TRANSMITTAL of OMAH A LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID #: ^^irryOif Date: n ^ //nf>. jpni o 

Address: 5",^ ^ .<? S | A< 

Stabilization Contractor: Pruden t Technologies, Inc . Year: 2010_ 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

y Video ofproperty (DVD) jyg _ fJAcL prs^ f 

y Executive Summary 

sf Signed Access Agreement for subject property 

y Pre-Renovation Form signed by Property Ovraer 

D Pre-Renovation Form for Occupant/Tenant, if applicable 

y Painting Agreement 

D Settlement documents (i.e., for damage or to replace plants, etc.) 

[j/ Renovation Recordkeeping Checklist signed by Certified Renovator 

y Photographs 

y Satisfactory close-out check list signed by Property Owner 

D Property close-out check list signed by EPA 

y Property information fi-om Douglas County Assessor's Office 

y Hazard analysis, if prepared 

D Safety Audit 

^ 30260145 

D Other (describe): 

Superfund 

rf)Q.4JdL^tiv^3^ t-4iitLi r n Lpf^j-^fr^ 

Pnident Technology, Inc. Signature /Date / 

/o/z/fro 

lahire Date 

(after file folaer review) 
TECHNOLOGIES,] 

Property Summary 

Date: 07/8/2010 | LBP STABILIZATION EPA CONTRACT EP-R7-08-07 | Month of; July 

Property Address; 536 S 31 Av. SAID #: 22604 

A. Executive Summary; 

a. Issues Encountered; NONE 

b. Issues Resolved; NONE 

c. Unique Findings; NONE 

d. Other Relevant Information; 

i. Access Date; 03/30/2010 

ii. Work Began; 05/14/2010 

iii. Close-Out Date: 05/14/2010 

B. Enclosures: 

1. Pre-Stabilization Video 

2. Post-Stabilization Video 

3. Signed Access Agreement Form 

4. Advance-Notice Form 

5. Pre-Stabilization Video Agreement Form 

6. Access Tracking Form 

7. Property Access Assessment Form 

8. Neighbor Access Agreement Form 

9. Property Paint Match Form 

10. Pre-Stabilization Property Safety Assessment Form 

11. Work-Site Hazards Analysis Checklist 

12. Pre- Stabilization Property Hazard Assessment Photographs 

13. Douglas County Assessor Property Information 

14. Signed Property Completion Agreement Form 

15. Property Close-Out Check List Signed By EPA 
200V07-21 01:59 4025041005 P4/6 >> 

Prudent Technologies, Inc. (Prudent) is under contract (Contract # EP-R7-Og-07) with the U. S. 

Environmental Protection Agency (EPA) to stabilize Lead Based Paint (LBP) at a number ofproperties 

located in Omaha, Nebraska, includiog the property locaied at: ^ 3 Zo ^ . 3/-^/ 4 tr ^ 

/)zn^/,a^.z?e z.yzz^ 

The EPA requests your permission to allow Prudent to perform LBP Stabilizalion st this propeity. By 

signing this form, the propeity owner gratUs pecmission to Prudent to perfoim activities lelated to LBP 

Stabilization inchiding scraping paint and painting of the lefeFcnced property. Further, tbe 

owner/tenant verifies tfiat they have received the LBP pamphlet ''Renovate Right." 

By signing this document I agree to allow an EPA contractor to conduct a soil cleanup at my propeity 

foUowing completion of lead^bascd paint stabilization, if the soil cleanup has not already beec 

pef&rmed. 1 tmdeistand that the stabilization contiactor cannot provide assurances of which 

contiactor will be bound to the soil cleanup. I further imdentand that the soil cleanup contractor will 

make all reasonable efforts to address concerns that I, as the property owner, may have regarding soil 

cleanup at my property. 

It/fVei), I have read and understand the paragraph above. 

3.30./^ 

Property Owner's Signamre Date 

If you bave any questions about the LBP stabilization planned for your property, please contact 

Prudent's Customer Relations/OSice Manager for the Lead Based Paint Stabilization, M**! flKIB't'* 

Shekar at 402- 504-1004 or 402.889-3811. General questions about the Omaha Lead Site cleanup can 

be directed to tfae EPA Public ItUfonsobon Centers at (402) 731 -3045 (South Omaha office) or (402) 

991-9S83 (Nonh Omaha ofRce). 

PrpDcrtv Aeccss Craated Bv: 

4rri,. ./Jy^Mff yC . £f,^^n-u^ 3 . 2>t>iZo 

P^perty Own«r^Signature '' Date 

^/» 2 U4 y M/ 9 y.L • S^T'er^/ses 

'lease Print Name 

tO80 W<*rd Parkmy, BiiMa 40e xso» N. 14* 8VMI. auit» soe ta n Vadical Orlv*. 8«itt« 42S0 

Kanus city, MO 84114 Omatia. NabtMka SB110 8an Antonio, 7X79229 

piMn»:(eie>M3-sro9 Pticra: (402) eO«>1Q04 PtwtM: (219)8»<«$sa 

Fu : (402)S04.1NS FIX: (210> 9794077 tfvt: <Bf6) 88S-S70r 

200V07-21 PaseZ 01:15 4025041005 
200V07-21 01:59 , ^ » 4G25041005 ^ P 5/6 

PROPERTY INFORMATION 

(To be completed by resJdeat and/or property owner - please print) 

RESIDENT NAME: Owner Tenant 

RESIDENT ADDRESS: ^S( ^ S . 2>/^Ayc ' 

EF RENTAL. PROPERTY OWNED BY: /^ ^ AOyi; / /DZ3 ^ P-Z. • ^ZTf^Z^rJe u 

OWNER'S MAILING ADDRESS: ^- ^ - ^ / /cF/ 2 

Ci)Ut!Z:/L. 'SycZPP^r T A ^zsr)Z- /A^zZ 

OWNER'S TELEPHONE NTJMBER: 

Home: l/Z-J/:^'3^o9 Work: CeU: J^^Z:_^!:££^ ^ 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: < 3 

TOTAL NUMBER OF OCCUPANTS: /S ^ 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS 

OR MORE PER WEEK: OZ) Ajg T Pdv 4 t/ t/ V TZZ ^ y j^h^.Zl 

COMMENTS OR SPECIAL INSTRUCTIONS ftttch as dop , entry mtw . ttcl : 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: Tl« acUvities to be implemented 

by EPA under this agreement are punuant to Section 104 ofCERCLA, 42 U.S.C. 9604. EPA's right 

of access to the property is providedfor is Section 104(e) ofCERCLA, 42 U.S. C 960S(e), which 

provides entry for "determining the need fbr response, or choosing or taking any response action under 

tfais thie, or otherwise enforcing the provisions of the title." 

Property Owner Signature:

• _.(^)^6 \ 0^ ^ _ / r>^yy 1^0./^ 

(Signature) "^ Date 

aoeo Ward Partcway, S ulta 4as 2«0S N. 24*" ativat. Suit* 308 4S42 Medical Oftva, Sirile 42M 

KifltM Clly, MO $4114 Omaha. Nttoraelia M l 10 U n Antanlo, TX 7S2SS 

Phon*: (BIS) MMTOS Phone; (402>S04-1004 Phona; (2l«)a2S'*B«S 

Fu : (816)3634707 Fax: (4021 Goa-ioas Fax: <2l«) STMs n 

200V07.21 01:16 4025D4100S P8«e 3/5 
2001-07-21 01:59 4025041005 P6/6 

PRE & POST PAINT STABfUZATION VIDEO AND PICTURES 

I understand that prudant Technologies (Prudent) will be coming out to shoot a PreStabilization video and to take pictures of my property. Prudent wilt use the videos and 

pictures to document the current property status/oondrtton. Also, Prudent wUI shoot a video 

shot fbllowing the completion ofthe paint stabiiizatlon. I give pemnission to videos and 

pichjres of my property. 

Please list any special conditions that Prudent employees need to be aware of before 

shooting a video (such as pets, prior notice, etc.). 

3'3( ^ 33/^" ^ ye. /)z:^/,u. /7e

Propert propenyy Aocires Address s

^za r 

Owner's Name Signature 

Z.Jiory^ 

Date 

ADVANCE NOTICE REQUIREMENT 

After signing the access you aNow Prudent to t>egin Lead Based Paint Stabilization. All 

PlantB, wieeds and any vehicles or items on open porch (endosed porches will NOT be 

BtabilizBd) must be removed prior to stabilization. All Pets must be out of yard during 

stafoOlzatlon. Please indicate t)elow how much advance notice you need to have the abovementioned tasks oompleted. If you are a landtord you will needfascontact the tenant as 

Prudent will only Inform the property owners. 

Do you have any pats that reside in yard: Jw_ 

Notioe needed: \JZS 

Phone number to call to give notice: ¥0l . *=?// O^J ^ 

Whom we are giving notice to: H m l-Z^y</ 

80BOWar4 Partway, BiMa40S ZBOS N. 24* Sliaat, Suiti 308 4J«2 Btadleal Ortva, SuKo 4280 

Kan«a4City,M0 84ll4 Omiha, Nabraaka 88110 San Antonio, 1X78220 

Phona: <B16) 363-3701 Phona: (402)694^1004 Phona: (219)62^668 

F»x:(8ie>383-J707 Fox: (402)604-1008 Fax: (210)5784677 

Page 4/6 ?nni.n7.? 4025041005 i nriR 
200V07-21 01:59 4025041005 

P3/6 

Current Sample Pre-Renovation Form 

Effective until April 2010. 

Confirmation of Receipt of Lead Pamphlet 

^ 1 have rece)s«d a copy of the pamphlet, Renovate Rght; Important Lead Hazard 

Information for Fainiiles, OiHd Care Providers and Schools infomUng me of 

the potential risk of the lead hazard exposure from renovation activity to be 

pertomied in my dwelling unit. I received this pamphlet before the woiH began. 

iiT|»eh!?ame of rsdipient • " 

Date 

lure of recipient 

Seif-Certllteatton Optton (for tenant-occupied dwellings only) — 

If the lead pamphlet was deilvered but a tenant algnature was not obtainable, 

you may oheok the appropriate box below. 

Q Refusal to sign — I certify thet I have made a good faith effort to deOver the 

panr^hlet, Ranovsfe Ri^t: important Lead Hazard lnfonf)atlon lor Families, 

Child Care Provldera and Schools, to the rental dwelling unit listed below at the 

date and time indicated and that ttw occupant rafused to sign the confirmation 

of receipt. I further certify that I have left a copy of the pamphlet at the unit with 

the occupant. 

0 Unavailable for signature "- 1 certify that I have made a good faith effort to 

deliver the pamphlet. Renovate Right: Important Lead-Hazard Infonnation for 

Families. ChUd Care providers and Schools, to the rental dwelling unit ileted 

bebw and that the occupant was unavailable tc 8jgn ttie oonflimation of receipt. 

I further certify that I have left a copy of the pamphlet at the unit by sliding It 

under the door, 

Printed name of person certifying 

Attenpted defivery 

date and time 

lead pamphlet delivery 

Signature of person certify^ lead pamphlet delivery 

^.^t^sr^z^'kizs A'ZT f^ ,1.3 9. r ^ /P^^.iZ,^ y?z /./zcr 

Unit Addreas 

Nota Regarding Mailing Option — As an altenretivd to delivery in per^n, you 

may mall the lead pamphlet to the owner and/or tenant. Pamphlet must be mailed 

at least 7 days before renovation (Document with a certificate of mating from tha 

post office). 

2001-07-21 01:19 4025041005 

Page 5/6 
200V07-21 01:58 4025041005 P2/6 

PAINT MATCHING FORM: 

1. TO BR FILLED OUT ONLY IF MATCIMNG COLOR 

PROPERTY ADDRESS: 3t36 > S-^Z^r^/ l y t pm±£j^jUB'h^/Gr 

BVD): 

The foDowiog notes arc for tbe benefit of paiat crew only. 

Location Paint Description FaintYes Paint No 

Siding 

Soffit 

7ri^f^\ FF iZ. 1/ 

Fascia ^ 

Comer Trim y " 

Window Trims S^2!l^ \ y 

Door Trims i X 

Front Porch Ceiling ^ ^ fl^^r'i y 

Front Porch Ceiling Beams t / 

Front Poich Floor 

Front Porcli Railings v/ 

y 

y 

Front Porcli Steps Ce^rynP-z}^ [y ^ 

Siding Baseboards r^^\-o.\ y 

Foundation T?rrcr^ y" 

p (fnetti. ( S^/c/fHt^ i>/ea.ie deciz U / i it/cupa / yfc^ J^\r € ^ ; 

IrO^oA­ vX 

Y"- ^ \X 

B ^ ^ < ^ P«^g'< L W^^A. ^>Vv'y t 

I UNDERSTAND SHERWIN WILLIAMS WKL MATCH MY CURRENT COLORS 

2 •7L 

Homeowner signal y^ /K y^ Datei . i. To.io 

80&0 Ward Partiany, Strita BOB 2605 N. 24**atnat, Sulla 308 4242 Madleal Oflve. Sulia 4260 

KaiMoa city, MO 84114 Omaha. Nabraaka 68110 SsnAmon(o.TX7St2« 

Phona; (BtB) 363-3703 

FaK:(81B)Sa3>3707 

Phona: (402) 8O4-i0O4 

Fax; (402)804.1008 

PhOfw: (210)822-«m 

Fax: (310) S7»4S77 

7nm.n7.7i ni'j n xn-jcn^innc 
'TECHNOUX}IES,INC 

ACCESS ASSESSMENT FORM: 53Z. s

Is the property stucco or asbestos? Y^€> 

If yes, Is any of the stucco or asbestos damaged or 

cracked? 

If yes, stop as we can't stabilize this property. It 

requires special preparation techniques. It will be 

returned to EPA and they will assign at a later date. 

Does this property require lots of scrapping? 

Does this property require a lift or scaffolding to reach 

upper levels? 

Does this property have lots of plants or items in areas 

where painting is required? 

Does this property have any significant structural 

damage? If yes, EXPLAIN? 

Does this property have a garage? 

If yes, describe location of garage. 

Does this property have aluminum siding? If yes, is it 

original factory finish or has it been painted over? 

Does this property have any other type of structural 

components? (I.e. roof shingles as siding)? 

Ifyes, EXPLAIN? 

Is this property vacant or occupied? 

Are there any pets at this property? 

Are there any low hanging power lines? 

Do we need neighbor's access? If yes please explain 

and get neighbor's property address and owner 

information. If possible, get signature from the 

neighbor. 

 51 S^A 

•\yn^cd 

Vvf C^ 

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V 

^ J £P 

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8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax:(210)579-6577 
(effective April 2010) 

RENOVATIO N RECORDKEEPIN G CHECKLIS T 

Name of Firm: Pnulm^ ^ ^ 

Date and Location of Renovation: ^ -/ ^ '/z D 3~J ^ S J? / A'lyzS ' 

Brief Description of Renovation: pi^CJ^^^_ ^ yayAi/-/'/Pf 

Name of Assigned Renovator: , ^^^ , -.,..j ^ ,,^^.^y^. 

Name(s) of Trained Workers: yr^r a Czl v (fV Ci> J>Z ^p/d /. Jgz n o ^ ^ u/ L 

Name of Dust Sampling Technician, Inspector, and/or Risk Assessor, if used: 

D Copies of renovator and dust sampling technician qualifications (training certificates, certifications) on file. 

Q'<^rtified renovator provided training to workers on (check all that apply): 

Gl-Posting warning signs O-Setting up plastic containment barriers 

B^aintaining containment S3'-Avoiding spread of dust to adjacent areas 

^..JW^e handling H-'Post-renovation cleaning 

D Test kits used by certified renovator to determine whether lead was present on components affected by 

renovation (identify kits used and describe sampling locations and results: 

Q-^Wmiing signs posted at entrance to work area. 

B^or k area contained to prevent spread of dust and debris. 

B'Windows in and within 20 feet ofthe work area are closed 

CfUoors in and within 20 feet ofthe work areas are closed and sealed 

fcTDoors that must be used in the work area are covered to allow passage but prevent spread of dust. 

Buround covered by plastic sheeting extending 10 feet Jfrom work area - plastic anchored to the 

building and weighted down by heavy objects. 

fflnf necessary, vertical containment installed to prevent migration of dust and debris to adjacent 

property. 

aste contained on-site and while being transported off-site. 

Renovation Recordkeeping Checklist Omaha Lead Site 
(effective April 2010) 

B'^or k site properly cleaned after renovation. 

tUAJfchips and debris picked up, protective sheeting misted, folded dirty side inward, and taped for 

removal. 

B''Work area HEPA vacuumed to get paint chips from ground surface, if necessary. 

n Certified renovator performed post-renovation cleaning verification (describe results): 

LtrTcertify under penalty of law that the above information is true and complete. 

Name and Title Date 

Renovation Recordkeeping Checklist Omaha Lead Site 
TECHNQIJOGI ^ IINC. 

Checklist for the Worksite Hazard Analysis 

Address: K "^^ 5 ^ 1 ^ V 

Crew: Pr^,^^_Kf Date: H- f^" l O 

Item OK? / Hazard Corrective Action 

Overhead Lines 

y . In-transit Vehicle Clearance (y ^ 

Levels around high wires 

Vehicle Clearance around 

high wires when working 

y

Phone lines 

/y. Cable lines z. 

Gas Line 

^ . 

Water Line 

y Sewer Line /z. Septic Tank L^"""' ^ ^ y 

Propane/Butane 

/ Z ^ Access to/on Property L^ . Neighbor Access Required 

High Traffic Area LZ^ ^ t "i r* 

Garage i Z y /-^4s 'Cr\iMf'<r>5 o ^ ^W<?i*^ 'i -I ^ 

Structures iZ. Driveway ^ ^ 

Sidewalk 

l y 

Foundation 

^ y 

Retaining Walls 

Fences y ^ ^ 

Trees lyy 

Foliage 

yy General Condition of yard y . Damaged Areas: sink 

holes/rotted wood 

^ 

Sprinkler System ^ . 

Pets .y^ ^ 

Insects y ^ y 

Weather Conditions 

yy Unsafe driving conditions ^ y Unsafe neighborhood ^y 

Crew Foreman/ Sub-Contractor 

8080'Ward Parkway, Suite 405 2505 N. 24^" Street, Suite 308 4242 Medical Drive, Suite 425 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402)504-1004 Phone: {210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 



200V09-08 06:52 >> 4025041005 P2/2 

V^- V,-

ENVIRONMENTAL A CONSTRUCTION TECHNOLOGI^ INC. SERVICES 

OMAHA LEAD BASED PAINT itF^jvyf^DIATION 

Property Owner Close-Out Form 2010 

(Lead-Based Paint Stabilization EPA Contnct EP-R7-08-07) 

SAID: 

Property Address: ^« f ^ .T'Y^ ^ ^ty . 

Owner'sName: AfTj^ ^ j ^ /'.^»J > 

Ptttonaance Standards/Close'OBt Criteria YES NO 

1. Was the entire structure(s) painted with the exception of the stated, excluded ateas? This 

would include painting of other associated features including fascia, eaves, siding, ail trim, 

porches, box beama, columns, rails, and exterior surfaces of garat^es. 

2. Was all swaping and other preparation work completed aatisfaetorUy? • y ^ 

3. Were allrequired areas ofthe staiKtuic(s) primed as needed and painted with two top coals? 

4. Was the paint products utilized equivalent to a 25 year product^quality? t

Z­ 5. Are all of the areas where contaminated malerials have been spilled thoroughly vacuumed^ 

cleaned? v ^ 

6. Did the contiactor coUect/vacuum all falling and scraped paint chips on the entire property, 

roadways, alleyways, public access areas and also remove any othor generated debris? 

7. Is the grass area that surrounds the 8tiucture(s) inreasotiably good condition? i^ 8. Are all items such as polyethylene sheeting, ladders, paint bmshes, cones, barrier tape, etc. 

proiierly removed? ; 

9, b there any evidence ofproperty damagetiiat was done by the comiBctor? Any pioperty 

damage needs to be completed prior to the EPA Close-Out. / 7

7

/ . 10, Are you satisfied with the work perfoimed? 

11. Are Ihere any property items that were temporarily re-located by the contractor that need -y 

7 to be moved back? 

12. Are there any (known) lingering issues with the propoty owiiei(8) that have been lefl 

unresolved? 

other Considentians/Property Owner Discussions/Additional Work that is Required: 

<A. ,^^ / 

Pioj er Signature Date 

Date 

BOBO Ward Psftargy. $ult« 40S 2S06 N. 24'^ StrMt, Suite 21B 4242 Mtdloil Drive, 8( M 4280 KansMaty. M064114 0«n*M. Ntbrttha 88110 tan Antonio. tX 7S229 Phorw ilHWs Ses-3T0S Pheiw: ^2 > 804-1004 Ptwm; l21O)a22-088e F«x: <81«) 3SM707 ^n : (402)S04.1p«e FaK:(210)B7B-<«Tr 

2D0V09-04 07:49 4025041005 Page 2/3 
Douglas County Account Information Page 1 of3 

Douglas County, Nebraska Property Record - R2101430000 

Print Report 

NEW Feature - Parcel Dimensions available &. scale 0-50 ft west of 52nd St - VJeW OO Ma p Infonmation is valid as of 2010-3-16 Treasurer's Tax Report 

New Feature ->-»- > Auto Sales Search 

Owner 

L^DDPETRAR \J(>'^ \ -3^^ ^ 

C/O DBA PL ENTERPRISES K^' CN^\ ' ^tb ^ 

PO BOX 1812 ^Y^-^ VV^^ ' ^«1^ ' 

COUNCIL BLUFFS IA 51502-1812 \ *^ - ^ *^ 

Property Informatio n 

Key Number: 0143 OOOO 21 

Account Type: Multiple Res 

Parcel Number 2101430000 

Parcel Address: 536 S 31 AV 

OMAHA NE 68105-0000 

Legal Description: REDICKS -E S- ADD LOT 4 BLOCK 2 S 5 FT LT 3 & N 40 FT 45 X 130 

Value Informatio n 

Land Improvement Total 

2009 $12,000.00 $63,000.00 $75,000.00 

2008 $12,000.00 $63,000.00 $75,000.00 

2007 $12,000.00 $63,000.00 $76,000.00 

2006 $12,000.00 $63,000.00 $75,000.00 

2005 $12,000.00 $63,000.00 $75,000.00 

2004 $12,000.00 $63,000.00 $75,000.00 

Sales Informatio n 

Sales Date: 2000-07-12 

Deed Type: D Book: 2157 Page: 259 

Price: $73,000.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 1997-07-07 

Deed Type: D Book: 2065 Page: 687 

Price: $65,000.00 

Grantor: 

http://douglasne.niapping-online.com/DouglasCoNe/static/accountinfo.jsp7accoun tno=R2101430000 3/23/2010 
Douglas County Account Information Page 2 of3 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.13 5850.0 1.0 0.0 0.0 No 

Improvemen t Informatio n 

Building 1 

IB In 

^^1 ^^^^1 

PHB 

t .^TH - Kv~<£~ 

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y^ 

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K »J ur arr I3 0 

TvmMery 

BxnrtBlocligi ItlO.Oiq.t 

1 CLICK TO ENLARGE IMAGE | CLICK TO ENLARGE IMAGE 

Square Footage: 1950.0 Percent Complete: 100.0% 

Perimeter 154.0 Quality: Average 

Unit Type: Condition: Average 

Built As: Apartment <= 3 Stories Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 10.0 

Exterior: Frame Aluminum Units: 6.0 

Interior: Drywall Baths: 6.0 

Roof Cover: Composition Shingle Bedrooms: 5.0 

Roof Type: i Gable Stories: 2.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1920 0% 1920 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 1110.0 

Basement Finished 960.0 

Fixture Additional Fixtures 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2101430000 3/23/2010 
Douglas County Account Information Page 3 of3 

Fixture 

Fixture 

Garage 

Porch 

Porch 

Base Fixtures 

Bath Full 

Detached 

Encl Screen 

Encl Screen 

1.0 

5.0 

216.0 

200.0 

25.0 

http://douglasne.mapping-onIine.com/DougIasCoNe/static/accountinfo.jsp?accountno=R2101430000 3/23/2010