P - 35495�•
BUll(�111� BUjj,�[N(1 AermitNo.:�;/v� �
Inspections RESIDENTIAL APPLICATION t�e�e�Ve�+ By: !���� ��
� 7��-s�2-3�0� CITY OF FRIDLEY p�, ��:n� 1 20
763-SG2-4977 FAX t�� -
EFFF.C�fIVC 7-I-2010
Dn"I�G ��'`l ('"��/ YOURE}--MAILAllDRCSS � �j/ ��� (/�P/�1+�/� `�0�'7r . C�V� ___--__
til I G ADDKL-SS � ��-� �/�1 w�� i-/'/R ���� . ✓� � - - --
THIS APPLICANT IS: ❑ OWNGK �1X VNTRACTOR
PROPERTY OWNER/ NnMC o i1, �` ��
TENANT qppR�ss:� Z C/�k.i� �' ��i CI'IY /'� '_��.
S"fA"I'I: � %II
PHONE: G �_� ` � lS
CONTRACTOR NAME: Sv ,/' CO�I G vi C
SUBMIT A COPY OF STATE LICENSE # EXP DATE O Z--
YOUR S"fA'TI; LICENSI: p ��
AND CL'RTIf�IC/�TE OP ADDRESS: "l O �° vC. CITY��S'IATG1Li�LIP ��Q
�NSU�z,aNCi; i�HON� (� � K?-K —�`�3 rnx 6- K —Ol
PROPERTY TYPE sirvai_r_ r-nMi�viNrw coNSTRUCrioN sizr-,
❑ I WO I=AMII.Y/NF.W CONS'I KUCTION S"f'ORIf:S
PERMIT TYPE ❑ ADDI"fION ❑ C'jARAGE/SHED O WINDOWS
❑ I3ASEMBNI }�INISH ��ftOOP O DRAIN TILG
❑ DECK ❑ SIDING ❑ OTHER
O SWfMMING POOL
TYPE OF WORK: ❑ NEW HOMI3 CONSTRUCTION ❑ AUDITION
�IGrINTENANCE/REPAIR ❑ REMODGLING
DESCRIBE WORK [3EING DONE: � '-� d !//%'� � �C � �C� �Q-�
SVE OF IMPROVEMGN"l� LENGTH WIDTki HEIGHT SQ Ff
ROO�ING C9��lOUSE ONLY
NUME3ER OP SQUARES � ❑ HOUSE & GARAGG BASGMBN"f RGMODBLING SU[3M1'1':
L Existing Ploor Plan�
CARACES ❑ ATTACHBD GARAGG 2. Proposed Floor plan � �
PftOPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to bc used
PROPOSED HEIGHT:
FOR NEW CONSTKUCTION INCI.UllWG DECKS.
SIDING ADDi'I'IONS. & PORCHES SUE3MIT:
❑ Vinyl ❑Sot�it
❑ Aluminum O Trim 1 Site Plan/Survey sho4ving Uie e�isting strucuttes
❑ QCher ❑ Fascia �i�d proposed project.
2. Two sets ofconstruction plans
WINDOWS 3 F,nergyCalculations
IN EXISTING OPENINGS ❑Yes ❑No LOCA7'ION OF WINDOWS FOR WINDOWS- PROVIDI: U-VALUG ANl>
OR FOR NLW OPENINGS-DESCRIBF, SIZE.OF MANUFACTURG STICKER ON WINDOW.
OPENING CHANGGS &
TYPE OF WINDOW "f0 BE WSTALLED NUMBER OP WINDOWS
ALL FEES ANE BAS�U UN VALUA'LIUN, INCLUll1NG 1'H� CU5"1' UN LA13UK AIVll 1V1A l�K1ALJ:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ ��I.t`'% X.i OCCUPANCI' TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Cin•b Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Tota{ Due
$ � i i �.,�
$
$
$ i�
$
$
$
$
$
$
$ % ,
See Back Page for Fee Schedule
65%of Building Permit Fee
.001 times tt�e total job valuation
.0005 x Permit Valuation Minimuni $5.00
$5.00 (State Licensed Residential Contractors)
$2100 per SAC Unit (Plans to MWCC for detennination)
ft+6ft= ftx$24=$
$450 Conservation Plan Review
Fee Detennined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks pavable to: Citv of Fridlev Attach Stipulations
THIS IS AN APPLICATION FORA PERMIT-NOT VALID UNTIL PROCF,SSED
1 hereby apply for a building pennit and l acknowledge that the information above is complete and accurate; that the w rk will be in
confonnance with the ordinances and codes of the City of Fridley aud with the Minnesota Construction Codes; that I w�der nd this is not a
permit but only an application for a permit and work is not to start without a permit on site; that the work will be in cordance with the
approved plan in the case of all requires review and ap�roval of plans-r. L
SIGNATUREOFAi'PIJCANT PRINTNAMG ytt�lo/� � �I DATF: `�O
APPROVAL INSPL-:CTOR SIGNAI�
PLEASE NOTE: SEPARAT PEEt I�;fS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK
r '
Superior Construction Services Inc.
�.,� �,SUPERIOR
�°�'�--- =R===�°�' 9702 85th Ave North
C�tau�c� ��,,G.�E,�:..
°��� �°� Maple Grove, MN 55369
�����4���,
_ Phone (763) 424-9434 Fax (763) 424-5428
Federal ID# 41-1766131 MN ID# 7231
Insured: COLEEN BELLEFEUILLE
Property: 122 CRAIG WAY NE
FRIDLEY, MN 55432
Home: 122 CRAIG WAY NE
FRIDLEY, MN 55432-3009
Claim Rep.: CONTRACT CONNECTION
Estimator: Dan Martineau
Contractor:
Company: Superior Construction Services Inc.
Business: 9702 85th Avenue North
Maple Grove, MN 55369
Home: (763) 732-2514
Business: (763} 571-6135
Other: (763) 732-2514
��Ji-'-. -7��-- %�is"— ��3�
Business: (763) 424-9434
Claim Number: 7222042880201Q102601 Policy Number: HOD 0026966617 Type of Loss: ALL OTHER PHYSICAL
DAMAGE
Date Contacted: 10/28/2010 12:00 PM
Date of Loss: 10/26/2010 Date Received: 10/27/2010
Date Inspected: 10/28/2010 12:00 PM Date Entered: 10/28/2010 1:46 PM
Date Est. Completed: 11/3/2010 8:52 AM
Price List: MNMN7X_OCT10
Restoration/Service/Remodel
Estimate: COLEEN_BELLEFEUILLE
f �
Superior Construction Services Inc.
�UPEPlQR
Cntis-r�,_,,,�,�,_ucT�c�N g�02 85th Ave North
.CJERVICE$ xr �
;;���:;�t,�,,.�=,�; Maple Grove, MN 55369
, Phone (763) 424-9434 Fa�c (763) 424-5428
Federal ID# 41-1766131 MN ID# 7231
,.-.,,. ;�----,�s. -�
�� `,-' „w � Roofl
�i -
�i�� rzsu E��y s� rv�p� �
�.��'�-�=°'p x�
DESCRIPTION
1. Remove 3 tab - 25 yr. - comp. shingle
roofing - w/out felt
2. 3 tab - 25 yr. - comp. shingle roofing -
w/out felt
Note: 10 % waste
COLEEN_BELLEFEUILLE
Main Level
2,709.38 Surface Area
247.98 Total Perimeter Length
QNTY
27.09 SQ
30.00 SQ
REMOVE
46.87
,1 11
27.09 Number of Squares
105.42 Total Ridge Length
REPLACE
0.00
142.38
TOTAL
1,269.71
4,271.40
10. Sheathing - plywood - 5/8" CDX 160.00 SF 0.00 1.61 257.60
Note: Above line item to remove and replace sheathing that was exposed and had visiable damages. May have additional sheets to
remove due to rot.
3. Ice & water shield 1,440.00 SF 0.00 1.26 1,814.40
4. Roofing felt - 151b. 12.70 SQ 0.00 21.33 270.89
5. Chixnney flashing - lazge (32" x 60") 1.00 EA 0.00 266.11 266.11
6. R&R Roof vent - turtle rype - Metal 3.00 EA 7.69 35.09 128.34
7. R&R Flashing - pipe jack 4.00 EA 6.03 22.67 114.80
8. R&R Exhaust cap - through roof 1.00 EA 7.69 60.06 67.75
9. R&R Furnace vent - rain cap and storm 1.00 EA 9.18 44.97 54.15
collar, 6"
12. Temporary Repairs (Bid Item) 1.00 EA 0.00 170.82 170.82
11. Taxes, insurance, permits & fees (Bid 1.00 EA 0.00 0.00 0.00
item)
Totals: Roofl 5,685.97
Total: Main Level 8,685.97
Exterior
DESCRIPTION QNTY REMOVE REPLACE TOTAL
COLEEN_BELLEFEUILLE 11/16/2010 Page:2
�, .
Superior Construction Services Inc.
.. �U�GflldR
Cor:ts-rr�uc-r�asv 9702 85th Ave North
CJ'c� V tCES
s.w°, ��"^°�°°U�°�°� Maple Grove, MN 55369
vfiMe:+xr±�fKat;tteE^J'.!'S4�
. Phone (763) 424-9434 Faac (763) 424-�428
Federal ID# 41-1766131 MN ID# 7231
CONTINUED - Exterior
DESCRIPTION QNTY REMOVE REPLACE TOTAL
13. Soffit & Fascia lnstaller- per hour 2.00 HR 0.00 68.89 137.78
Note: Above line item for labor to reset loose fascia.
Totals: Exteriar 137.78
Line Item Totals: COLEEN_BELLEFEULLLE 8,823.75
Grand Total Areas:
0.00 SF Wa11s
0.00 SF Floor
0.00 SF Long Wa11
0.00 Floor Area
412.91 Exterior Wall Area
2,704.38 Surface Area
105.42 Tota1 Ridge Length
0.00 SF Ceiling
0.00 SY Flooring
0.00 SF Short Wa11
0.00 Total Area
0.00 Exterior Peruneter of
Walls
27.09 Number of Squares
0.00 Total Hip Length
0.00 SF Walls and Ceiling
0.00 LF Floor Perimeter
0.00 LF Ceil. Perimeter
0.00 Interior Wall Area
247.98 Total Perimeter Length
COLEEN BELLEFEUII..LE 11/16/2010 Page: 3
, t •
Superior Construction Services Inc.
� �=PERIGIP.
Co�s�ra�c ,�TioN 9702 85th Ave North
�eawc�s .�.,�. s�.�tt
��,„��.��:.�� Maple Grove, MN 55369
, Phone (763)424-9434 Fax (763)424-5428
Federal ID# 41-1766131 MN ID# 723 ]
Line Item Total
Matl Sales Tax Reimb
Replacement Cost Value
Less Deductible
Net Claim
Summary for Dwelling
@ 7.125% x
Dan Martineau
8,823.75
3,631.62 258.75
$9,082.50
(1,000.00)
$8,082.50
COLEEN_BELLEFEUII..LE 11/16/2010 Page:4