TSI Registration 2022218S. 16th Street
Blair, NE 68008
(402) 426 4191 FAX: (402) 426 4195
Email: building@blairnebraska.org
FOR OFFICE USE ONLY
Date Paid:
Receipt No: Of Baa
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: El Contractor -$60.00
❑ Electrical Contractor - $60.00
❑ Gas Line Installer - $25.00
❑ Mechanical Contractor- $60.00
❑ Plumbing Contractor- $60.00
Business Name: TSI Group, LLC
Applicant Name: James Lytal
Business Address:
Mailing Address:
Email Address:
Phone #:
❑ Tree Trimmer- $60.00
❑ Drain Layer- $60.00
❑ Fire -Security System Installer -$25.00
❑ Water Service Line Installer- $60.00
City:
City:
ax #: Mobile #:
State:
State:
Business Address outside of Nebraska: 10921 North 161 st East Ave Owasso, OK 74055
City: Owasso
State OK
Contact Person: Julie Fraedrich
Number of Employees: 20
Other Licenses Held:
Zip:
74055
permits@tsi-grp.com
Apprentices:
Insurance/Worker's Compensation Company:
CNA
Phone: 214-427-4606
Journeymen:
Zip:
Zip:
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
couv of your Nebraska State License.
All
i 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 15 days of the change.
I hereby make application to the Licensing Board of Blair, Nebraska and certify that I am competent and experienced to engage in
fteg
e said voc on. I agree to conform strictly to the Ordinances of the City of Blair, Nebraska relative to said vocation and obey
der, requirem is and regulations of its I wful constituted authorities. This certification applies to the original license and/or
tration and any r ewals ther�f.
orized Signature
Date
10-13-22
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