HomeMy WebLinkAbout3/4/2002 arbogast ITY OF IOWA CITY, IOWA ,.
APPLICATION FOR AN ELECTRICIAN'S LICENSE
This application must be filled out completely and in detail
and shall be on file with the Building Official.
CITY OF IOWA CITY
Type of license for which you are applying:
NAME A/)6/' /
RESIDENCE ADDRESS
CITY0 '.'- ¢; !
[] Journeyman
[] Master's
[] Restricted
[] Maintenance
TELEPHONE NUMBER 712-
PRESENT EMPLOYER L
ADDRESS OF EMPLOYER
AGE /'7/ / DATE OF BIRTH ,~4". / 7- ~ O BIRTHPLACEcf~y/r,i'¢- /__¢1~'¢ -~o I&,'c4.
State
Have you ever had an electrical license revoked?
And if so, give reasons:
By whom?
Have you previously been examined for an Electrical License by this Board?
If so, state type and results of examination:
A/o
Was it approved?
Have you previous made an application for a City of Iowa City EleCtrical License?
(o vet}
CIVIC CENTER, 410 EAST WASHINGTON STREET, IOWA CITY, IOWA 52240' (319) 356-5000
ELECTRICIAN'S LICENSE APPLICATION - CITY OF IOWA CITY Page 2
ELECTRICAL EMPLOYMENT RECORDS
(Give previous and present employers and complete address.) .....
EMPLOYER
381~ b ~-~
COMPLETE ADDRESS
DATES EMPLOYED: From
Type of Electrical Work
EMPLOYER
DATES EMPLOYED: From DOa,, /qfC?
· .
Type of Electrical Work O~ ~-q[r~ ~/~r ~[ C~/
Oo~ 0~
EMPLOYER
DATES EMPLOYED: From
Type of Electrical Work
3'IOO 4¢/,-.,Wc. Ave.
COMPLETE ADDRESS
to
COMPLETE ADDRESS
to ~.~
EMPLOYER
COMPLETE ADDRESS
DATES EMPLOYED' From
Type of Electrical Work
to ~-~,Z' ¢'?
I If this application is approved by the City, you will be notified as to when you will take your examination.
The foregoing statements are true and correct to the best of my knowledge and belief.
Signature of App~
.%
hisblg\etecdic, app
Date
i NYC-001335637-00
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF iNFORMATiON ONLY AND CONFERS
MARSH USA INC./ NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
RISK MANAGEMENT DEPT -42ND FLR POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
1166 AVENUE OF THE AMERICAS AFFORDED BY THE POLICIES DESCRIBED HEREIN.
ATTN WINSOME PASSMORE-212 3453666/FAX 3454735 ~ COMPANIES AFFORDING COVERAGE
NEW YORK10036
COMPANY
105145---2001/2 I A LUMBERMENS MUTUAL CASUALTY CO
INSURED COMPANY
LUCENT TECHNOLOGIES INC. B N/A
283 KING GEORGE ROAD
ROOM C3C23 COMPANY
WARREN, NJ 07059 C AMERICAN PROTECTION INSURANCE CO.
COMPANY
D
COVERAGES This cedificate supersedes and replaces ~Y PreVioUsly issued certificate for the Policy pe~°d ri°ted bei°w~ 0
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED,
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES, LIMITS SHOWN
MAY HAVE BEEN REDUCED BY PAID CLAIMS
...... POLICY EFFECTIVE POLICY EXPIRATION ~
LTRCO~[ TYPE OF INSURANCE II POLICY ~umuc~ DATE (MMIDDIYY) DATE (MMIDD/YY) / LIMITS
A GENERAL LIABILITY 5,'6u~ 045 741-00 ; 09/30/01 09/30/02]
$
'~ 1 COMMERCIAL GENERAL LIABILITY ' IGENERALAGGREGATE
~_ ...... ! PRODUCTS- COMP/DP AGGI $ 1,000,000
____ _J CLAIMSMADE [~ j OCCURL I PERSONAL&ADVINJURY $ 1,000,000
OWNER'S & CONTRACTOR'S PROT [ I EACH OCCURRENCE $ 1,000,000
- ] I ] FIRE DAMAGE (Any one fire) $ 300,000
I I I MED EXP (Any one person) ; $ 10,000
l AUTOMOBILE ! COMBINED SINGLE LIMIT $
LIABILITY
BODILY INJURY ,
iI -i ALL OWNED AUTOSNON-OWNED AUTOS i i (Per pers°n)
SCHEDULED AUTOS i
HIRED AUTOS , BODILY INJURY
~ (Per accident)
F
t i PROPER 'O^MAGE $
ANY AUTO i I OTHER THAN AUTO ONLY:
I
_ [ i EACH ACCIDENT $
I AGGREGATE $~
EXCESS LIABILITY ~ i $
---1UMBRELLA FORM i] AGGREGATEEACH OCCURRENCE $
] OTHER THAN UMBRELLA FORM ) I $
n,3/01/0q v I WC STATU- J J OTH-
C 5BR 002 984-01 (WI) 02/01/02 , u~ o ~ ~ TORY LIMITS
~5BR 002 985-01 (AZ. LA) 02/01/02 02/01/03 ~EL EACH ACCIDENT $ 1,000,000
cC J' THEPROPRIETORipARTNERSiEXECUTiVE [ ~ ,NCL 5BR 002 986-01 (~O) 02'01/02 ~0~'0"03 ..... ~-EL;~.~ U~:~-~
OFFICERS ARE ' EXCL , , L - ~p ~q~% i 1, 1
DESCRIPTION OF OPERATIONS/LOCATIONS~EHICLESISPEOIAL ITEMS {LIMITS MAY BE SUBJECT TO OEOUCTI~LE~ ~E~EtE~IONSf ~M & g &Ur& ~' L~'
CERTIFICATE
HOLDER
CANCEL~ ION OVV;:~: C
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE
CITY OF IOWA CITY CERTIFICATE HOLDER NAMED HERE~N, BUT FAILURE TO MAIL SUCH NOTICE SHALL ~MPOSE NO OBLIGATION OR
410 EAST WASHINGTON STREET
IOWA CITY, IA 52240 LJABILI~ OF ANY KIND UPON THE iNSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES
MARSH USA INC.
BY: Lisa Trimble ~~3(~
(9i99) VALID AS 0¢ 02!22t02
CONTRACTOR REGISTRATION CERTIFICATE
STATE OF IOWA
IOWA WORKFORCE DEVELOPMENT
DIVISION OF LABOR SERVICES
CONTRACTOR REGISTRATION
1000 East Grand Ave.
Des Moines, IA 50319-0209
Phone (515) 242 - 5871
DATE ISSUED: 10/02/2000
DATE EXPIRES: 10/02/2002
NUMBER: 64866-00
LUCENT TECHNOLOGIES INC
283 KING GED RD # C3DO6
WARREN, NJ 07059
Byron K. Orton, Commissioner
City of Council Bluffs, Iowa
Public Works Department
Building Inspection Division
209 Pearl Street
Council Bluffs, IA 51503-0826
(712) 328-4625
February 6, 2002
to: Whom It May Concern
ref:
Test Results ofNeil Arbogast
Tested as a Master Electrician #201
This is certification that Neil Arbogast passed the proctored Experior exam #201 on
May 5, 2001, with a score of 84.1% correct.
Part I: 81.6% Part II: 81.4% Part III: 86.7%
Sincerely,
Dan E. Woellhof, CBO
Building Official
City of Council Bluffs
05/11/2001
EXAMINATION SCORE REPORT
NElL A.RB OGAST
13002 OVERLAND TRAIL
COUNCII, BLUFFS, IA 51503
Dear NElL ARBOGAST:
The following is your grade results for the examination(s) you have taken.
Applicant Number:
Exam Date:
Exam Site:
Exam Sponsor:
484-84-5749
05/05/2001
COUNCIl. BLUFFS, IA
Council Bluffs
EXAM PART 1 PART 2 PART 3 EXAM STATUS
SCORE
20 llA22-Ma~ter ElecttScian 81.6 81.4 86.7 84.1 PASS
Council Bluffs requires a passing percentage of 75%.
Sincerely,
Experior
91328
Experior Assessments, LLCTM · 2100 NW 53~ Avenue · Oainesville, FL 32653
Toll-Free: 800.280.3926 · Fax: 352.336.4513 · www.experioronline.com
OFFICE ¢205
CiTY HALL
209 PEARL STREET
KEVIN HARTMAN
CHIEF ELECTRICAL INSPECTOR
DEPARTMENT OF
PUBUC WORKS
BUILDING DIVISION
Phone (712} 328-4826
FAX (712) 322-3418
t,,' j-Ma~ETE le ctr ici a n
( ) Journeyman Electr. ician
( ) Journeyman Plumber
DAVIT OF E;,'PF, RIENCE
.~: (check one)
( )'Electrical Contractor
( )..Plumbing Contractor
'(~.'~ Code Enforcement Officer
( ) Union Representative
( ) Other:
I, ~J/~/(~ '~.~,'-/~,~ _,b=.ingdu, lF.~worn_,depose.,andsayu'~at, i~nmy
capacity as checked ;'U,':,',,'o. I personally kno~. 7%.. /"//¢/'/' ,f"'-.z/,,.-,,~,~ ~2~ S / ...
has actually be~n e.r~,nlr'.v..:cl in the tr~.de of(u_~-,,,=7;",-',¢,,'~, / ,/~.-~'~-,¢~,,-,,'?~.,.-as a ( )
Journeyr~an or ~-~s .~n ( '~ Apprenti,~ .ff;r /'~/'. years and ~ months,
_,~_-3ig,qature)
(Type or Pi"int Name as Signed Above)
(Bate)
MAILING ADDRESS:
Street
City State Zip
~&~)' ' '(Phone. Number)
Please describe be[ow th~ type ~nd extent of work experience attributable to applicant.
Be as explicit as possible. , .
. .-: .
Nell L Arbogast
'c?': '.' ' 13002 Overland Trail
~' "L.' '. Council Bluffs, IA 51503
MASTER ELECTRICIAN CERTIFICATE OF COMPETENCY
Expires:01/31/03
Number:2180
FEE:$ 50.00
City of Omaha
Permit & Inspection Division
JOURNEYMAN ELECTRICIAN
Minnesota State Board of Electricity "..
Class 'A" Master Electrician's License ,, ",
This is to cerdfy that '"
, Nell L Arbogast , ......
is the holder of a CIa~' 'A" Master electrician;s license. THIS'.'. 2
IS NOT A CONTRACTOR'S LICENSE. . ...... ..,.
." ,,'""".'' .' '"' ":::, ':)':.i", '
AM06704 ' ' ..01/16/2001 . 02/28/~...,:
Ucense Number Effective Date .:' Expiration Date.Ti
STATE OF NEBRASKA ° STATE ELECTRICAL BOARD
Lincoln, Nebraska'
Date: 12/0'412000This is to certify that
~l'k'~T. L ARBOOAST
t 3oo30V]~T..AND ~
COUNCIL BLUFF~. IA 51503
is her~..~:ta~d *h~l~n§ license
?resident
Fee Received $ "<150~0 4602
Unless sooner revoked License shall expire Decmber 31,2002
.........................*NEIL2OO$-2~)O2~RBOGAST*
is licensed and authorized as
Electrical Journeyman and to
such ~ork within the city limi,t~
of Council Bluffs, Iowa, until~_'~
the expiration date of C
To
'i ~' ~2':~-~l~s-~-fb-'~ltf~that/.~_ NElL ARBOGAST is hereby
~ ~rm{~d t~engape as a Journeyman Electrician as
~.'_. -~i~ed by~ity ~dinances until December 31, 2002,
, ['~ r~ ~n~e~ ]~nse~hall be s~ner revoked. '~
: 'a~:"' ~ O~ha, Ne~a ~ Janua~ 1, 2001 -
........... ' ~ ; ~- -' ~f ~le~r~cal Inspector
License # 916
Issued by: City Clerk
Council Bluffs,
.......... :9 ~ Ci~ of Omaha
_' '; .:'~ Permit &'nspecti~n Division
(~.." ~ECTRICAL CONTRACTOR
fkiYi~ tO'~i~ that NElL ARBOGAST is hereby
permitted to engage as an Electrical Contractor as
provided by city ordinances until December 31, 2002,
unless this license shall be sooner revoked.
Omaha, Nebraska - Januau 1,2001
:' NEIL ARBOGAST
il//'' is licensed and authorized and
. ~ -:~:~.:,: .
Electrical Contractor
such ~ork mithin the City 1~~?:~-::'
expiration date of O~-~I:~'~L '
the
Zssued by: City Clerk
~'-- t)' ~to; Council 8i~~
G~]~El&tdca~ :nspec
Hinw~h~ ~ L~nn Co,
Ci~ o[C~d~ ~np~ds, M~riom
THE CITY' OF ELKHORN, NEBRASKA
2002 REGISTRATION
TO ALL WHO SJ;[~LL SEE TI{IS SHALL KNOW THAT
I S HEREBY REGISTERD AS'AN
ELECTRICAL CONTlt~CTOR
FOR TI-IL PERIOD ENDING DECEMBER 31, 2092
NOT V~I~ID UNLEgg'gTGNED BY INSPECTOR'
Number: 000181 Date:
Status: Active Status Expires:
NElL L ARBOGAST
13002 OVERLAND TRAIL
COUNCIL BLUFFS, IA 51503
METRO MASTER ELECTRICIAN
This cert is valid in Cedar Rapids, Marion. Hiawatha
& Linn Co. la unless revoked for cause by proper authoriW.
DON HARBAUGH
P. uihlinc*
12/18/01
12/31/02
SERVICE CORP.
BRUCE E. RASMUSSEN 3100 Nebraska Avenue
President Council Bluffs, IA 51501-7033
Telephone (712) 323-0541
VISIT US AT www. rasmech.com
FAX 1-712-323-8681
Toll Free 1-800-237-3141
February 25, 2002
To Whom It May Concern:
Nell Arbogast was employed at Rasmussen Mechanical Service Corp. from June of 1987 to
January of 2001. During his employment with us, he was responsible for the installation and
maintenance of a wide variety of electrical apparatus. The following is a list of what some of his
duties were:
Installing new electrical services for customers as well as in our own buildings.
Installing power and control circuits in boiler rooms for industrial applications.
Installing power and control circuits for chiller installations.
Installing Energy Management Systems.
Installation of new and rewiring of existing boiler/burner flame safeguard controls.
Service calls of many different types.
If you have any questions or need additional information, feel free to contact me at the telephone
number above.
Sincerely,
Donald L. Campbell
General Manager
DLC/sd
EMPLOYMENT RECORD ~,, FEB
(Start with present employer)
Employer , 6 ~t c_e~] 7~ -c o [~ Address,,
City ~m~X~ State ~ Zip (~/07 From ~
Position ~q~~
Supervisor ~o~e,~/t k'c//~ Phone (61A2 ¢ 2 6-, ?3 o
Employer ,~aJ- fll (4 ~'J-e~ /~¢o~ ~ece;c~Aadress
Position
Supervisor
Phone
Employer n ~ c
c,~r (~~_ ~ ;//~/~,~;~ st~= ~__.d._
Position C~o ur
Supervisor
Address
Z iD .3~/3'o ('
From/Ce~ ~PY To /~Taw '~'7 .......
Employer ca-~ ~P 7-¢c~ 2~n c,
City O~ e ~ State~
Address
Zip?~~_
Position
Supervisor
Employer t~ e 7Lro ~-/~Ta;"b"c .... , .... Address
City O/n~ State A/~__ Zip~/__~~
Position, ~q~~~ ~/cc~rl'C/~ , ,
Supervisor ' ~e~ ~i[~°~ Phone
Employer ~o-/e fllq La-/e~cTcp/c . Address
Position ~,'~;
Supervisor
,9'o '-( ,.70.
Fr om~_~.~To
Phone. 67/2-) SA~- o~lS'
Name of High School
Address. /9'~
EDUCATION
FEB 2 8 2002
city. do~,,~//E/o~,state~ zip ~-/ro.y
Are you a graduate of a Trade School?
Year 7~/~/ Name of School~,,,, .~~-"t,~),, ,,,,, ~oca/
Address ~ ~4/6 /__...r'/~, ¢~-/-- C: O~
State A/~-...Zip ~o~/27
Are you a graduate of an approved apprenticeship school?
Year 7~/~/ Name of School
Address, 0°~5/~ L ,,,-f'79"c~7a ~ ~t State/~/~Zip~,,,/~,7,
State other courses of study in this trade area, if any
Name and address of above
Additional
Information