34 Longview Dr #57
Fee Paid:
Permit to Move Building or Demolish Structure
( j j I I
lei
Date:
$15.00
Owner
Contractor
Name: lctLu'E::'nCJ!" [,,{J()0
Name: l-trdc\\ Trer\,,(Iun'ci
I
Address:
) ~lYl Z (1:';, lkUl) ?o(~,
j?) I /~(~iO Y
--~'~")
The above described person is hereby granted a permit to (Move) or ~em~~))a
:;2;--
building :5 i~: feet io~g, and /0 feet high, now located on l-o(!c; VI t'ld'4{"C;7 ,
,
2) (I L' '\r ", ,J "
, 101 1(:j\iLUJ Ii ~ '
Address:
r) 1
t::>lnl,(
City of Blair, Nebraska, to be finally located on
. The (Move) or
(Demolition) is to be done on i /1 L; Ie) I
and shall take
hours. The
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):
0J
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
purposes.
{~tatement that ~taJ;:es 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 !-~ltr ! ~5(cJl 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
AUTO HOME BUSINESS HEALTH LIFE
GEORGE HALL AGENCY, INC.
]641 WASHINGTON STREET
P.O. BOX 326
BLAIR, NEBRASKA 68008-0326
OFF: 402-426-4860 RES: 402-426-2379
E-MAIL: ghall@amfam.com
November 15-2001
Laurence & Carolyn Long
34 Longview Drive
Blair, NE. 68008
To whom it may concern,
The property located at 57 Longview Drive Blair, NE. 68008 has never been insured with
AJ.~~_r.. amily Insurance.
~~.
George Hall Agency
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BUILDING INSPECTION REPORT
Q CITY OF BLAIR
D WASHINGTON COUNTY
D OTHER
LOCATION OF INSPECTION:
NAME OF OWNER:
DATE INSPECTION REQUESTED:
TYPE OF INSPECTION
BUILDING: D FOOTING D
COMMENTS:
UTILITIES:
CONTRACTOR:
TIME INSPECTION REQUESTED:
PERMIT NO:
ST A TUS CHECK
PASSED FAILED
D D
D FIXTURES D FINAL D MOTORS D PERMANENT SERVICE D TEMPORARY SERVICE
PASSED FAILED
D D
COMMENTS:
ELECTRICAL: D ROUGH IN
D PARTIAL
D SEWER TAP D SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE
D PARTIAL
PASSED FAILED
D D
COMMENTS:
MECHANICAL: D ROUGH-IN D AlC D FURNACE D FINAL D PARTIAL
PASSED FAILED
D D
D GROUNDWORK D ROUGH-IN D FINAL D WATER METER INSTALLED D PARTIAL
COMMENTS:
PLUMBING:
PASSED FAILED
D D
COMMENTS:
o OCCUPANCY GRAN)JP D CONDI~IONAL OCCUE NCY GRANTE~ ' ,
NOTES/REMARKS: ~~5 S; G b~ ~ m ~
~~ "b€-~ @;L) eJL71I ()~CJ:5:5'I,6I(-'J el4$~ 6J~;- yJp s-' :
, .
gc&2
r
--
ATE OF INSPECITON MADE, {{; - /,9 - tJ I TIME, 4c c ~
'lov?U
TO CONNECT SERVICE: DYES D NO
BUILDING INSPECTION REPORT
o CITY OF BLAIR
o WASHINGTON COUNTY
D OTHER
LOCATION OF INSPECTION:
NAME OF OWNER:
CONTRACTOR:
DATE INSPECTION REQUESTED:
TIME INSPECTION REQUESTED:
PERMIT NO:
TYPE OF INSPECTION
CONFERENCE
D STATUS CHECK
BUILDING:
D FOOTING D FRAMING D DRYWALL D FINAL D PARTIAL
PASSED FAILED
D D
COMMENTS:
UTILITIES:
D SEWER TAP D SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE
D PARTIAL
PASSED FAILED
D D
COMMENTS:
ELECTRICAL: D ROUGH IN D FIXTURES D FINAL D MOTORS D PERMANENT SERVICE D TEMPORARY SERVICE PASSED FAILED
D PARTIAL D D
COMMENTS:
MECHANICAL: D ROUGH-IN D AlC D FURNACE D FINAL D PARTIAL
PASSED FAILED
D D
COMMENTS:
PLUMBING: D GROUNDWORK D ROUGH-IN D FINAL D WATER METER INSTALLED D PARTIAL
PASSED FAILED
D D
COMMENTS:
D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS:
~7)/-50,{~e:D dJP71(2:J<} h.e &p/1/b,Je;
eRA /~ w Jtle-J1 c..IIUG){T h fGE
-
--"
DATE OF INSPECTION MADE: ~ - / /- cJ /
It) rt)o
TIME: /( .
TO CONNECT SERVICE: DYES D NO
11/15/2001 12:53
4024259580
HENTON
PAGE 01
~"
ACQRDN CERTIFICATE OF LIABILITY INSURANC~~t~2 I DATE (MM/DDIYYI
04/25/01
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Omaha. ONLY ANDCONlOgRS NO RIGHTS UPON THE C~RTII"ICATE
Insurance. Servic8s Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Bo,g 4.5489 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Omaha ME 68145-0489
Phone.: 402-592-4455 INSURERS AFFORDING COVERAGE
INSURlOO - """"''-------.''''~~-'..-,,_. ~..-..-.._..- .....~~".f''''''',.'......_.. .__ .._."-,,..~.,.N.-.,....,,~._____.._-.-,-........
: INSURER A: General Casualty Co.
1...__,...,...-.......
Henton Tre.nChing, Inc. ~I.~~_~~~,~;;.
John << Donna Henton DBA ' INSURER C:
3.3092 US RIO #30 ~._--_--I'M.....'-....., --
: INSURER D:
:81air NE 68 0 ~-----'-'-"'''''''''''''''"'--'
I ; INSURER 10;
COVERAGES
THE POLICIES OP INSURANCE t.ISTE:O 6ElOW HAVE BEEN ISSUf.() TO THE INSURED NAMlOD AllOV!: f'OR THE POLICY PERIOD INDICAtED, NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CE~'rIFICATE MAY BE: ISsUlOO OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE: POLICIES DESCRIBED HEREIN IS SUaJECT to ALL THE TERMS, ~ClUSIONS ANO CONDITIONS OF SUCH
POLlCI(;S, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUC(;D BY PAID CLAIMS,
INSIl, ~-~ "--';~~~~~';u-;iiER----'''--TCW~~~yti ! "t?k+i~a~?N!
I.TR TYPl! OF INSURANCE , UIVIITS
G!!NER.AL t.IA13lliTY I i EACH OCCURReNCE 51,000,000
......"':'-\ ! FIRE; DAMAGE V\I1y one ma)
A X ! o.OMMERCIAL G(;Nl2RAL l,lABILlTY : CCJ:02J.4286 05/02/01 05/02/02 550,000 ,
~~,'~~'M'l CLAIMS MADE; [!] OCCUR i Ml2D ~P (A,nY~ln~ p~rqon) $5,000
! I P(;RSONA,L & Abv INJlJRY 51,000,000
- -- f Gf;NERAL AGGREGAiE ..............-
$2,000,000
-- ~-" ..'0' I PRODUCTS - COMP/OP AGG
~~N'l MG~I~E ~~~~ APPLIES f'E~: , $2,000,000
"'1 POLICY JECT II LOC , : I
AIJTOMOelLE LIABIliTY ; I I
1--- I I COMBINE:D SINGLE LIMIT sl,ooo,oOO
A ~ ANY AUTO CBA02J.4286 , 05/02/0J. 05/02/02 i (f:a accidenl)
~
All OWNED AUTOS f aODll Y INJURY $
-'" , i (Per persDn)
I SCHEDUL):D AUTOS --
tJ HIREi.D AUTOS ! BODILY INJURY $
, , NON..oWNED AUTOS i (Per accident)
,-- ,
i
1---., ".w___ -, ~._.._~~-_._~._..- I i PRDPl2RTY DAMAG€< S
I i (Per ~cci<lCln~)
, ; i AUTO ONt. Y . E;A ACCIDENT ~
GARAGE LIABILITY I i
---~I ANY AUTO i I OTHER THAN ~-'"-"-~
I
, 1
i ! AUTO ONLY: AGG $
, I 1 EACH OCCURRENCE $J.,OOO,OOO
~~"'~'urr !
A ~:=I OCCUR 0 CLAIMS MADE CCI02::L4286 05/02/01 I 05/02/02 i AGGR!;:GAT!;: $
I !
I , I S
DEDUCTIBLE ! ; $
;
X RET(;NTION $ 10,000 i ! .$
WORK:~RS COMPI;NSATlON ANti i i rORY L1MrrS I IOlH'
ER
A EMPLOYERS' LIABILITY I CWC02J.4286 05/02/01 i o 5 / 0 2/ 02 i E.l. EACH ACCIDl.:NT $100,000
; i i EL DISEASE - EA EMPLOYEE $3.00,000
! i
; i ! E;L DISEASl2 . POLICY LIMIT $500,000
~ - ! I
OTH/:!R , i
i
r !
,
DESCRiPTION OF OpERAtIONSIl.OCAllON5NEHICLEiS/EXClUSION5 ADDEiD BY ENDORSEMENTISI'ECIAll'ROV1S1ONS
CERTifiCATE HOLDER I N I ADDmONAlINst)~l!ll:i; INSURE~ I.I!:TTER; CANCELLATION
CJ:TY046 SHOULD ANY OF THE ABOVl! DI!SC:R1l!l!!D POLICIES 151' CANCELLED BEFORE THE ~PIRATlO~
DAtE ,(l1iOfU,OF, THE ISSUING INSURER WILL ENDEAVOR TO MAlL 2:Q.~", DAYS WRiTTEN
NOrlCE TO THE CERTIFICATE HOI.CEIt NAMED TO THI1 LEFT. BUT FAILURE TO DO SO SHALL
City of Blair IMPOSE NO OBLIGATION OR LIABiliTY OF ANY KIND UPON THE INSIJRI!R. ITS AGENTS OR
2.:1.8 S 16th Street
Blair NlIl 68008 REPRESENTATIVES.
.~ ~",,--~.;' '/,./ /
Phil WinkAlm h-. ,., , , =-, ./ -,
ACORD 25-8 (7/97) ,./ @ACORD CORPORATION 1988