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2239 Jackson StFee Paid: $15.00 Name: Address: Permit to Move Building or Demolish Structure Owner The above described person is hereby granted a permit to (Move) or (Demolish) a building 4(C feet long, and °, c feet high, now located on City of Blair, Nebraska, to be finally located on ;z 2 . The (Move) or (Demolition) is to be done on c (~ 2u and shall take Date: (`) C ( f Contractor Name: �3 N & u Address: rf G ; 3 o n 2 ,0":16 i1 r d) L ( route to be taken in the removal thereof is as follows: (Here designate the names and numbers of the streets, alleys, or public grounds to be crossed): c_J-c, The removal thereof shall be under the direction of the Street Commissioner and the Director of Public Works. The building is to be used for A statement that all taxes and special assessments on the building to be moved or demolished and on the land from which it is to be moved or demolished have been fully paid was received and is attached. A corporate surety bond or two (2) personal sureties to pay all damages that may be sustained to any property, public or private, and including curbs, paving, manholes, public utility lines and pipes, by reason of the moving or demolishing of such building was received on and is attached. City Clerk City Administrator hours. The purposes. 6 Yt, 33- cS G7 �'G 2 1- [I] CITY OF BLAIR 11 WASHINGTON COUNTY El OTHER LOCATION OF INSPECTION: NAME OF OWNER • CONTRACTOR • DATE INSPECTION REQUESTED TIME INSPECTION REQUESTED PERMIT Nn• TYPE OF INSPECTION REQUESTED: 0 CONFERENCE 0 STATUS CHECK BUILDING: 111 FOOTING 0 DECK FOOTING o FRAMING 0 DRYWALL FINAL E PARTIAL PASSED FAILED COMMENTS: UTILITIES: LIl SEWER TAP El SEWER 0 SEPTIC WATER TAP 0 REMOTE El WATER SERVICE PASS ," FAILED E PARTIAL ; Lil COMMENTS: ELECTRICAL: 0 ROUGH IN FINAL 0 PERMANENT SERVICE E TEMPORARYSERVICELI PRECONNECT PASSED FAILED • PARTIAL 0 LI COMMENTS: MECHANICAL: 0 ROUGH-IN E A/C E FURNACE 0 RADIANT HEAT 0 FINAL E PARTIAL PASSED FAILED PLUMBING: LI GROUNDWORK LI ROUGH-IN LI FINAL LI WATER METER INSTALLED El PARTIAL PASSED FAILED 0 0 COMMENTS: COMMENTS: NOTES/REMARKs: 0 OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED INSPE O PRESSURE TEST FAXED OPPD \BURT REA BUILDING INSPECTION REPORT ■.■ - " TO CONNECT SERVICE: ON BY DATE OF INSPECTION MAPIF-• / 47 TIME• ,lam t FIELDCREST DR • 0 TEREST ;TRICT #1 B, C -2 IME B -2 RAN HOME B -1 0) i. x HILLCREST DR CHERRY CL o HICKORY CL DEERFIELD VD \, SUNRISE DR N p, �-P Sr NORTHGATE EGE DR !( N CO CV 17 . 0 • LINDEN CL ASPEN ST CEDAR CL 2 • 1 � I STILL BIRCH CL MEADOW CL VOSS CL z WRI o ra ST -4 JACKSON ST z PARK ST o .•1- - CO -.: - N N F N ' NEBRASKA ST ,CO SOUTH ST I- # E v-e1■ 1311 a - 9 v CLARK ST a SUNDAY 4:00 -9:00 24TH ST CAUBLE CL 23RD AV NORTHRIDGE CL MEADOW DR ARBOR DAVIS DR BUTLER ST ( 13 CL 9 CRESTRIDGE DR , JENSEN DR , FRONTIST 3 0 WASHINGTON ST U \ U OQ' BARONAGE x \ iL j°48N A -.. -. - MARY BETH CL BA RON! - C OBEY DR _ F �4 /IEW, C ADAMS ST FLYNN DR - N 1- 1 F I DR' Q LI � CO ct © x x x x Ft.?'.� y 1- I•a � I 1- v WRIGHT CAD o JACKSON ST ©' PARKST__i T r NEBRASKA ST STATE AVE STATE ST 1 1 3 1 ; 1 • I ; IOWA AVE r a r it= F ,I - IOWA ST x FRONT ST WASHINGTON ST 28 7, PARK PL rj 14 410 1712 720 171 - ▪ 5 28 © 0 i 22 27'10 LINCOLN ST N N ®_ GRANT ST^ _F ®N _ 16 x 21 cn COLFAX ST = °' y! �: • ! i�= � • r I�r 111 24 SOUTH ST 0 x • CO co I = I CO ST KRISTEN CL HOLLOSTONE DR ^' BUTLER �tiETTE ST OAK DR PROSPEC AV WILBUR- ST 0 CC 1- 0 ' o ' 2 18 o RIVERVIEW DR 0� '' I ARTHUR S oc CO 1 1 0 o , JACKSON ST HIGHWAYS --- STREET a POINTS OF INTEREST ■ COMMUNITY SCHOOLS PARKS & RECREATION - CHURCHES CITY LIMITS N GRANT ST -- 29 COLFAX ST ADMIRgi SHERIDAN ST ADAMS ST A -1, C -1 ADMIRAL DR 0 -2 1- I- STREET INDEX EASTGATE DR iTAivELLE BLVD A, B -2 FRONT ST B, C -2 GARFIELD ST D -1 WW\ DIX( RYAN SHERI SKYBL From: Melissa DeMars At: Maguire Agency FaxID: Maguire Agency Inc To: City of Blair Date: 9/15/04 04:46 PM Page: 1 of 2 IE Maguire Agency 1935 West County Road B -2, #241 Roseville, MN 55113 Date: 9/15/04 04:46:01 PM To: City of Blair Phone: ( ) - Fax: (402) 426 -4195 From: Melissa DeMars Phone: (800) 666 -9393 Fax: (651) 638 -9762 Re: Scrpbs's House Moving, Inc. Number of pages including cover sheet: 2 Certificate of Insurance FEU< Cover Sheet From: Melissa DeMars At: Maguire Agency FaxID: Maguire Agency Inc To: City of Blair Date: 9/15/04 04:46 PM Page: 2 of 2 PRODUCER Maguire Agency 1935 West County Road B -2, #241 Roseville MN 55113 Phone:651 -638 -9100 INSURED Scrib's House Moving, Inc. P.O. Box 2 David City, NE 68632 COVERAGES GENERAL LIABILITY A X COMMERCIAL GENERAL LIABILITY GEN'L AGGREGATE LIMIT APPLIES PER POLICY I X JECT I I LOC AUTOMOBILE LIABILITY A X ANY AUTO ALL OVVNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON -OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS LIABILITY DEDUCTIBLE RETENTION 1 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OTHER OCCUR A Cargo Coverage 79477576 DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS CERTIFICATE HOLDER CERTIFICATE LIABILITY INSURANCk CLAIMS MADE X OCCUR CLAIMS MADE N City of Blair Fax:651- 638 -9762 79477576 79477574 ADDITIONAL INSURED; INSURER LETTER: XBLAIRZ OP ID MD DATE (MM /DD/W) CRIB -1 09/16/04 THIS CERTIFICATE I5 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURER A INSURER B INSURER C INSURER D INSURER E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSK TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE LTR DATE (MM /DDNY) 06/01/04 06/01/04 06/01/05 INSURERS AFFORDING COVERAGE Federal Insurance Company POLICY EXPIRATION DATE (MM /DD/YY) EACH OCCURRENCE 06/01/05 I FIRE DAMAGE (Any one fire) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP /OP AGG 06/01/04 06/01/05 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY EACH OCCURRENCE AGGREGATE LIMITS EA ACC AGG I TORY LIMITS I I O ER E L EACH ACCIDENT E L DISEASE - EA EMPLOYEE E L DISEASE - POLICY LIMIT ACV up to $125,000 £1,000,000 £1,000,000 £ 5,000 $ 1,000,000 $2,000,000 $1,000,000 $1,000,000 $ $ 1 $1,000 Ded. CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTI- PRIZED R RESENT IVE a I, t J_- ACORD 25 -S (7/97) i ©ACORD CORPORATION 1988 - 0 -..., c . ._ DATE NAME ADDRESS (!-,: Year Corrected .School Dist. No. \ Tax Dist. No. \ \ ( A. ` ) • °<13. ) Tax Book No: t:-. Page No. \ l l Description of Property !,,Ai!-!!)--0---J.- ID No, STATEMENT CONSOLI- SCHOOL SCHEDULE VALUATION RATE TAX D HOMESTEAD PENALTY TOTAL TAX VALUE H A L NO. MALE IST. NO. TAX OR ACTUAL TAX DATED OR TAX Tax List Corrections, ORIGINAL TAX CORRECTED TAX CictLf• GI DEDUCTED TAX 789 —REDFIELD Ex COMPANY Inc 014,111.4 ORIGINAL-TREASURER'S COPY DUPLICATE-COUNTY BOARD'S COPY TRIPLICATE-COUNTY ASSESSOR'S COPY CHAIRMAN By County, Nebraska s/D.'" ic)..``i I (c,:),, Reason for Correction I hereby direct the County Treasurer of County to accept this Official Correction made for the above named party and description and to issue his receipt in payment of the corrected tax as shown above. ALL CORRECTIONS MADE ON THE TAX ROLL MUST BE SHOWN IN RED. Approved by action of the County Board. this day of COW TY ASSESSOR-COUNTY CLERK Cs_ • DEPUTY , !;•i HI I L1 MISCELLANEOUS RECEIPT COUNTY TREASURER'S OFFICE WASHINGTON COUNTY NEBRASKA September 22, 2004 1,621.68 RECEIVED OF G ERNEST ABARIOTES the sum of One Thousand Six Hundred Twenty -One Dollars And Sixty -Eight Cents collected by KAY for PD 2004 TAXES ON 2003 BOOK & LEVY 890087051 MOVED HOUSE Credits To: 9502 PARTIAL PAYMENT 47601 $1,621.68 No. 309496 Kay Erwin County Treasurer KAY Deputy DATE: KAY J. ERWIN WASHINGTON COUNTY TREASURER P.O. Box 348 ® Blair, Nebraska 68008 (402) 426 -6888 TO WHOM IT MAY CONCERN: ON THIS DAY r I (r1 PAID THE TAXES ON jj .r� ( � _ n Lky) �UL FOR THE YEARS OF Do . PLEASE CONTACT OUR OFFICE IF THERE ARE ANY QUESTIONS REGARDING PAYMENT MADE. THANK YOU, KAY J. ERWIN �,/q, //�� �p BY : L-r �!YV l� 1. k j rr.W w :r:110r °ro::14141+:1401.rrx•111164,r+.: :1rrr r+ =ra:■..r. ■4mgd4rwitovr KNOW ALL PERSONS BY THESE PRESENTS: That we, Oneil Company Inc of the City of Williston State of N orth Dakota , as Principal, and WESTERN SURETY COMPANY, a corporation duly licensed to do surety business in the State of Nebraska City of Blair 218 S. 16th St. Balir NE 68008 sum of One Thousand and 00 /100 DOLLARS ( $1,000.00 1, lawful money of the United States, to be paid to the Obligee, for which payment well and truly to be made, we bind ourselves and our legal representatives, firmly by these presents. THE CONDITION OF THE ABOVE OBLIGATION IS SUCH, That whereas, the Principal has been licensed House Mover NOW THEREFORE, if the Principal shall faithfully perform the duties and in all things comply with the laws and ordinances, including all amendments thereto, pertaining to the license or permit applied for, then this obligation to be void, otherwise to remain in full force and effect until May 3rd 2005 , unless renewed by Continuation Certificate. This bond may be terminated at any time by the Surety upon sending notice in writing, by First Class U.S. Mail,_ the Obligee and to the Principal at the address last known to the Surety, and at the expiration of thirty five 5)-.days from the mailing of said notice, this bond shall ipso facto terminate and the Surety shall thereupon ,be_r=eheved from any liability for any acts or omissions of the Principal subsequent to said date>'I,egrdless_of=te number of years this bond shall continue m force, the number of claims made against trns bond, and the. limber of premiums which shall be payable or paid, the Surety's total limit of liability shallnot be cumulative from year to year or period to period, and in no event shall the Surety's total liability fo_ alI claims exceed tivie amount set forth above. Any revision of the bond amount shall not be cumulative. Countersigned (where required) By Dated this 17th day of Form 532 -5 -2002 Resident Agent Western Surety Company LICENSE AND PERMIT BOND May OD% , State of Nebraska By Effective Date: May 3rd, 2004 Bond No. 14589222 , as Surety, are held and firmly bound unto the 2004 f WESTE SURET. , as Obligee, in the penal by the Obligee. Principal Principal COMPANY Paul T. Bruflat, Sior Vice President . ��w :warr�',�rw•,rvbw��Wr'•rrw'•��a �: r;• r:�w;w•.�.�w,Wr�w.+�';ww�n.t�.� �.� � � �.�.� � �,� � � �._.'�� STATE OF SOUTH DAKOTA ss COUNTY OF MINNEHAHA On this 17 th day of May 2 0 04 , before me, the undersigned officer, personally appeared Paul T. Bruflat , who acknowledged himself to be the aforesaid officer of WESTERN SURETY COMPANY, a corporation, and that he as such officer, being authorized so to do, executed the foregoing instrument for the purposes therein contained, by signing the name of the corporation by himself as such officer. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. +444444444444444444444444 + p D. KRELL NOTARY PUBLIC .r SOUTH DAKOTA 144444444444444444444444 i My Commission Expires November 30, 2006 STATE OF COUNTY OF On this day of known to me to be the individual described in and who executed the foregoing instrument and acknowledged to me that he executed the same. My commission expires STATE OF COUNTY OF On this who acknowledged himself/herself to be the of , a corporation, and that he /she as such officer being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing the name of the corporation by himself/herself as such officer. My commission expires E 0 U day of , before me personally appeared 0 } SS 0 0 al al m 0 ra ACKNOWLEDGMENT OF SURETY (Corporate Officer) Notary Publicf South Dakota ACKNOWLEDGMENT OF PRINCIPAL (Individual or Partners) 0 , before me personally appeared Notary Public ACKNOWLEDGMENT OF PRINCIPAL (Corporate Officer) Notary Public 4, 0 cd Western Surety Company KNOW ALL MEN BY THESE PRESENTS: That WESTERN SURETY COMPANY, a corporation organized and existing under the laws of the State of South Dakota, and authorized and licensed to do business in the States of Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, and the United States of America, does hereby make, constitute and appoint Paul T. Bruflat of Sioux Falls State of South Dakota , its regularly elected Senior Vice President , as Attorney -in -Fact, with full power and authority hereby conferred upon him to sign, execute, acknowledge and deliver for and on its behalf as Surety and as its act and deed, all of the following classes of documents to -wit: Indemnity, Surety and Undertakings that may be desired by contract, or may be given in any action or proceeding in any court of law or equity, policies.jademnifying employers against loss or damage caused by the misconduct of their employees; official, bail, and surety and fidelity boricfs;_=`Indemnity in all cases where indemnity may be lawfully given; and with full power and authority to execute consents and waiver tb "_r'rrodFfy`:or change or extend any bond or document executed for this Company, and to compromise and settle any and all claims or demands made orexi4ting against said Company. Vett?rn Surety Company further certifies that the following is a true and exact copy of Section 7 of the by -laws of Western Surety Company duly adopted aradmow in force, to -wit: Secflon 7:" All bor{dsr` policies, undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in the corporate name-of the ompany by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President, or by such other officers as. the Soard.,of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys -in -Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile. In Witness Whereof, the said WESTERN SURETY COMPANY has caused these presents to be executed by its Senior Vice President with the corporate seal affixed this 17th day of May , 2004 , ATTEST STATE OF SOUTH DAKOTA COUNTY OF MINNEHAHA On this $ 8 8 s s s 8 (D Zeld...,2r7 Assistant Secretary Form F1975 -4 -2002 ss 17th day of the voluntary act and deed of said Corporation. s s s D. KRELL NOTARY PUBLIC SOUTH DAKOTA s s ' a' c.sc.,4a4.,eicaSyScir.aSc My Commission Expires November 30, 2006 POWER OF ATTORNEY May By 2004 WESTE URETY- COMPANY Paul T. Bruflat and L. Nelson who, being by me duly sworn, acknowledged that they signed the above Power of Attorney as Senior Vice President and Assistant Secretary, respectively, of the said WESTERN SURETY COMPANY, and acknowledged said instrument to be f. Paul T. Bruflal!Senior Vice President , before me, a Notary Public, personally appeared Notary Public