P - 45843Building BUILDING Pe�it rto.'� ���
Inspections RESIDENTIAL APPLICATION Received By: '
763-572-3604 CITY OF FRIDLEY D ' i
763-502-4977 FAX EFFEC�vE �-�-zo�� �� ������
DATE �O�L��� / YOUR E-MAIL ADDRESS
SITE ADDRESS �7 Z� i�C''i!S ���✓L�
THIS APPLICANT IS: ❑ OWNER �`CONTRACTOR
PROPERTY OWNER/ NA�: �j,' lI ���c �
TENANT ,a,DDxESS: S7 Zi �Zc..,�, i�,�.,'.rc CrrY �,c,i c�lc� STn� zir
PHONE: 7(0 � , � 3 . OQI � �I
CONTRACTOR NAME:�vr�G.�iv�, (��.,�K,�_�y;cP�
SUBMIT A COPY OF STATE LICENSE #%Z.3 (— LEAD CERT NUMBER /J AT ��'I f�% l Z� I
YOUR STATE LICENSE
AND CERTIFICATE OF ADDRESS: � 70Z, pjSF ` A��e. ,N��h CITY�Ies�,�„� STATF�_ZIP � bC)
INSURANCE pHONE E�i 1 L. Z l �'I Z FAX
PROPERTY TYPE �iSINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FANIILY/NEW CONSTRUCI'ION STORIES
PERMIT TYPE � �DIT'ION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING Jg'jOTHER
❑ SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSIRUCTION ❑ ADDITTON
MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: !'�P n�,,��o SR,r�� �,nnsL._ ,c �'� W��r„ o w4f..
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT
ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMI'L:
NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan
GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑Soffit ADDIT'IONS_ & PORCHES SUBMTf:
❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures
❑ Other ❑ Fascia and proposed project.
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS ❑Yes �No LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE 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 AKL BASLll UlV VALUA'1'IUN, 1NCLUll1NG'1'HL�' CVJ'l� Vl+' LASVK ANll MAIL� KIALJ:
.-� ��(iJ�SING THE 1�97 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ �I�/�GS
$ �.---
$
$
$
$
$
$
$
$
$ > n�
TYPE
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 navable to: Citv 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 wark 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 application r it and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the c Ne o la or Lhic requires review and approval of pl
S I G N A T U R E � F A P r L I C A T .� r PRINT NAME � 4, n 1 �w�}, I► w� DATE /!�� LS �/
APPROVAL INSPECTOR SIGNATU ��
L ,
' Superior Construction Services Inc.
5�.,�F�,����
L'ONSTRUCTIDN 9702 85th Ave. Nolth
S'CRVICE
_, ; Maple Grove, Mn. 55369
Phone (763)424-9434 Fax (763)424-5428
Federal ID# 41-1766131 Mn Contractors License# 7231
Iusured: Bill � S� 1�.¢.✓ Home: (763) 443-0947
Property: 5721 Regis Dr
Fridley, MN 55432
Estimator: Ryan Zyvoloski Business: (612) 210-3178
Business: 8702 85th AveN
Maple Grove, MN 55369
Claim Number: Policy Number: Type of Loss:
Date of Loss: Date Received:
Date Inspected: Date Entered: 8/23/2011 221 PM
Price List: MNMN7X_AUG11
Restoration/S ervice/Remodel
Estimate: SALAZAR_BILLREPAIR
0
" Superior Construction Services Inc.
S I..1PF..1=?IOR
�'ONSTRUCTION'� 9702 85th Ave. North
S'ERVICE6
,K.,.,..,�,_,�, �.�, ,, Maple Grove, Mn. 55369
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Phone (763)424-9434 Fax (763)424-5428
Federal ID# 41-1766131 Mn Contractors License# 7231,
SALAZAR_BILLREPAIR
Main Level
Main Level
DESCRIPTION QNTY REMOVE REPLACE TOTAL
1. Taxes, insurance, pernuts & fees (Bid 1.00 EA 0.00 0.00 0.00
itein)
2. Haul debris - perpickup truck load - 0.50 EA 122.63 0.00 61.32
including dump fees
Total: Main Level 61.32
1--17.5"-�
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2a a
�
1:_ 4• y'..,i- H4� 4••�� �
mxu 9' s�sse:a
Bedroom
385.33 SF Walls
530.25 SF Walls & Ceiling
16.10 SY Flooring
48.17 LF Ceil. Perimeter
Height: 8'
144.92 SF Ceiling
144.92 SF Floor
48.17 LF Floor Perimeter
DESCRIPTION QNTY REMOVE REPLACE TOTAL
3. Batt insulation - 4" - Rl 1 30.00 SF 0.00 0.42 12.60
4. Polyetirylene vapor barrier 30.00 SF 0.00 0.25 7_50
5. Drywall replacement per LF - up to 2' tall 15.00 LF 0.00 5.88 88.20
6. Paneling 72.00 SF 0.00 1.91 137.52
7. Seal & paint paneling 72.00 SF 0.00 0.7 L 51.12
8. Baseboard - 3 1/4" hardwood 40.00 LF 0.00 3.54 141.60
9. Stain & finish baseboard 40.00 LF 0.00 0.95 38.00
10. Carpet pad 144.92 SF 0.00 0.61 88.40
11. Carpet 166.65 SF 0.00 2.99 498.28
{ W}% waste added for Cazpet.
Totals: Bedroom 1,063.22
SALAZAR_BILLREPAIR
10/25/2011
Page: 2
Superior Construction Services Inc.
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Coivs-rr+ucTi�ni 9702 g5th Ave. North
S'ERVICES
,,.,W...�, ,.,,, �. _.�,, Maple Grove, Mn. 55369
:. :.... .....: ::... .
Phone (763)424-9434 Fax (763)424-5428
Federal ID# 41-1766131 Mn Contractors License# 7231
T
m
[V
1
1---6' 3" -�
Closet 2
126.67 SF Walls
139.13 SF Walls & Ceiling
1.38 SY Flooring
15.83 LF Ceil. Perimeter
Height: 8'
12.46 SF Ceiling
12.46 SF Floor
15.83 LF Floor Perimeter
DESCRIPTION QNTY REMOVE REPLACE TOTAL
12. Bifold door set -(4 slabs only) - Double 1.00 EA 0.00 40.15 40.15
Detach & reset
13. R&R Carpet pad 12.46 SF 0.10 0.61 8.85
14. Remove Carpet 12.46 SF 0.24 0.00 2.99
15. Carpet 14.33 SF 0.00 2.99 42.85
15 % waste added for Carpet.
16. Contents - move out then reset - Small 1.00 EA 0.00 43.00 43.00
room
Totals: Closet 2 137;84
T �
co p�s�� 1 9" � �u:et
'ry J�- N
1
F--6' Z" -1
Closet 1
125.33 SF Walls
137.61 SF Walls & Ceiling
1.36 SY Flooring
15.67 LF Ceil. Perimeter
Height: 8'
1228 SF Ceiling
12.28 SF Floor
15.67 LF Floor Perimeter
DESCRIPTION QNTY REMOVE REPLACE TOTAL
17. Bifold door set -(4 slabs only) - Double 1.00 EA 0.00 40.15 40.15
Detach & reset
18. R&R Caipet pad 12.28 SF 0.10 0.61 8J2
19. Remove Carpet 12.28 SF 0.24 0.00 2.95
20. Carpet 14.12 SF 0.00 2.99 42.22
15 % waste added for Carpet.
21. Contents - move out then reset - Small 1.00 EA 0.00 43.00 43.00
room
Totals: Closet 1 137.04
SALAZAR_BILLREPAIR 10/25/2011 Page:3
� Superior Construction Services Inc.
5�..,�F�,����
CoNST�ucriorv 9702 85th Ave. NoTth
S'EqVICES
„_,„.,..,._,.,,,�.,,,, Maple Grove, Mn. 55369
, .....:-..,: �..:..:
Phone(763)424-9434 Fax(763)424-5428
Federal ID# 41-1766131 Mn Contractors License# 7231
_, Porch .
�
�
�..
565.33 SF Walls
871.19 SF Wails & Ceiling
33.98 SY Flooring
70.67 LF Ceil. Perimeter
Height: 8'
305.86 SF Ceiling
305.86 SF Floor
70.67 LF Floor Perimeter
DESCRIPTION QNTY REMOVE REPLACE TOTAL
22. Remove Indoor / outdoor carpet 305.86 SF 0.61 0.00 186.57
23. Indoor / outdoor carpet 351.74 SF 0.00 1.59 559.27
15 % waste added for Indoor / outdoor carpet.
24. Contents - move out then reset - Extra 1.00 EA 0.00 171.80 171.80
large room
Totals: Porch 917.64
Total: Main Level 2,317.06
Line Item Subtotals: SALAZAR_BILLREPAIR 2,317.06
Adjustments for Base Service Charges Adjustment
Carpenter - Finish, Trim/Cabinet 12$.02
Drywall Installer/Finisher 262.44
Flooring Installer 140.66
Insulation Installer 105.76
Painter � 93.50
Total Adjustments for Base Service Charges: 73038
Line Item Totals: SALAZAR_BILLREPAIR 3,047.44
SALAZAR_BILLREPAIR
10/25/2011 Page:4