JTech Registration 2014.tif i
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2 10 S. I Ca h Street RecelptWo: d , ;
Date issued.
Bla NE 68008 BOND EXPIRES:
(402) 426 4191 F1 X: ( 02) 426 4 195.
Email: cittof b1air9d.b1 k ft.rle.us
Application is: X 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 . C1 Electrical Contractor - $ &0.00
E Water Service Lime Installer - $60.00 ❑ 'Tree Trimmer - $60.00
Ej Fire /Security System Installer - $25,00 [] Gas Line installer - $25.00
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Mechanical Contractor- $60.00 Plumbing Contractor- $60.00
Drain Layer - $60.00
Business Name: ' - e & h -
A licant Dame: '" ' go y)
Business Address: 1 �' ` �.J City: � '� � 4� state: z i pj �_,_,,,�, '
Email Address: l
Phone #. N9 ( °° �� Fa #. � � � �� � Mobile #. � ��' 9S
Business Address outside of Nebraska:
c ity.. State zi Ph o ne..
Contact Person: Wit t f 'e
Number of Employees. � 0 A p p rentices: men: Journe
Y AA y
Either Licenses Held:
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Insurarnce/1lorker's Co mpensation Company: it
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Drain Layers /Electrical, Plumbing and Mechanical Contractors,/Water Service Line Installers need a S5.0 permit bond In favor
of the City of Blair. 'free Trimmers need a $5,000 permit bond in favor of the City of Blair. Electrical Contractorand Fire
Security systems Installer will need to submit a copy of your Nebraska State License.
General Contractors deed to submit a CertifIcate of Insurance with minimum limits of 1,000,000,Aiggregate /$300,000 each
occurrence.
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 glair, 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.
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Authorized Signature Date
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CITY F I)L'"
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GENERAL CONTRACTOR REGISTRATION REFERENCES
Due to the large number of general contractors seeking roofing and siding work within the
zoning jurisdiction of the City of Blair, the following reference information is required.
References will be checked, so please ensure reference names and phone numbers are
current.
NO WORK SHOULD BE DONE PRIOR TO RECEIVING
A GENERAL CONTRACTOR REGISTRATION.
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Three communi #es in which you are currently registered and have been issued permits:
Community #1 : U YA('6v) ft i` Phone: f# I �
Community #2: (0 rnpk Phone: 44 - 7
Community #3: 4 float n Phone:
Three personal references for whom you have recently done work:
Client #1 : MMCCA 6 0Y - d0" Phone:
Client #2 : Cvew Yna,Y) Phone: � �� Zn -vat I
Client #3' Le
Phone. q
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Contractor /Applicant Date
References verified by: Date
21 8 South ? Mn Sf(eel 8 Blaif, Nlebr ska 68008 402- 0 (j cerA In
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NcbraskaDcpartment of Labor
Contractor Registration
550 So, 16th Street, Lincoln, NE 65508
(402) 471 - 2239
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Date Issucd ..
1 '11/15/2013 Date Expires
12/15/2014
CONTRACTOR RFGISTRATION CERTITTCATE
'n11> caiifiCate It WISH- 1[UIISfGrJt)i[ '
Fee Paid. $40.00 Registration #
36130
Year
13
Business: j
J -TECH CONSTRUCTION
7730 N 56 ST#.x 1C
LINCOLN, ATE 68514 -4724 Cmm�dssioncrnt t,, r
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Department of Labor
Labor Law / Contractor Registration
4 W � E B RAS KA
550 South 16th Street, 3rd Floor
DEPARTME LAB OR Lincoln, NE 68508
(402) 471 - 2239
Registered Contractors and Subcontractors Locator
Contractor /Subcontractor Name: J -TECH CONSTRUCTION
Address: 7730 N 56 ST # 1C
City: LINCOLN
State: NE
Zip: 68514 -9724
Telephone: (402) 261 - 3682
Certificate Number 36130
Certificate Expiration 12/15/2014
Contractor Option: 2
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