Eyman Registration 2024CITY 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:
AN
Receipt No:
Check # or CC:
to
Amount Paid:
11 1
CONTRACTOR REGISTRATION / LICENSE RENEWAL
EYMAN PLUMBING Please verify and correct the
company / 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:
CEYMAN TRU S TE YMAN. C 0 M
Please submit a current reciprocating license for those which will or have expired
Name:
Reciprocating License:
Expires:
EYMAN TOM
BELLEVUE
12/31/2023
Please submit new certificatesor bond renewals and NDOL for those which will or have expired:
Name:
Certificate of Liability or Bond:
Expires:
EYMAN TOM
PLUMBING
9/24/2024
EYMAN PLUMBING
NDOL
9/15/2023
Place a check in the box next to the licenses you wish to renew:
Renew?
Name:
License At Registration:
Expires:
`'Amount:
❑
EYMAN TOM
MASTER PLUMBER
1/01/2024
60.00
218 S. 161h 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: ElNew� 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 ❑ Tree Trimmer - $60.00
❑ Electrical Contractor - $60.00 ❑ Drain Layer - $60.00
❑ Gas Line Installer- $25.00 ❑ Fire -Security System Installer-$25.00
❑ Mechanical Contractor - $60.00 ❑ Water Service Line Installer- $60.00
0' Plumbing Contractor - $60.00
Business Name: &I 0,y'1 0�k I M \-,)i Yl Cl
Applicant Name: TM Wl'M A, Y\
Business Address: %Sb[o S 1-14j" 5 City: L.a V i -F a State: N Zip., tzlK
Mailing Address: % 56 (o S. 1 (7t" 5 1- City: L L)Ns+e. State: Zip:C0 212 Y,
Email Address: C EC 4 w\G.IA r^ I-"S+! ..yMan . ao w%
Phone #: Fax #: Mobile #:
Business Address outside of Nebraska:
City:
Contact Person:
Number of Employees:
Other Licenses Held:
State
Apprentices:
Zip: Phone:
Journeymen:
Insurance/Worker's Compensation Company: G Y r' - V.00.k,-V
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 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
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.
Authorized Signz#ure Date
12/5/23, 12:55 PM Official Nebraska Department of Labor - Contractor Registration - Contractor Details
Contractor Details
Contractor/Subcontractor Name
EYMAN PLUMBING, INC.
Corporation Name
EYMAN PLUMBING, INC.
Business Entity
Corporation
8506 S. 117TH STREET
Address
LAVISTA, NE 68128
City
LAVISTA
State
NE
Zip
68128
Telephone
(402)731-2727
Registration Number
21387-23
Registration Expiration
9/15/2024
Sales Tax Option
1
Number of Employees
130
Worker's Compensation Status
Certificate on File
https:Hdol,nebraska.gov/conreg/Contractor/Details/2138723 1 /1