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P - 40099Building Inspections 763-572-3604 763-502-4977 FAX DATE SITE ADDRESS THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE � BU�LDING RESIDENTIAL APPLICATION CITY OF FRIDLEY BFFECTIVE 1-1-2011 YOUR E-MAIL ADDI 7..� �� '�Y2 � � ❑ OWNER PHONE: STATE LICENSE #. ADDRESS: R%Z � SINGLE FAMILY/NEW CONSTRUCTI( ❑ TWO FAMILY/NEW CONSTRUCTION �_c1� -K�� T tz �l� � �s� ❑ ADDITION ❑ GARAGE/SHED ❑ BASEMENT FINISH ❑ ROOF ❑ DECK ❑ SIDING ❑ SWIMMING PO� LEAD CERT FAX �iCp.,,i *i ` SIZ� STORIES ❑ WINDOWS ❑ DRAIN TILE �OTHER 'k TYPE OF WORK: ❑ NfiW HOME CONSTRUCTION ❑ ADDITION MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: � /��✓� � � SIZE OF IMPROVEMENT LENGT WIDTH ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING L] Vinyl ❑ Aluminum ❑ Other ❑ ATTACHED GARAGE ❑ DETACHED GARAGE Permit No.: �� Received By:_ Date Rec'd: � It�.P._l�_,f�itr��'. � � a� r�. (� 1 STATF,�LI�1i _C BASEMENT REMODELING 5UBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural membets to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculahons IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALLTE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: � (USING �'HE 1997 U.B.0 FEE SCHEDiTLE) TOTAL JOB VALUATION $ �I /1 fil� � OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ $ $ $ $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $5.00 $5.00 (State Licensed Residential Contractors) $2230 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$25=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks pavable to: City of Fridlev Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an applicatio for a pe i d r s not start without a permit on site; that the wark will be in acco dance with the approved plan in the case of •1� � �ew nd ap val of p s. SIGNATURE OF APPLICANT � P T NAME � DATE � APPROVAL INSPECTOR SIG R ✓ __ n,� � y A�w�R�ca�u �ar��.Y American Family Insurance Group �j0.�'J 1� � Attn: Scanning Center 6000 American Parkway Madison, WI 53783 Office (800) 692-6326 Fax (877)381-3926 Insured: O ROURKE, KEVIN S& O ROURKE, PAMELA Home: (763) 572-2687 M Property: 5300 MATTERHORN DR NE Cellular: (612) 418-6758 FRIDLEY, MN 55421-1336 � Home: 5300 MATTERHORN DR NE FRIDLEY, MN 55421-1336 Claim Rep.: Keith Strombecic Business: (763) 424-9434 Title: Estimatar Company: Superior Construction Services Estimator: Keith Strombeck Business: (763) 424-9434 Title: Estimator Company: Superior Construction Services Contractor: Business: (763) 424-9434 Company: Superior Construction Services Ina Business: 9702 85th Avenue North Maple Grove, MN 55369 Claim Number: 00841166410 Policy Number: 22D3105401 Type of Loss: Water/Plumbing Date Contacted: 8/9/2011 Date of Loss: 7/31/2011 4:00 PM Date Received: 8/1/2011 Date Inspected: 8/10/201 l Date Entered: 8/8/2011 11:41 AM Date Est. Completed: 8/17/2011 12:06 PM Price List: MNMNSB AUG11 Restoration/Service/Remodel Estimate: O ROURKE KEVIN S& �� _ ,�(c�e�- — MG SsS ( I-(�,jtP, �,.�r�k �-u�n.— �) �o� q �� „ R��EWED FOR �L�G Inspector Date �� AMERICAN FAMiLY American Family Insurance�Group Attn: Scanning Center 6000 American Parkway Madison, WI 53783 Office (800) 692-6326 Fax (877)381-3926 If �our home is older than 1978 it may contain lead painted materials. The EPA may require contractors to follow special procedures to contain and/or remediate lead from the damaged area. If a lead test is taken and your home was found to contain lead, American Family Insurance requires you to notify us before beginning any repairs. Please be aware that the EPA regulations consider lead to be a pollutant. Your policy limits the testing, cleaning, containment and removal of a pollutant to $10,000.00 for covered losses. Phvsical mail vou submit: Anzerican Family Insurance appr�eciates your assistance in the handling of your claim. Any documentation you subinit will be scanned and electronically Yetained in your claim file. Please include the claim number on the items submitted. Tlze original documentation will be destroyed after 30 days. If you would like your documents returned, please indicate this on the documents and p�ovide the address where you want the documents sent. O_ROURKE_KEVIN_S_&_ 8/17/2011 Page:2 AMERICAN FAM14Y American Family Insurance Grou� Attn: Scanning Center 6000 American Parkway Madison, WI 53783 Office (800) 692-6326 Fax (877) 381-3926 � � �� z� � a^ --a FAMILY '� .F----20"7t" � � _ i o 1 � � �i � � ze,r i.l � � i---- 2s• e° -� Missing Wall: 1- 2'10" X 7'0" DESCRIPTION O_ROURKE_KEVIN_S_&_ Basement 541.33 SF Walls 855.83 SF Walls & Ceiling 34.94 SY Flooring 77.33 LF Ceil. Perimeter Opens into Stairl QNTY REMOVE Ceiling Height: 7' 314.50 SF Ceiling 314.50 SF Floar 77.33 LF Floor Perimeter Goes to Floar/Ceiling REPLACE TOTAL 1. Contents - move out then reset - Extra 1.00 EA 0.00 147.52 147.52 large room 2. Remove 1/2" drywall - hung only (no 155.00 SF 0.36 0.00 55.80 tape or iinish) 3. 2" x 4" lumber - treated (.667 BF per LF) 37 75 LF 0.00 1,93 72:86 - Install bottom plate on exterior walls. 4. Rigid foam insulation board - 3/4" 24.50 SF 0.00 0.60 14.70 5. Rigid foam insulation board - 1 1/2" 238.00 SF 0.00 0.99 235.62 6. Polyethylene vapor barrier 262.50 SF 0.00 0.25 65.63 7. 1/2° drywall - hung only (no tape ar 310.75 SF 0.00 0.82 254.82 fmish) 8. R&R Interior door - oak veneer - oak 1.00 EA ] 6.40 279.74 296.14 veneer jamb & casing 9. Door lockset - Detach & reset 1.00 EA 0.00 20.28 20.28 10. Paneling 541.33 SF 0.00 19I 1,033.94 l l. Paneling Installer - Finish Carpenter - 8.00 HR 0.00 64.01 512.08 per hour Contractor's Note: Above labor includes building a box to cover the water meter, fabricating a door for access to under the stairs and building a box/door for the clothes chute. 12. Baseboard - 3 1/4" hardwood 72.17 LF 0.00 3.54 255.48 13. Stain & finish door slab only (per side) 2.00 EA 0.00 33.79 71.58 14. Stain & finish door/window trim & 2.00 EA 0.00 25.09 50.18 jamb (per side) 15. Stain & finish baseboard 72.17 LF 0:00 0.95 68.56 16. Suspended ceiling system - 2' x 4' 314.50 SF 0.00 2.28 717.06 17. (Install) Heat/AC register - 2.00 EA 0.00 10.71 21.42 Mechanically attached O_ROURKE_KEVIN_S_&_ 8/17/2011 Page:3 AMERICAN FAMILY American Family Insurance Group Attn: Scanning Center 6000 American Parkway Madison, WI 53783 Office (800) 692-6326 Fax (877) 381-3926 CONTINUED - FANIILY DESCRIPTION QNTY REMOVE REPLACE TOTAL 18. FLOOR COVERING - CARPET 1.00 EA SEE SUB-BID 19. Final cleaning - construction - 314.50 SF 0.00 0.22 69.19 Residential Line items below are for the mitigation. 41. Content Manipulation charge - per 2.00 HR 0.00 39.02 78.04 hour 45. Tear out trim/base and bag for disposal 67.00 LF 0.63 0.00 42.21 42. Remove wet suspended ceiling tile and 314.50 SF 0.28 0.00 88.06 bag for disposal 43. Tear out wet paneling, bag for disposal 541.33 SF 0.40 0.00 216.53 44. Tear out wet drywall, cleanup, bag for 300.00 SF 0.69 0.00 207.00 disposal 48. Tear out and bag wet insulation 100.00 SF 0.50 0.00 50.00 49. Tear out wet non-salvageable carpet, 314.50 SF 0.36 0.00 113.22 cut & bag for disp. 46. Tear out wet carpet pad and bag for 314.50 SF 0.35 0.00 110.08 disposal 47. Tear out ta.ckless strip and bag for 49.60 LF 0.66 0.00 32.74 disposal 50. Clean floor 314.50 SF 0.00 0.29 91.21 51. Apply anti-microbial agent - 855.83 SF 0.00 0.17 145.49 54. Air mover (per 24 hour period) - No 24.00 EA 0.00 25.00 600.00 monitoring 55. Dehumidifier (per 24 hour period) - No 4.00 EA 0.00 51.00 204.00 monitoring 52. Pod 1.00 EA 0.00 397.00 397.00 56. Dumpster load - Approx. 20 yards, 4 1.00 EA 318.21 0.00 318.21 tons of debris Line item above is far the dumpster for one month. There maybe additional charge if it is there longer. Totals: FAMILY 6,656.65 0_ROURKE,KEVIN_S_&_ 8/17/2011 Page:4 AMER{CAN FAMILY American Family Insuranc� Group Attn: Scanning Center 6000 American Parkway Madison, WI 53783 Office (800) 692-6326 Fax (877) 381-3926 J �i , :� , �i •, rrr�€i_ .. �i •. �rs� • iii Stairl 140.17 SF Walls 174.39 SF Walls & Ceiling F� 5.66 SY Flooring - 26.99 LF Ceil. Perimeter Ceiling Height: Sloped 34.23 SF Ceiling 50.98 SF Floor 24.16 LF Floor Perimeter Missing Wall: i- 2'10" X 8'0" Opens into FAMILY Goes to Floor/Ceiling DESCRIPTION QNTY REMOVE REPLACE TOTAL 20. Remove 1/2" drywall - hung only (no 24.00 SF 0.36 0.00 8.64 tape or finish) 21. Rigid foam insulation board - 3/4° 24.00 SF 0.00 0,60 14.40 22. Polyethylene vapor barrier 24.00 SF 0.00 0.25 6.00 23. 1/2" drywall - hung only (no tape or 24.00 SF 0.00 0.82 19.68 finish) 24. Paneling 24.00 SF 0.00 1.91 45.84 25. Seal then paint part of the walls and 150.39 SF 0.00 0.57 85.72 ceiling (2 coats) 26. FLOOR COVERING - CARPET 1.00 EA SEE SUB-BID 27. Final cleaning - construction - 50.98 SF 0.00 0.22 11.22 Residential Totals: Stairl 191.50 Total: Basement 6,848.15 MisceIIaneous DESCRIPTION QNTY REMOVE REPLACE TOTAL 28. City of Fridley building permit - 1.00 EA OPEN 29. Dumpster load - Approx. 12 yards, 1-3 1.00 EA 252.28 0.00 252.28 tons of debris Totals: Miscellaneous 252.28 Sub-Bids O_ROURKE_KEVIN_S_&_ 8/17/2011 Page:S AMERICAR[ FAMILY American Family Insurance Group \ Athl: Scaiming Center 6000 American Parkway Madison, WI 53783 Office (800) 692-6326 Fax (877) 381-3926 Electrical DESCRIPTION QNTY REMOVE REPLACE TOTAL 30. R&R Recessed light fixture (Bottom of 1.00 EA 9.75 112.46 122.21 stairs) 31. Recessed light fixture - Detach & reset 1.00 EA 0.00 4.00 4.00 trim only (By fireplace) 32. Electrician - per hour - Check rest of 1.00 HR 0.00 98A2 98.02 wiring. 33. SPECIALTY ITEMS - Profit on 1.00 EA 0.00 42.29 42.29 electrical work by South Side Electric Totals: Electrical 266.52 Floor Coverings DESCRIPTION QNTY REMOVE REPLACE TOTAL 34. Remove Carpet - High grade 50.98 SF 0.24 0.00 12.24 35. Remove Carpet pad 50.98 SF 010 0.00 5.10 36. Carpet pad 365.48 SF 0.00 0.61 222.94 37. Carpet - High grade 420.31 SF 0.00 5.39 2,265.47 15 %o waste added for Carpet. 38. Step chazge for "waterfall" carpet 12.00 EA 0.00 5.81 69.72 installation 39. Carpet - metal transition strip 3.00 LF 0.00 3.15 9.45 40. SPECIALTY ITEMS - Profit on carpet 1.00 EA 0.00 288.15 2$8.15 by DPMH, LLC & SBL Inc Totals: F1oor Coverings 2,873.07 Tota1: Sub-Bids 3,139.59 Line Item Subtotals: O_ROURKE,KEVIN_S_&_ 10,240.02 Adjustments for Base Service Charges Adjustment Carpenter - Finish, Trim/Cabinet 128.02 Drywal1 Installer/Finisher 262.44 Electrician I96.04 0_ROURKE_KEVIN_S_&_ 8/17/2011 Page:6 ae��R�ca� FA�+��.v American Family Insurance Group Attn: Scanning Center 6000 American Parkway Madison, WI 53783 Office (800) 692-6326 Fax (877)381-3926 Adjustments for Base Service Charges Adjustment Flooring Installer 140.66 Painter 93.50 Tota1 Adjustments for Base Service Charges: 820.66 Line Item Totals: O_ROURKE_KEVIN_S_&_ 11,060.68 Grand Total Areas: 681.50 SF Walls 348.73 SF Ceiling 1,�30.23 SF Walls and Ceiling 365.48 SF Floor 40.61 SY Flooring 101.49 LF Floor Perimeter 0.00 SF Long Wal1 0.00 SF Short Wall 104.33 LF Ceil. Perimeter 365.48 Floor Area 368.96 Total Area 481.25 Interior Wall Area ' 496.42 Exterior Wa11 Area 70.92 Exterior Perimeter of Walls 0.00 Surface Area 0.00 Number of Squares 0.00 Total Perimeter Length 0.00 Total Ridge Length 0.00 Tota.l Hip Length O_ROURKE_KEVIN_S_&_ 8/17/2011 Page:7 AMERlLAN FAAAILY American Family Insurance Group Attn: Scanning Center 6000 American Parkway Madison, WI 53783 Office (800) 692-6326 Fax (877)381-3926 Summary for Dwelling Line Item Total ` 10,240.02 Total Adjustments for Base Service Charges 820.66 Matl Sales Tax Reimb @ 7125% x 3,772.42 268.78 Subtotal 11,329.46 Overhead @ 10.0% x 10,918.61 1,091.86 Cleaning Sales Tax @ 7.125% x 1,661.88 118.41 Replacement Cost Value $12,539.73 Less Deductible (500.00) Net Claim $12,039.73 Keith Strombeck Estimator 0_ROURKE_KEVIN_S_&_ 8/17/2011 Page: 8 AMERI£APJ FAMILY American Family Insurance �roup Attn: Scanning Center 6000 American Parkway Madison, WI 53783 Office (800) 692-6326 Fax (877)381-3926 O&P Items ACOUSTICAL TREATMENTS CLEANING CONTENT MANIPULATION GENERAL DEMOLITION DOORS DRYWALL ELECTRICAL FLOOR COVERING - CARPET FINISH CARPENTRY / TRIMWORK FINISH HARDWARE FRAMING & ROUGH CARPENTRY HEAT, VENT & AIIt CONDITIONING INSULATION LIGHT FIXTURES PANELING & WOOD WALL FINISHES PAINTING WATER EXTRACTION & REMEDIATION Subtotal Base Service Charges Matl Sales Tax Reimb Overhead O&P Items Subtotal Non-O&P Items CLEANING SPECIALTY ITEMS Non-O&P Items Subtotal O&P Items Subtotal Cleaning Sales Tag Total O_ROURKE_KEViN_S_&_ @ @ @ Recap by Category 7.125% 10.0% 7.125% Total Dollars % 717. 6 5.72% 91.2 0.73% 25.56 1.80% 1,538.26 12.27% 279.74 2.23 % 274.50 2.19% 9 2 0.78% 2 5 .58 20.48% 255.48 2.04% ` 20.28 0.16% 72.86 0.58% 21.42 0.17% 336.35 2.68% 116.46 0.93 % 1,591.86 12.69% o 7 2.20% `�� 10.74%0 9,829.17 78.38% 820.66 6.54% ° 268.78 2.14% 1,091.86 8.71 % 12,010.47 95.78%0 Total Dollars % $0.41 0.64% 330.44 2.64% 410.85 3.28% 12,010.47 95.78%0 118.41 4.94% 12,539.73 100.00% 8/17/2011 Page:9 ., � N � � � � 0 _ { ,•� � .-" � m � a � 0 N � � � � °'�I � � � , � I � � � � � �