514 N 12th St
Owner
Contractor
Permit to Move Building or Demolish Structure
Fee Paid: C;~~.~~:J Date: 61 S (63
Name:'1\ab2 rt 4trif c('SUI\
Address: 35- 2 SO 19M :::/
6ICid' /Vb
Name:
Address:
The above described person is hereby granted a permit to (Move) or (Demolish) a
building
feet long, and _feet high, now located on
City of Blair, Nebraska, to be finally located on The (Move) or
€;;;;; to be d~:Y' W. and sball take hours. Tbe
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): 5(4 N, I J2!!'.2>t.
The removal thereof shall be under the direction ofthe Street Commissioner and the
Director of Public Works. The building is to be used for
purposes.
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 Administrator
BUILDING INSPECTION REPORT
o CITY OF BLAIR
o WASHINGTON COUNTY
OTHER
LOCATION OF INSPECTION:
NAME OF OWNER:
CONTRACTOR:
('," ;'1
DATE INSPECTION
TIME INSPECTION REQUESTED: i
!~ L J {;
PERMIT NO:
TYPE OF INSPECTION o CONFERENCE
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL 0 FINAL 0 PARTIAL
o STATUS CHECK
COMMENTS:
UTILITIES:
PASSED FAILED
o 0
o SEWER TAP
o PARTIAL
SERVICE
COMMENTS:
ELECTRICAL: 0 ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
MECHANICAL: 0 ROUGH-IN 0 AlC 0 FURNACE 0 RADIANT HEAT 0 FINAL 0 PARTIAL
PASSED FAILED
o 0
COMMENTS:
PLUMBING: 0 GROUNDWORK 0 ROUGH-IN 0 FINAL 0 WATER METER INSTALLED 0 PARTIAL
PASSED FAILED
o 0
COMMENTS:
o OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS:
INSPEC~7~(}il ~0"mSPECl10NMADE~ /?? ~
TIME:
//c~
f
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
CITY OF BLAIR, NEBRASKA
Phone 402-426-4191
RECEIVED OF:
ADDRESS
CITY, STATE, ZIP CODE
THANK YOU
KEEP THIS COPY FOR YOUR RECORDS,
RECEIVED BY
EMANUEL PRINTING. FREMONT, NE 68025
(of]
tt ~ & N S .;;. , G
& IS! i~ e & f'-'
"
& (i1 . . .
(ij , & >Sr G ii1 N & I.:l x
-' '- >-
f"-~ a: f<"j s IS! W i..D :<: CL
,-!f- LU . , . -- W iJJ () 0
UJ
,u. ~ ul 1St IS! :r: 0
....0 iJJ () W
a:: ....w
No... tD 0
<C :-~ u::
w
>- z u..
w 0
~
>< >- en UJ f- UJ
<C <l: to- ::l is w :r:
a. is ..J W u.. i;:9 f- (9 Cl en
I- <l: ~ ~
u.. 1St UJ > a:: (!) r<; en z UJ
0 is a:: () z w Ci5 b
() Cl :J a::
w <l: Cl f- Ul w i= UJ ~
~ . UJ UJ <l: u: Z f- a:: ...J
1St a:: UJ i..D ..J Z
to w w ~ UJ ~~
Cl 0 f- > 0
w en 5 ::2: lJJ
(!l IL UJ W ...J Cl ()
UJ ::2:
<( [ll ~ ...J <l: ..J
Z 0 <l: <l:
;;: X :r: 0 f- f- a.
a: ~ :r: en 0 IL ~
0 ~ f- 0
I- Cl
Il. 0
W :r: ,
f-
0 OJ [-:") [>:) UJ
::2:
W & 1'9 & 1St ...J
c: .... i9 is 1St ...J X
" ::>
>< Cij (!j OJ tl ~ 11.
0
<C ... ....... '... , w
>
I- i.!1 .,...; .,...; .,--1 wu. I I
w r~1 rot) 1St;s!@;;!
:::>
--' , , ':,._ a: :;;
~ (IJ u1AJ'I ~ ~
-~ r*'S& ~
OJ J >-
..:
a) 0..11.
W l- lL IL ...J
r"Sf. <(
::l Z ...J ...J J:
!'- Cl w <l: <l: :!1
::l :r: J:
~ -:r en 0 (j) -0
UJ
IS! ('1") X Z ~ c:
~ (i1 <l: :J C\J
(f'! t'- f- UJ
Cl
COw CD
!;( 0:1.
a:
x .,.., ...
~ Q)
Z ...
::l t-
:.D ~ (/) n::
<Il
a: Q) w
...
u W f- 0::
0.. ~ ~ 0
c: '-".
b -4" ~ ::l is
0 IS a:
>- a: . , 0
I- eD .,-; t- &
?- m IS 0::: r- is ...
Z 15 1)J 1St tl: W Z
(!l I
::) (n ,..:-, ill CO 0
z '-'-'
O~ x 0 0::: G (,:1
..: :::c Ct: , is 0:::
I- r-
0(1) (fJ cJ ;.1
'-'-'
<l: t:Q 0: lJJ Q
Za::
Om Z
. ll.I !'- ([
~..~
-~
~
;,I ~ SCOTTSDALE INSURANCE COMPANY@
ENDORSEMENT
NO. 004
ATTACHED TO AND ENDORSEMENT EFFECTIVE DATE
FORMING A PART OF (12:01 A.M. STANDARD TIME) NAMED INSURED AGENT NO,
POLICY NUMBER
DFS0458353 09/11/2002 ROBERT A. & KERRIE ANDERSON 26001
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
It is understood and agreed that:
1. Rate Basis............................. D
2, Premium................................ D
3. Limits of Insurance................ D
4, Inception Date...................... D
5. Expiration Date...................... D
6. Name of Insured.................... D
7, Location of Property.......,...... D
8. Classification Added ............. D
CHANGE ENDORSEMENT
9, Classification Deleted............ 0
10. Mailing Address
ofthe Insured........................ 0
11, Description of
Property Covered...............,.. D
12, Coverage ...........................,: 0
13, Additionallnsured
Endorsement.........,....... ....... 0
14. Endorsement.......,..............., 0
15, Mortgagee Added ................ 0
D No Change In Premium
D Additional Premium
. []I Return Premium
State Tax
Stamping Fee
Total Premium
293.00
9.55
302.55
16. Mortgagee Deleted ,.............. D
17. Loss Payee Added ..........,.... D
18. Loss Payee Deleted............., D
19. Deductible ................,........., 0
20. Other .................................. ~
[KJ Is Amended to Read as Follows
D The Following Form(s) is/are made a part of the Policy
D The Following Form(s) is/are Deleted from the Policy
PREMISES #2 LOCATED AT: 514 N. 12TH STREET, BLAIRi--NE.~ 68008 IS HEREBY DELETED FROM THE
POLICY
.~
.-'
UTS-79g (3'98)
~~4~~
AUTHORI ED REPRESENTATIVE
AGENT
/ 1 0 / 0 3/2 0 02 RR
DATE
;,J ~ SCOTTSDAlE INSURANCE COMPANY@
ENDORSEMENT
NO. 004
ATTACHED TO AND ENDORSEMENT EFFECTIVE DATE
FORMING A PART OF (12:01 A.M, STANDARD TIME) NAMED INSURED AGENT NO.
POLICY NUMBER
DFS0458353 09/11/2002 ROBERT A. & KERRIE ANDERSON 26001
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
It is understood and agreed that:
1. Rate Basis............................. D
2. Premium..............................., D
3. Limits of Insurance..............., D
4. Inception Date ...................... D
5, Expiration Date...................... D
6. Name of Insured,................... D
7, Location of Property,............, D
8, Classification Added ............. D
CHANGE ENDORSEMENT
9, Classification Deleted............ D
10. Mailing Address
of the Insured................. ....... D
11 , Description of
Property Covered,..,.............. D
12, Coverage ............................. D
13. Additionallnsured
Endorsement........................ D
14. Endorsement........................ D
15. Mortgagee Added ..............., D
o No Change In Premium
o Additional Premium
!ZJ Return Premium
State Tax
Stamping Fee
Total Premium
293.00
9.55
302.55
16. Mortgagee Deleted.........,..,.. D
17. Loss Payee Added ............... D
18. Loss Payee Deleted.............. D
19. Deductible...............,........... 0
20. Other ................,................. ~
~ Is Amended to Read as Follows
D The Following Form(s) is/are made a part of the Policy
D The Following Form(s) is/are Deleted from the Policy
PREMISES #2 LOCATED AT: 514 N. 12TH STREET, BLAIR,--NE; 68008 IS HEREBY DELETED FROM THE
POLICY
.-."t
UTS.79g (3.98)
-~~4l\.~
AL.;THORI ED REPRESENTATIVE
AGENT
/ 10/03/2002 RR
DATE
WASHINGTON COUNTY
BLAIR, NEBRASKA
RECEIPT NUMBER
2IZ10;:~-00 11531
TAXING DISTRICT
208
_EGAL
'ERTY
PTION
HOUSE BEING BURNT ON BC LOT 7
ELK 90 CORR#5939
J PAYMENT CODE:
~LS VJW
KAY ERWIN
County Treasurer
I
ANDERSON, A ROBERT
352 S 19TH ST
BLAIR, NE 68008-0000
L PI:jID BY
~MEN~F
ANDERSON, A ROBERT
T AX YEAR
T AX RECEIPT
200E:
DATE OF PAYMENT05/i=:8/2QI03
DRAINAGE TYPE OF TAX
8'30086899
TAX RATE
in 887'33.4-
VALUE
TAXES DUE
DELINQUENT
12/31/2002
1 '.' 00lZl
1st HALF IZl5/01/2003
2nd HALF 09/01/2003
0.00
REr=lL
TAX BEFORE CREDITS
HOMESTEAD VALUE
HOMESTEAD CREDIT
LATE FILING FEE
18.88
0. lZl1Zl
0. iZI0
PAYMENT RECEIVED INSTALLMENT TOTAU TAX 'DUB ~-
151 HALF 1 2nd HALF FULL - -
T v 18.88 18.88
^
/7) INTEREST 0. QllZI
, ADVERTISING
/(fJ) 0.00
/"
i
! ."". TOTAL COLLECTED lB.88
()PiKJ,
v \/ /""); /
rti~/
METHOD OF PAYMENT: \ CASH \ CHECK;(
~ ~ q. ~ T.~XP.i\YER'S COpy
f"#) ,
OJ r::;. G S oS< 1St
..,.
& os;. f,,;~( ~ e f'1
S (iJ . . . ,
(lJ -..... , (<:'J tSG bl ~j S In x >-
...J r~
~~ cr: ;Sl IS lD i..D :<: CL
,...p- W . , , lJ:i lD () 0
UJ
,u- n:-: ill l$:iS :r: 0
,0 iJJ ()
a:: ..;:rw w
Gn. ti) 0
<C 1- ~ u::
w
> z u..
w 0
~
>< ~ en UJ f- Ul
<C f- ::l is w :r:
n. is ..J W u.. j~ tn (9 Cl en
l- I$! UJ <l: a:: (!) f'; w ~ ~
u. > z
a G a:: () z UJ Cii f-
() Cl ::; a:: ()
w <l: 0 f- u} w i= UJ t=-:
~ . UJ w <l: u: Z f- a:: ..J
is a:: w -' z
a tn f- W UJ '--.J,.: ~ UJ a ~~
0 UJ en ~ ~ llJ >
II. UJ Cl ()
(!l UJ W -'
<( lD ~ ~ -' <l: ..J
Z a ~ <l:
<c ~ :r: a f- 0-
0: :r: en a II. ~
0 ~ f- a
I- Cl
Q. a
iii :r: ,
0 (;J '<! f~) Iii
, . ~
w 5: r:5t 1St 1St ..J
a:: ..J
..:t ;::-, oS< ;S; ::> ><
,"'" u.
>< 02 OJ (Ii (lj 0
<C .... -. , , w
....
I- l!1 ~; .,...; > I 1
' , iiiu.
UJ ("l1 f~'J G;s!@~
::>
...J , ....... ........- ~ '0
<( OJ
> If.L-(r't z~
..-l ,r:::. N W
,,- - :::
OJ ~
OJ n.U-
W f- u.. II. ..J
Q <(
::l Z -' ..J J:
i'- Cl w <l: <l: ~
::l :r: :r:
.;t .;t en 0 'Ii) "
W
tSf r~"j x z ~ <:
1St cr'; <l: ::; N
(f1 f'~ f- W
Cl
Cjw CO
!;;: oJ
c:
~ .,-; ...
Q)
Z ...
;:) l--
t.D ~ l/) n:::
<<l
c:: Q) w
...
r , W l- I):!
~,
CL ~ >- 0
- ~
c ~
~ ;:) ;SI
ti --! ~ 0
-' 0 ;St c:
a: CO I- i9
tii ..-l
1St a:: I- IS .-
is OJ IS! UJ iJJ I Z
(!) !J1 0:: !d oJ 0
z '-'-'
X 0 0;:: G (;;
~ ~ u: l- IS C(
rJJ CO ill
OS n- i..D Ci
"""
I Z
i'-- l- W ,..,.
"'-
i:.n z
..-l