810 N 21st St
Fee Paid:
Permit toe Building or Demolish Strncture
/($15.00 \ Date: fa - If - kv/
'~." )
Owner
Name: Uhdld (~.Act a In So/I
Address: Cjj J... c/~he{js Wid I Gr': /e~
Contractor
(" I' //'
Name: () II/ElL (OIJ1/tli1lhc
Address: 'PO ;3 ay.., III "
_C(? leit y, N c-' 6ffDO&" 'dR/A S~1'1 IV () :-)"'&9;02
The ~~~ ~~J {";;~n is hereby granted a permit (~~8':: d>=~s~/ ;s- 8'
building;,t?X70( feet long, and ~feet high, now locate~;n If/tJ AI. 2/ '!! 5-f-d14;'r ;.I;!.~
"
City of Blair, Nebraska, to be finally located on '890 y;{)..d~ d s-~} tJ!;./'r lV~ifhe ~~~)~r
(Demolition) isto be done on "#:(fi::f!/Sball take ~ 11 bo~~n;e
.0\ It 1 '. ,cd f),Vl .
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): ___<J>e ~ e he It> '> ed:
lA 0 ~ te- mcl f
;1
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 f(e,;J errl/4/
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
,;J "
(J.t '
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
KAY J. ERWIN
WASHINGTON COUNTY TREASURER
P.O. Box 348 II Blair, Nebraska 68008
(402) 426-6888
DATE:
\ (' )1 > /)" \
\.) - (',. U . I. I
TO WHOM IT MAY CONCERN:
Ii.... /"'.... . \
ON THIS DAY ''\ \ e f{\O \{ \ (J\ \
PAID THE TAXES ON
~~d \~ \,e
p-)c ~~-\Y\ tV\.\ t\.~ s
J',
FOR THE YEARS OF ~ O()C)
Q" (' \
c ,( '), )
PLEASE CONTACT OUR OFFICE IF
THERE ARE ANY QUESTIONS REGARDING PAYMENT MADE.
THANK YOU,
KAY J. ERWIN
\.~ijV/\\, "--1
BY: l ,) "lA/v, .I~'
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7 ,) 1 / 17 I.: - ,':), ,~: ::: ::;
STATE OF NEBRASKA
DEPARTMENT OF ROADS
Special Permit to Move a Building on State Highways
To Whom It May Concern
Permission is hereby granted for a permit to move a building with the following described vehicle or combination of vehicles and load,
exceeding Nebraska limitations in regard to dimension or weight, which must of necessity use the highways of the State to reach its
destination.
Distribution
White . Mover
Canary . Lincoln Office
Pink . District Engineer
Goldenrod . Main!. Sup!.
Standard Form RM-434, Oec 85
Issued to, VehicIe Owner .........(,iNJi;.l.L....!.:IC)JJ$.K...M{.l:\l.U~.C......~............... ,Address ..E....fL......E:.l:l;'.c...1.t1.:;:...ki.1.1i.s.t.c.D.....j~JL..
Truck Make Year License No. State Trailer and/or Doilies License No. State
1989 6800 ,. ND ' ,uo 1. 1. 1. e s, .t..,{, \)!) (j 1.\ U
[/18 C k lJOLL.leS /.,", u tl ':;: ".(, .
!.'1:-,'
Load: Owned by .......j)o+I....A.d :am.s.o.l:<~. .........~...... ...... ...:.. .:.~...m......~..:........~...:. of ............lU.2.i:r:.,.... ,N.t.:............ .......... ................ ............
' , . ~ /, f ' . 7 c, , ' ' 1 ',') I
Overall WIdth ....,............':t...................................... Overall HeIght ..............I..l.l.............................. Overall Length ...........m.~}.6.'..............................
Total Weight of Truck, Truck Tract~r, Trailer and Dollies ........"........5-\;..,.00')........... Pounds
, Total Weight of Building ..:......::;.O...1JiJ{).'........:....... Ptiurids' ' , "
Total Gross Weight of Building and Hauling Units ......::.f2.0.~.G4).Q.................... Pounds
Number of Axles 1 2 3 ,~ , 5 6 7 8 9
Weight on 10 , 000 " :2'0 ~ () 00 20,000 11,667 11,667 11,66i
Each Axle 11,,667 11,667 1:1.667
Axle Spacing '.',18' " t~' _ g!V '40' -ll-8 !.p~8
Route' c.'!- <> ~ j.. '. ,? '~,;,~ .<:;~. r '':'',C' 't'.;,., ;:) l' .>'7 1"' 110' ii' . t- '" f-j' 1; <"l"l.:"'\~7 '" '\l -/. 1::\ .', i"i l~ l' ?" '1, X [il j 1 e [_:
. . . ..._....._.......~~.I..-.........._._...,.J..l...~-.........,...i-_._~_.. ~.._...L...L\.......u.. ~;.t.,_....l...t.....UI.~..,.................~........ "c...,. ....l....'~;.~.."........ .....:,..,....,.....J..t.a<..Q,...II...r..!......la.J...':...u...;......:.......~l;':.................
t" ('r'J.l,.,I-\: 00"",,\ '[')-1< t,~ P.QD""t.." T~..,q? 2'""/.' t.n '('nl':n1',/ 'i\o,"'\~ ";'F', to l';.;~hv~'p'.l 11".'
...... ...J.:,J......l...:..I..oJ. .o.lo...."-,.......J:'\... ..'~a.l.........c...... 1..L...... ...u......).....j .I.J.. ?}....."-....'W.~.'t.J...... .. ....,....... :,-c.....~...... ....Al..J.c..~........\......lO.::.-;j...~J.....h;../....$-............I............J..-J<I'..L~.........:l..;.......:..-...';:..u~...........
....t.l'~l?D....No.r,th....(~n....!:!i.g.h:w:e,y....3.O'~...l.A.S.'...mi.l.e.s.:.nn......,.......:.................'...................................................................................~.....n
. . '.
.....................................................................a.....................................................................................................................................,;.......................................................................................................................................................................................................................
Th t 'b d b h h 'f 1 F). "11 :J. M d c:; . (\ '1 ^ M . h' d . db' .
e move 0 e ma e etween t e, ours 0 ......... .'-~.~_ .........J:_. an ..................'....,.;':'>.,,;.....,i::. ,Wit In a ten. ay peno egmnmg
...i,).c..t.......JLL...................., lSi.2:ClOJbriless specifically indicated below, no move may be made on Saturdays, Sundays or holidays or
when road surfaces areslippe~ due to ice, packed snow 'or rain or when winds Cause a hazard or during rain, snow, sleet or fog.
N' fIe' d ' ,"', 'j' . 1 T ,/", " A f I' $ 1..1 '1'\ ,.., '1 '
aine 0 nsurance 'arne ...........~.!i?.J:. ,:;lr.z. .....l..Ll.~,.....:..\..O................................................ mount 0 nsurance ....J....JH..h_J... ..~..yn' ..........
N"ot'f'catt' hall'b . t '0 .,"".' 't.{ ,.,0'''' M~', 'I' ~'.. ''',,;'- nl,',';.t. ,"(\')/-L':'7..."2(~7 "J"-"': Lt~\"
1 .~ on s e -gIven 0 U'l,.)~i-~.....,...:1;ju....t...~a-'1...,H...lr}.........,............~;;.d.-:u.. -...........,;,J..Jt-........................... ..~~..);,....u..-~.....~~..-'-of.... ......... ......-..'.. ..............n...... .w.Jo,.~.... CJ..:.:f~....................,
, " JC' .,,' ", J ' C' i (, r' /. I, (' 1" '1 \', n " 'N b k
,1"'IM~""'i\3~~(...S.ffi(!l-{-1.l;"..~.~~....lJ;.a.&t~.:",.11.p.,..t.0~.... (;:.l,),.:,l.t;.y....l.t...,~. ..l-I..;J...!.:-:..:;..,~.....,;;..............................................~............................., eras a,
Telephone No. .m:'\:....m...~........_.........................................., Twenty-four hours prior to the move and after the move is completed.
A certified check in the amount of $ .........5..0.0....00.............,.................., deposited at ................LL~l.r...o.lr.J.....................................n Office,
made payable to the Department of Roads. Check to cover any damage to highways or structures and (1) D will be returned to
owner, or (2) [XJ remain on deposit in the event no damage or inspection fees incurred due to the move.
General Provisions: lhe permit is granted for the understanding that: (1) The applicant assumes all liability and responsibility for
all property damages or personal injuries, which may occur in consequence of this movement. (2) The mover or applicant shall comply
with all laws of the ,State of Nebraska and all rules and regulations of the Department of Roads which have been or which may be
hereinafter adopted relative to the use of the roads for the movement of special vehicles or objects. This permit is issued only to
the highways for which the Department has the maintenance responsibility.
This permit is invalidated by any variance from its terms or conditions.
Special Provisions: .i:1u.s..t.....b.e....mo.Q.iJ;.v:x;.e.d.._.b.y.....a....laJl?...f:.nLo.r.c.:em.e.11.L...a.~:,.e.us:..y...,.......Y;2.1i.d....QD.ly:....Q.E.........
''It-r,t' f"*..,:.... ',""l- ,"-:T. ":r: ':. "t .-.,'~':)~...,....;<,.)~~,.4 l'~ 1"1'" I'l"t~r""c~1~._:l.t-!3 I"~''l'''' !.t.~...t:>....:'l':,.~.:J\-l {'~.'v':;~,.("C;~.ll j;-, t;1'
.;)."~",.""'..gn....CJ.,g"'l.W..:l,.:Y...;>...m....<~li)........J;,il.;)iVIl-......~::.lv.....J:l._......~.J..'......OM......I 1.;:.... . J.. .."".....,...,...... .........0.;.............<....'_.=""-1..1." ....1..:. .................. ....
.(~~~1~:.t.\41.....[)~;;..f::l'\i)..,................................................................................................................................."'......................................................................................................~..............._........."..............................
Issued at ......1..2..;.~.(L..1i:M, this ............~).............. day
of ............,.....Q5;-;,.ts;,>J?.~.C..n......................... ,~....;4.Q.q 1
./
...I..~'.:-t1..}tf:jJ..........._................................~..;,....~.~::.:....~T.................................."...._...................................
/"~.-........" App'Jicants Signature. .
/ \ j. DEPA?-TMENT d~ROADS
I I . I !'
( i '~ ,.,,'
.........\~..~,.., /,&tJ",'.onL.....:::,:::.,.:~.:j:,CL...._.................._..._........~.
I Dlslric/"'Engineer
~ "
See Reverse Side for General Prowsions,... printad on ,acyclad papa'
v' ,
Permit Fee $ ...........J.'O.,.D.\L....................
--r&..
PERMIT NO. 00441-,"8
ACORD,u CERTIFICATE OF LIABILITY INSURANC~Ii~l I DATE (MM/DDNY)
03/01/01
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
The Maguire Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1935 West County Road B-2,#241 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Roseville MN 55113 INSURERS AFFORDING COVERAGE
Phone: 651-638-9100 Fax: 651-638-9762
INSURED INSURER A: Federal Insurance Company
INSURER B: Travelers Insurance Companies
O'Neil com~an~, Inc. INSURER C:
P. O. Box 11 INSURER 0:
Williston, NO 58801
I INSURER E:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL
IMPOSE NO QBLlGATION OR LIABILITY OF ~ ~ PON THE INSURER, ITS AGENTS OR
REPRESEl TATIVES. \ I' r}
MatthEJi'm ~de~\ c~ll
'VJ" """,,",' ~@A~1
COVERAGES
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.
I~f~ TYPE OF INSURANCE POLICY NUMBER b~'rIfM,r,b~mYE p~.}f~~~~)b'6m?N LIMITS
GENERAL LIABILITY
-
A X COMMERCIAL GENERAL LIABILITY
_ ~ CLAIMS MADE ~ OCCUR
EACH OCCURRENCE
FIRE DAMAGE (Anyone fire)
MED EXP (Anyone person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS. COM PlOP AGG
79395950
06/01/01
06/01/02
-
-
GEN'L AGGREGATE LIMIT APPLIES PER
I POLICY IXl ~~gTn LOC
AUTOMOBILE LIABILITY
-
A X ANY AUTO
-
ALL OWNED AUTOS
79395952
06/01/01
06/01/02
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY
(Per person)
-
SCHEDULED AUTOS
-
X HIRED AUTOS
-
X NON.OWNEO AUTOS
-
-
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY
~ ANY AUTO
EXCESS LIABILITY
A ~ OCCUR D CLAIMS MADE
I DEDUCTIBLE
I RETENTION $ None
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
AUTO ONLY. EA ACCIDENT
OTHER THAN
AUTO ONLY:
EA ACC
AGG
79395953
06/01/01
06/01/02
EACH OCCURRENCE
AGGREGATE
B
6KUB684X632900
11/01/00
11/01/01
I fgR~Ttr~YTSI IOJ~'
E,L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYE
E.L. DISEASE. POLICY LIMIT
OTHER
A Cargo Coverage
79395950
06/01/01
06/01/02
ACV up to
$100,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER
I N I ADDITIONAL INSURED; INSURER LETTER:
XBLAIRZ
CANCELLATION
City of Blair
Building Inspector's Office
218 South 16th Street
Blair NE 68008
I
ACORD 25-S (7/97)
$1,000,000
$1,000,000
$ 5,000
$1,000,000
$1,000,000
$1,000,000
$1,000,000
$
$
$
$
$
$3,000,000
$3,000,000
$
$
$
$ .100 L900.___
$100,000
$ 500,000
$1,000 Oed.
10/17/2001 07:18 402-425-5843
OCT-16-2e01 l~:l~
WASH CO PLANNING
PAGE 01
W ASRINGTON COUNTY ROAD DEPARTMENT
BUILDING MOVING PERMIT
NAME OF MOViNG /) J f II /l r f .'i. '
CONTRACfOR: l/ 'lVel ~ l'()' tMl/,~-fDIL 1U fl.
NAMltOFO\VNER: ])~J{ /)d()~~.,
TYPE OF BUILDING:_
~-?~ -Ij'~ fl I,
1h~5~ _
TELEPHONE NO. :
APPRQXIl\lATE WEIGHT:
SIZE:
h.-~--~-~ WroTR
_10'
LENGTH
DATE WHEN MOVING:
..2 VI J
PLACE OF ORIGIN: f I CJ ~ - :J-r
MOVTNGT01~ '8"0 :2~1-A g14~ r
(a 14..hO\lr notiee is required)
B ltJ.~ ~
COUNTY ROADS TO BE 'IRA VELED WflEN MOVING BUD..DING OR HOME:
_..-C ~ 1ft,
_ ce. 1.7
c ~ _ 2~
SIGNED BY: 11(1 _~A~~ '~if~
(MOVSftg: Contrador)
A'PPROVEDBY:~" ~ f7 ~ DATE: /O,../J,fI"()/
Alan ~l
Wl\lIhin~ton Counry Nighway Superintendent
A FEE OF 510.00 IS REQUlRED TO PROCESS THIS PERM.IT!
Method ofPayntent: (cash)*- (check no,)_~__ Receipt No. at" I
>Ioln the event treel!l must be Cut down or trimmed to \nove a house, they must be loaded and disposed
of immediately,
TOTAL P.Ol
Continuation
Certificate
~ hio Farmers Insurance Co.
o Westfield Insurance Co.
Westfield Companies
Westfield Center, Ohio 44251-5001
In consideration of an agreed premium payable in advance, the Bond described below is hereby continued in force for the period
indicated. Continuation is subject to the condition that the maximum aggregate liability under the Bond and any and all continuations thereof
shall in no event exceed the amount of liability shown herein. This endorsement shall be valid only when executed by an attorney-in-fact of this
Company.
CONTINUED
BOND NO. ORIGINAL EFFECTIVE DATE BOND AMOUNT RENEWAL PREMIUM FROM TO
5668134 5/3/98 $1,000 $50.00 5/3/01 I 5/3/02
PRINCIPAL
Oneil Company, Inc. PO Box 1113 Williston NO 58801
OBLIGEE
City of Blair 218 S. 16th St. Blair NE 68008
TYPE OF BOND (DESCRIBE) EXECUTED AT (City - State) DATE EXECUTED
PUB. OFFICIAL Ixx SURETY
Rapid City, SO 4/1j/.Q1
--:7
.I;JJ~~_I5_Hm~_~.9~tl~y.LJn~,________u_____________ _________ _ _ _ ______ _ _ _ _ ___ __ _ _ _ ___
Agency
- /
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By o,;ni.;p:iiiaii. ';e...iiti:"e'j::::-.m........c:::....m. ......
.~li!p.l~_ ~j!y' .l;iP. _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
City & State
BD 5403 (11-91)
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