Department of Consumer and Regulatory Affairs Permit Operations Division

1100 4th Street SW

Washington DC 20024 Tel. (202) 442- 4589 Fax (202) 442- 4862

TO SCHEDULE INSPECTIONS PLEASE CALL (202) 442 - 9557

oece•ven n NOV 1 7 2016 u BY:. ___ _

Date: November 15, 2016 Cap ld : R1700029

D.C. Historic Preservation Office 1100 4th Street S.W., Rm E650

Washington, DC 20024

Re: Request for clearance of premises subject to razing operations

An application to raze the structure identified below, located in the District of Columbia, was filed on

this date with the Permit Operations Division. Our records do not reveal any kind of conservation holds

on this property. We are hereby requesting confirmation from your office, in order to release the subject

permit.

Address:

3702 HARRISON ST NW

LOT: 0041 SQUARE: 1877 TYPE: VACANT: Yes

Please notify our office of the satisfactory completion of your inspection of the premises, by fill ing out

the clearance section below and returning this form to the D.C.R.A. Perm it Operations Division, II 00 4th Street S .W .. Wllshin!ltnn n .r.. 20024 .

CLEARANCE

This is to inform you that we researched our records concerning the structure identified above and we

have no objections to proceeding with the proposed razing of said structure.

Date: Signature: ---------------------------------------

Name of releasing HPO Official. (print)

Page 9 of 13

Page 3: Raze Applications Applied for: November 10 - December 5, 2016 · Plumber's Name 34. Plumber's License Number 35. Raze Method (ball, bulldozer, by hand, etc.) I frso I Bulldozer I

--_ . ._ __ , , __ _ ·-·

Government of the District of Columbia • ..I ...

:: f t t :l II ~ :;~

:: .:: II J I :: i: I I I . :.; ~ :. = :: t r•t• ::I I:::: 1 . 1::: APPLICATION FOR RAZE PERMIT

nEN.TM!.''T OF COXD!Ml1\ & Ulitit.l10t:l o\!'FAI~

4. DESCRIPTION OF BUILDING 15. DescripUon of Building to be Razed (e.g., two story brick single family dweHing) 16. Existing Number of Stories of Bldg:

})y_~_!roP. L~~~ c,K, fJ!~i_WlJI'JG 'S1tv~t.li PAf1H .. f :D~ fi..J.-t..tiVh

REVUIU Page 1 of 5 Effective April 9, 2009

Page 4: Raze Applications Applied for: November 10 - December 5, 2016 · Plumber's Name 34. Plumber's License Number 35. Raze Method (ball, bulldozer, by hand, etc.) I frso I Bulldozer I

SECTION A. RAZE PERMIT 23. Raze Contractor's Name 24. Contractor's Address (including zip code) 25. Contractor's Phone

26. Historic District? [JYes 33. Raze Contractor Signature

27.CFA? [JYesiJNo

28. Raze Entire Building? 34. Property Owner Signature

29. Building Condemned?

30a. Party Wall?

31 . Building Vacant?

32. Public Space Vault?

REVtj,{U

Page 2 of 5 Effective Apnl 9, 2009

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Page 1 of 1

1877 0041 08/08/2004

http:l/citizenatlas.dc.gov/mobilevideo/20040808/081 04658.jpg 11117/2016

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3030 0805 08/19/2004

3701 New Hampshire Avenue NW

Page 7: Raze Applications Applied for: November 10 - December 5, 2016 · Plumber's Name 34. Plumber's License Number 35. Raze Method (ball, bulldozer, by hand, etc.) I frso I Bulldozer I

* * * ~ oc Government of the District of Columbia Department of Consumer and Regulatory Affairs

Permit Operations Division

11 00 4th Street SW

Washington DC 20024

Tel. (202) 442 - 4589 Fax (202) 442- 4862 TO SCHEDULE INSPECTIONS PLEASE CALL (202) 442 - 9557

n-o~~~~~~~ I:W:.---

Date: November 28, 2016 Cap ld : R1700030

D.C. Historic Preservation Office 1100 4th Street S.W., Rm E650

Washington, DC 20024

Re: Request for clearance of premises subject to razing operations

An application to raze the structure identified below, located in the District of Columbia, was filed on

this date with the Permit Operations Division. Our records do not reveal any kind of conservation holds

on this propetty. We are hereby requesting confitmation from your office, in order to release the subject

permit.

Address:

2812 GEORGIA AVE NW

LOT: 0331 SQUARE: 2886 TYPE: Single Family VACANT: Yes

Please noti fy our orti ce of the sati sfactory completi on of your inspection of the premi ses, by fill ing out

the clearance section below and returning thi s form to the D.C.R.A. Permit Operati ons Divis ion. II 00 4th Street S .W .. W:o~shim>ton 0 .1.. 20024.

CLEARANCE

This is to inform you that we researched our records concerning the structure identified above and we

have no objections to proceeding with the proposed razing of said structure.

Date: Signature: -------------------

Name of releasing HPO Official. (print)

Page 9 of 13

Page 8: Raze Applications Applied for: November 10 - December 5, 2016 · Plumber's Name 34. Plumber's License Number 35. Raze Method (ball, bulldozer, by hand, etc.) I frso I Bulldozer I

Print Form . :: = a I I ~

ill P,U.IIl' 1 nr CO\\U\\IR& RIGlHIORI.\1 I.IIRI

Government of the District of Columbia

APPLICATION FOR RAZE PERMIT

Application can be downloaded and is fillable except for signature area. If not filling out on computer, please type or print legibly in ink. Please provide detailed information. Write N/ A (non-applicable) for items that do not apply. Erasing, crossing out, whiting out, or otherwise altering any entered information will void this application. The owner of record must sign the application with an original signature.

Applicable code sections are in the 2008 DC Building Code Supplement Chapter I§ 105.1. 7, 105.1.7.1, 105.1.7.1.1, 105.1.7.1.2, 105.1.7.2, and Section 155A.

Application Date: I I 1. INFORMATION ON PROPERTY

1. Address of Proposed Work 2. Quad 3. Ward 4a. Square 4b. Suffix 5. Lot

~2812 Georgia Ave IEJ ~ fs86

I ~ 1110331

2. APPLICANT INFORMATION 6. Property Owner 7. Complete mailing address (include zip) 8. Phone Number(s) 9. Email

[Farideh Anaraki ~~~1144 Halesworth Dr, Potmacm MD II II [ 13. Email 10. AgenUContractor for Owner (if applicable) 11. Complete mailing address (include zip) 112. Phone Number(s)

lAshiey Brown I 4802 Fort Totten Drive NE, Wash DC

IE! Raze Permit

4. DESCRIPTION OF BUILDING 15. Description of Building to be Razed (e.g ., two story brick single family dwelling) 16. Existing Number of Stories of Bldg:

Fwo story common brick I Ewo I 17. Use(s) of Property (specifically indicate if any use is residential.) 18. Materials of Building (brick, wood , etc.)

I

![Residential IIBrick I 19. Bldg Length (ft) 20. Bldg Width (ft) 21. Bldg Height (ft) 22. Bldg Volume (cu ft) (L x W x H)

[ L{ l I I

r).o . 5 I ~ ~Cj II ~3 I 53Lj I OFFICIAL USE ONLY

CONDITIONS/ COMMENTS:

REVll/11

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SECTION A. RAZE PERMIT 23. Raze Contractor's Name 24. Contractor's Address (including zip code) 25. Contractor's Phone

I~BD I~BD I Eso I 26. Historic District? DYes~No 33. Raze Contractor Signature

27.CFA? DYesiE] No

28. Raze Entire Building? rEJYesO No 34. Property Owner Signature

29. Building Condemned? DYes~No

30a. Party Wall? ~YesONo 30b. If yes, adjacent property owner signature is required .

30c. Any raze permit application for a building(s) involving party walls must be include 2 copies of a plan that show how the party wall(s) will be protected.

31 . Building Vacant? ~YesDNo Building must be vacant before Raze Permit issuance.

32. Public Space Vault? DYes IE] No Official Use Only Fee By Date

33. Plumber's Name 34. Plumber's License Number 35. Raze Method (ball , bulldozer, by hand, etc.)

Eso I frso I Bulldozer I 1. You must submit a Certificate of Insurance covering the raze operation/contractor- unless the building you plan to raze is an accessory building 500

square feet or less in area and not more than one story, wholly detached from any other building on the same or adjoining premises.

2. The Certificate should:

• Show the holder of the insurance as: Deputy Director, Permit Division, 1100 4th St SW, Washington, DC 20024 • Include a 30-day advance notice cancellation clause .

• Include these amounts of insurance coverage: Bodily Injury, $100,000; Aggregate, $300,000; and Property Damage, $100,000 . • State that the insurance covers "Razing Operations in the District of Columbia," if the scope of the insurance is for blanket coverage .

• If the insurance is for one specific address only, state that, "Razing Operations at " (address of raze operation)

36. Insurance Company 37. Policy or Certificate No. 38. Expiration Date

I 39. Asbestos in Building? I DYesDNo Official Use Only If yes, indicate location:

Fee By Date

REV U/11

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2886 0331 08/30/2004

http:/ I citizenatlas .de. gov /mo bilevideo/200408 30/D U 1 003 52 .j pg 12/5/2016

Page 11: Raze Applications Applied for: November 10 - December 5, 2016 · Plumber's Name 34. Plumber's License Number 35. Raze Method (ball, bulldozer, by hand, etc.) I frso I Bulldozer I

* * * W[;_ARr;_ WASHIHdTO,..

oc Government of the District of Columbia

Department of Consumer and Regulatory Affairs

... ~,\..;E - • .....- tr' IVE~ ,, DEC 0 5 2016

Permit Operations Division

1100 4th Street SW

Washington DC 20024

Tel. (202) 442 - 4589 Fax (202) 442- 4862 TO SCHEDULE INSPECllONS PLEASE CALL (202) 442 • 9557

Date: November 28, 2016

D.C. Historic Preservation Office llOO 4th Street S.W., Rm E650

Washington, DC 20024

Re: Request for clearance of premises subject to razing operations

Cap (d:

BY:----

R1700031

An application to raze the structure identified below, located in the District of Columbia, was filed on

this date with the Permit Operations Division. Our records do not reveal any kind of conservation holds

on this property. We are hereby requesting confirmation from your oft1ce, in order to release the subject

permit.

Address:

2814 GEORGIA AVE NW

LOT: 0330 SQUARE: 2886 TYPE: Single Family VACANT: Yes

Please notifY our office of the satistactory completion of your inspection of the premises. by tilling out

the clearance section below and returning this form to the D.C.R.A. Permit Operations Division, II 00

4th Street S .W .. WilshinPton O .l. . 20024.

CLEARANCE

This is to inform you that we researched our records concerning the structure identified above and we

have no objections to proceeding with the proposed razing of said structure.

Date: ------------------ Signature: -------------------------------------

Name of releasing HPO Official. (print)

Page 9 of 13

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Print Form

fll •• 1 i . ~---...._-~

111 u n 111 1:: u a t:

••• .:: n:••• fu n c :: 1 ! 1 3 J ' J~= 0 1 '::

PI PARIMl \ 1 Ill· (ll~\U\1\R& RI(; \J LAlOR~ AI lAIR\

Government of the District of Columbia

APPLICATION FOR RAZE PERMIT

Application can be downloaded and is fillable except for signature area. If not filling out on computer, please type or print legibly in ink. Please provide detailed information. Write N 1 A (non-applicable) for items that do not apply. Erasing, crossing out, whiting out, or otherwise altering any entered information will void this application. The owner of record must sign the application with an original signature.

Applicable code sections are in the 2008 DC Building Code Supplement Chapter I§ 105.1.7, 105.1. 7.1, 105.1.7.1.1, 105.1.7.1.2, 105.1.7.2, and Section 155A.

Application Date: I

1

1

1. INFORMATION ON PROPERTY 1. Address of Proposed Work 2. Quad 3. Ward 4a. Square 4b. Suffix 5. Lot

~281 4 Georgia Ave IEJ EJ 12886 II lll0330 I 2. APPLICANT INFORMATION

6. Property Owner 7. Complete mailing address (include zip) I 8. Phone Number(s) 9. Email

2814 Geogia Ave LLC 709 Oak Knoll Ter, Rockville, MD II I 10. AgenUContractor for Owner (if applicable) I 11 . Complete mailing address (include zip) I 12. Phone Number(s)

!f 802 Fort Totten Drive NE, Wash DC

IE! Raze Permit

4. DESCRIPTION OF BUILDING 15. Description of Building to be Razed (e.g. , two story brick single family dwelling) 16. Existing Number of Stories of Bldg :

'Ywo story vinyl siding I E wo I 17. Use(s) of Property (specifically indicate if any use is residential.) 18. Materials of Building (brick, wood , etc.)

~Residential I Einyl siding I 19. Bldg Length (ft) 20. Bldg Width (ft) 21 . Bldg Height (ft) 22. Bldg Volume (cu ft) (L x W x H)

I 41 I ~ C).() · 5 I ~ !J.-( I ~ d-3 , 5 3tf I OFFICIAL USE ONLY

CONDITIONS/ COMMENTS:

REVll/ll

Page 1 of 5 Effective April 9, 2009

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SECTION A. RAZE PERMIT 23. Raze Contractor's Name 24. Contractor's Address (including zip code) 25. Contractor's Phone

Eso I ~TBD II~BD II

26. Historic District? ICJYes~No 33. Raze Contractor Signature

27. CFA? D Yesi!E] No

28. Raze Entire Building? ~YesONo 34. Property Owner Signature

29. Building Condemned? ICJYes~No

30a. Party Wall? IEJYes D No 30b. If yes, adjacent property owner signature is required.

30c. Any raze permit application for a building(s) involving party walls must be include 2 copies of a plan that show how the party wall(s) will be protected.

31 . Building Vacant? ~YesiCJNo Building must be vacant before Raze Permit issuance.

32 . Public Space Vault? IDYes~No Official Use Only Fee By Date

33. Plumber's Name 34. Plumber's License Number 35. Raze Method (ball, bulldozer, by hand, etc.)

Eso I I~BD I BD I

1. You must submit a Certificate of Insurance covering the raze operation/contractor- unless the building you plan to raze is an accessory building 500 square feet or less in area and not more than one story, wholly detached from any other building on the same or adjoining premises.

2. The Certificate should:

• Show the holder of the insurance as: Deputy Director, Permit Division, 1100 4th St SW, Washington, DC 20024 • Include a 30-day advance notice cancellation clause .

• Include these amounts of insurance coverage: Bodily Injury, $100,000; Aggregate, $300,000; and Property Damage, $100,000 . • State that the insurance covers "Razing Operations in the District of Columbia," if the scope of the insurance is for blanket coverage .

• If the insurance is for one specific address only, state that, "Razing Operations at " (address of raze operation)

36. Insurance Company 37. Policy or Certificate No. 38. Expiration Date

I 39. Asbestos in Building? OYesfD No Official Use Only If yes, indicate location:

Fee By Date

- ---

REV 11/ll

Page 2 of 5 Effective April 9, 2009

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Page 1 of 1

2886 0330 08/30/2004

http:/ /citizenatlas.dc.gov/mobilevideo/20040830/DU 1 00405 .jpg 12/5/2016

Page 15: Raze Applications Applied for: November 10 - December 5, 2016 · Plumber's Name 34. Plumber's License Number 35. Raze Method (ball, bulldozer, by hand, etc.) I frso I Bulldozer I

* * * W (:; A R(:; WASHINGTON

oc Government of the District of Columbia

Department of Consumer and Regulatory Affairs Permit Operations Division

1100 4th Street SW

Washington DC 20024

Tel. (202) 442 - 4589 Fax (202) 442 - 4862 TO SCHEDULE INSPECTIONS PLEASE CALL (202) 442 • 9557

Date: November 28, 2016

D.C. Historic Preservation Office 1100 4th Street S.W., Rm E650

Washington, DC 20024

Re: Request for clearance of premises subject to razing operations

Cap ld: R1700032

RECEIVEq NOV 2 8 2016 li

BY:-------=

An application to raze the structure identified below, located in the District of Columbia, was filed on

this date with the Permit Operations Division. Our records do not reveal any kind of conservation holds

on this property. We are hereby requesting confirmation from your office, in order to release the subject

permit.

Address:

331 NSTNE

LOT: 0023 SQUARE: 0772 TYPE: VACANT: Yes

Please notify our office of the satisfactory completion of your inspection of the premises, by filling oul

the clearance section below and returning this form to the D.C. R.A. Permit Operations Division, 1100 4th Street S .W .. W;;~shin Dtnn n .r.. 20024 .

CLEARANCE

This is to inform you that we researched our records concerning the structure identified above and we

have no objections to proceeding with the proposed razing of said structure.

Date: Signature: ---------------------------------------

Name of releasing HPO Official. (print)

Page 9 of 13

Page 16: Raze Applications Applied for: November 10 - December 5, 2016 · Plumber's Name 34. Plumber's License Number 35. Raze Method (ball, bulldozer, by hand, etc.) I frso I Bulldozer I

Government of the District of Columbia I_ Print Form :J

APPLICATION FOR RAZE PERMIT

Application can be downloaded and is fillable except for signature area. If not filling out on computer, please type or print legibly in ink. Please provide detailed information. Write N j A (non-applicable) for items that do not apply. Erasing, crossing out, whiting out, or otherwise altering any entered information will void this application. The owner of record must sign the application with an original signature.

Applicable code sections are in the 2008 DC Building Code Supplement Chapter I§ 105.1.7, 105.1.7.1, 105.1.7.1.1, 105.1.7.1.2, 105.1.7.2, and Section 155A.

~ 11 000 'Z.. Application Date : I //. t S ' I{;J 1. INFORMATION ON PROPERTY

1. Address of Proposed Work 2. Quad 3. Ward 4a. Square 4b. Suffix 5. Lot

1331 N Street """ IIEJ ~ 1772 II[ 1123

2. APPLICANT INFORMATION 6. Property Owner 7. Complete mailing address (include zip) 8. Phone Number(s) 9. Email

1331 N Just, LLC_

10. Agent/Contractor for Owner (if applicable)

~ Raze Permit

4. DESCRIPTION OF BUILDING 15. Description of Building to be Razed (e.g., two story brick single family dwelling) 16. Existing Number of Stories of Bldg:

IITwo story brick commercial/retail building 1112 17. Use(s) of Property (specifically indicate if any use is residential.) 18. Materials of Building (brick, wood, etc.)

I com merciai/Retail II IBrick

19. Bldg Length (ft) 20. Bldg Width (ft) 21 . Bldg Height (ft) 22 . Bldg Volume (cu ft) (L x W x H)

II

I II

1164' 111129 11137' lllh1 c. ')(\Q

J ll' I OFFICIAL USE ONLY

CONDITIONS/ COMMENTS: f-82, 1-T'J-.. et.l~.

REV :1.:1./ :U

Page 1 of 5 Effective April 9, 2009

Page 17: Raze Applications Applied for: November 10 - December 5, 2016 · Plumber's Name 34. Plumber's License Number 35. Raze Method (ball, bulldozer, by hand, etc.) I frso I Bulldozer I

SECTION A. RAZE PERMIT 23. Raze Contractor's Name 24. Contractor's Address (including zip code) 25. Contractor's Phone

IFoulger-Pratt C?ntracting 1112435 Park Potomac Ave, Potomac, M~l~r2-4-0--4-9-9---9-60-0---------~JI 26. Historic District? DYes IE] No 33. Raze Contractor Signature~ ? r--J ~

27. CFA? 0 YesiE!J No ~----_/

8--i : ~1\ N J\lSt J L-L-~ k \~ , ' 28. Raze Entire Building? IEJYes 01 No 34. Property Owner Signat~u~e ~

29. Building Condemned? DYes IE! No ~_X"')j_ ~

30a. Party Wall? DYes 1EJ No 30b. If yes, adjacent prop~ rty~sitrflature is required.

30c. Any raze permit application for a building(s) involving party walls must be include 2 copies of a plan that show how the party wall{s) will be protected.

31. Building Vacant? IEJYes D No Building must be vacant before Raze Permit issuance.

32. Public Space Vault? DYes IE! No Official Use Only Fee By Date

33. Plumber's Name 34. Plumber's License Number 35. Raze Method (ball , bulldozer, by hand, etc.)

IFoulger-Pratt Contracting II ~ 5_026~44 I Bulldozer j 1. You must submit a Certificate of Insurance covering the raze operation/contractor- unless the building you plan to raze is an accessory building 500

square feet or less in area and not more than one story, wholly detached from any other building on the same or adjoining premises. 2. The Certificate should:

• Show the holder of the insurance as: Deputy Director, Permit Division, 1100 4th St SW, Washington, DC 20024 • Include a 30-day advance notice cancellation clause. • Include these amounts of insurance coverage: Bodily Injury, $100,000; Aggregate, $300,000; and Property Damage, $100,000. • State that the insurance covers "Razing Operations in the District of Columbia," if the scope of the insurance is for blanket coverage. • If the insurance is for one specific address only, state that, "Razing Operations at •

(address of raze operation)

36. Insurance Company 37. Policy or Certificate No. 38. Expiration Date

I Lib-e..~±'fMvhlUA..If'ISU~ComPG~ \l32.-"'Z..'SI-Z..~12\3-oHo II IO{Oij1.617 II 39. Asbestos in Building? I DYes IE! No Official Use Only If yes, indicate location:

Fee By Date

REV :li/:1.1

Page 2 of 5 Effective April 9, 2009

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