Eyman Registration 2022-0t)71se of (:*—
CITY OF BLAIR
218 S 16"' Street
Blair, NE 68008
(402) 426-4191
Fax (402) 426-4195
Email: building@blairnebraska.org
FOR OFFICE USE ONLY
Date Paid: 5— w
Receipt No:
Date Issues:
BOND EXPIRES:
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1
s_
CONTRACTOR REGISTRATION / LICENSE RENEWAL
EYMAN PLUMBING Please verify and correct the
company I business
8506 S 117TH ST Information listed here:
LAVISTA NE 68128
Type of Business: CONTRACTOR LICENSE
Contact information on record:
Type: Phone Number: Type: Phone Number
Work (402)731-2727 Fax (402)731-4538
Cell
Email Address: JRYBIN TRUSTEYMAN.COM
Please submit a current reciprocating license and NDOL for° those which have expired.-
Name:
x ired:Name: Reciprocating License: Expires:
EYMAN TOM OMAHA 12/31/2021
Please sztbmit new certificates or bond renewals for those which have expired:
Name:
Certificate of Liability or Bond:
Expires:
EYMAN TOM
PLUMBING
9/24/2022
EYMAN PLUMBING
NDOL
9/15/2021
Place a check in the box next to the licenses you ivish to renew.-
Renew?
enew:
Renew? Name: License / Registration: Expires: Amount:
❑ EYMAN TOM MASTER PLUMBER 1/01/2022 60.00
218S. 16th Street
Blair, NE 68008
(402) 426 4191 FAX: (402) 426 4195
Email: building@blairnebraska.org
FOR OFFICE USE ONLY
Date Paid:
Receipt No:
Date Issued:
BOND EXPIRES:
Application is: ❑ New ❑/ Renewal
CONTRACTOR REGISTRATION/LICENSE RENEWAL
(Please type or print in ink — If you need more space, please attach additional sheets)
Application is for: ❑ Contractor - $60.00
❑ Electrical Contractor- $60.00
❑ Gas Line Installer - $25.00
❑ Mechanical Contractor - $60.00
0 Plumbing Contractor- $60.00
Business Name:
Applicant Name:
❑ Tree Trimmer- $ 60.00
❑ Drain Layer - $60.00
❑ Fire -Security System Installer -$25.00
❑ Water Service Line Installer- $60.00
Business Address: 2�ou S I ! ro_- Si City: " Sk6 State: Zip: `- 0 2
Mailing Address: S l 1 "1� St City: VjjEj-4State: _ Zip:0
Email Address: 4,C) 1n 4Y\AS+.eA 4 tn, 0L, • C-V-
Phone #: Fax #: Mobile #: golz - (PII-%_(23
Business Address outside of Nebraska:
City:
Contact Person:
Number of Employees:
State
Apprentices:
Zip:
Other Licenses Held: Ci1;N Yct*y- - CWYY CVA -+n l uwci i tit
Phone:
Journeymen:
Insurance/Worker's Compensation Company: WAIIAr� - D- ,1tiA-e_�r%oi1 p_,,a,l LN5i/w66^u (mac p�u
Electrical, Gas Line Installer, Mechanical, Plumbing Contractors and Tree Trimmers need a $5,000 permit bond stating 'John Doe
dba Company Name" in favor of the City of Blair. Electrical Contractor and Fire Security Systems Installer will need to submit a
copy of your Nebraska State License.
General Contractors need to submit a Certificate of Insurance with minimum limits of $1,000,000 Aggregate/$300,000 each
occurrence with the certificate holder being the "City of Blair".
All types of registrations must include proof of registration with the Nebraska Department of Labor.
All information contained in this application is true and correct. I will notify the City of Blair of any changes in the information
reported on or with this application form within IS days of the change.
1 hereby make application to the Licensing Board of Blair, Nebraska and certify that I am competent and experienced to engage in
above said vocation. I agree to conform strictly to the Ordinances of the City of Blair, Nebraska relative to said vocation and obey
all order, requirements and regulations of its lawful constituted authorities. This certification applies to the original license and/or
registration and any renewals thereof.
lu �, I
rAu orized S"at Date
5111/22, 2:00 PM Official Nebraska Department of Labor- Contractor Registration - Contractor Details
UALr r eis
Contractor/Subcontractor Name
EYMAN PLUMBING, INC.
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Corporation Name
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EYMAN PLUMBING, INC.
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Business Entity
Corporation
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8506 S. 117171-1 STREET
Address
LAVISTA, NE 68128
City
LAVISTA
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State
NE
Zip
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68128
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Telephone
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(402) 731-2727
Registration Number
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21387-21
Registration Expiration
9/15/2022
Sales Tax Option
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1
Number of Employees
130
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Worker's Compensation Status
Certificate on File
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https://dol.nebraska.gov/conreg/Contractor/Details/2138721 111