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Kraut
��G���E� � . NOTICE OF CLAIM FORM to the��ity ofS�aint Paul, Minnesota , ._- �.�.,t ��, .�. � s Minnesota State Statute 466.05 states that"...eve erson...who claims da es b�"�"" �Y` ' - ry p g fr arry municipality...shall cause to be presented to the governing bpdy of the municipality within 180 days a,�ler the alleged loss or injury is discovered a notice stating the time,place,and circumstances thereof,and the amount of compensation or other relief demanded" Please coniplete this form in its entirety by clearly typing or printing your answer to each question. If more space is needed,attach additional sheets. Please note that you will not be contacted by telephone to clarify answers,so provide as much information as necessary to egplain your claim,and the amount of compensation being requested. You will receive a written acknowledgement once your form is received. The process can take up to ten weeks or longer depending on the nature of your claim. This form must be signed,and both pages completed. If something does not apply,write`N/A'. SEND COMPLETED FORM AND OTHER DOCUMENTS TO: CITY CLERK, 15 WEST KELLOGG BLVD, 310 CITY HALL, SAINT PAUL, NIN 55102 First Name_��e v� Middle Initial �•�/- Last Name ���4� Company or Business Name + _ _ _.__ __�,~e�a���suraz:ee Cc:gps.�?�e�/ ��Y�,�a�Nu�nber? Street Address �(� ��j�� L,,, , �,�,,� ZF17 --- - ---- - - - City_ ��0�v State �"l/� Zip Code���� Daytime Phone(���-���Cell Phone(fij��- �-(�/17�vening Telephone��� Date of Accidend Injury or Date Discovered��x 3/Z(�1i Time ? am/pm � � . � Please state,in detail,what occurred(happened), and why you are submitting a claim. Please indicate why or how you feel the City of Saint Pau1 or its employees are involve andlor responsib e for your damages, . i . ` s �r , � � ,� I l. �c � i , , �, 0►'r� a � nace c%Ancd t,/as{+e. � �r c, ,e �e�olaced,d►,�{�alQ s�r,.���1�c��e - lease chec�C the x es)t�at most c osely represent t�e reason for�mpleting tlus fofm: n �p�f �✓n d clt�nP.� 0 My vehicle was dama ged in an accident ❑ M y vehicle was dama ge d urin g a tow ❑My vehicle was damaged by a pothole or condition of the street ❑ My vehicle was damaged by a plow �y vehicle was wrongfully towed and/or ticketed ❑ I was injured on City pro erty` Other type of property damage-please specify ' ' .' �,J`!( i,� �5�,,,,,,,�►- ❑Other type of injury-please specify ' �,,.,,��e/, ' In order to process your claim you need to include copies of all annlicable documents. For the claims types listed below,please be sure to include the documents indicated or it will delay the handling of your claim. Documents WILL NOT be returned and become the property of the City. You are encouraged to keep a copy for yourself before submitting your claim form. O Property damage claims to a vehicle:two estimates for the repairs to your vehicle if the damage exceeds $500.00; or the actual bills and/or receipts for the repairs , O Towing claims: legible copies of any ticket issued and a copy of the impound lot receipt O Other property damage claims:two repair estimates if the damage exceeds$500.00;or the actual bills ' and/or receipts for the repairs;detailed list of damaged items O Injury claims:medical bills,receipts O Photographs aze always-welcome to document and support your claim but will not be-returned. Page 1 of 2-Please complete and return both pages of Claim Form Failure to complete and return both pages will result in delay in the handling of yoar claim. All Claims-ulease complete.this section Were there witnesses to the incident? es No Unknown (circle) Provide their names,addresses and telephone num ers: �r.d�G 1�,6�/Svh Ff7� ir �. � �' ��� "�'�S'`f J s ' � � 2 _ �i t -3fo���S20 �f�Pr,u�A�•�.nJ �'��..I � � Were the police or law enforcement called? Yes � Unknown (circle) �� �S ..�i,-c�� If yes,what department or agency? Case#or report# ��(_y,�-$�j$3 Where did the accident or injury take place? Provide street address,cross street,intersection,name of park or facility, closest landmark,etc. Please be as detailed as possible. If necessary,attach a diagram. �7y �l3urr 5�,. J� /''t�l Please indicate the amount you are seeking in compensation or what you would like the City to do to resolve this claim to your satisfaction. � S � � �'� �� � 6 � � ' ' �t5 GI�A,��w1 85 d-l't�+1 A CArriBs�i d�►�d�'�vrDrE.ln �LrS �� a�.� SS' �.�og Vehicle Claims-please complete this section fdcheck box if this section does not anplv Your Vehicle: Year Make Model License Plate Number State Color Registered Owner Driver of Vehicle Area Damaged ' , City Vehicle: Year Make Model License Plate Nuxnber State Color Driver of Vehicle(City Employee's Name) Area Damaged ' ' ` � Injurv Claims please com�lete this section �check box if this section does not anplv ; How were you injured? � What part(s)of your body were_injured? Have you sought medical treatment? Yes No Planning to Seek Treatment(circle) When did you receive treatment? (provide date(s)) Name of Medical Provider(s): - Address Telephone � Did you miss work as a result of your injury? . Yes No I When did you miss work? (provide date(s)) __ Name c�3rs:���o3=e�: --- -- - _ _ _--- -. --- __--_____ _ Address Telephone ❑ Check here if you are attaclung more pages to this claim form. Nnmber of additional pages By signing this form,you are stating that all information you have provided is true and correct to the best of your knowledge. Unsigned forms will not be processea� Submitting a false claim can result in prosecution. Date form was completed �T?�t� � Print the Name of the Person who Completed this Form: � /�� Signature of Person Making the Claim: �✓ Revised Febn►ary 2011 , � DEPARTMENT SAFETY ANL INSPECTIONS Fire Inspection Division Ricardo X. Cervantes, Director CITY OF SAINT PAUL 37.i Jnckson Street,Suite 210 Telephone 65/-266-8939 C{�r�islopher B. Colernart. Mnyor Saint Pau[,MN�5101-1806 Fax: GS1-266-895/ �� March 28, 2012 STEVEN W KRAUT Apogee Properties Llc 2817 Anthony Ln S #207 St Anthony MN 55418-2490 CORRECTION NOTICE - COMPLAINT INSPECTION kE: �74 BURK ST Ref. # 114078 Dear Property Representative: An inspection was made of your building on March 28, 2012 in response to a referral. You are hereby notified I that the following deficiency list must be corrected immediately. A reinspection will be made on April 5, 2012 at 9:30 A.M.. Failure to comp?}�may:esui+ in a criminal citation or revocation of the Certificate of Occupancy. The Saint Paul Legislative Code requires that no building shall be occupied without a Certificate of Occupancy. The code also , provides for the assessment of additional reinspection fees. ! DEFICIENCY LIST � 1. Basement - SPLC 34.23, MSFC 110.1 - This occupancy is condemned as unsafe or dangerous. This occupancy must not be used until re-inspected and approved by this office.-Remove all mattresses from the basement no egress � 2. Basement - SPLC 34.10 (5), 34.33 (4), 34.16 - Provide and maintain interior in a ciean anct sanitary condition.-Basement has to be cleaned. j 3. SPLC 34.09 (1) b,c, 34.32 (1) b,c - Provide and maintain all exterior walls free from holes and deterioration. All wood exterior unprotected surfaces must be painted or protected from the elements and maintained in a professional manner free from chipped or peeling paint. 4. UMC 1346.703 - Provide 30 inches clearance around all mechanical equipment. Saint Paul Legislative Code authorizes this inspection and collection of inspection fees. For forms, fee schedule, inspection handouts, or information on some of the violations contained in this report, please visit our web page at: http://www.stpaul.gov/cofo You have the right to appeal these orders to the Legislative Hearing Officer. Applications for appeals may be obtained at the Office of the City Clerk, 310 City Hall, City/County Courthouse, 15 W Kellogg Blvd, Saint Paul MN 55102 Phone: (651-266-8688) and must be filed within 10 days of the date of the original orders. If you have any questions, email me at: james.thomas@ci.stpaul.mn.us or call me at 651-266-8983 between 7:30 a.m. - 9:00 a.m. Please help to make Saint Paul a safer place in which to live and work. Sincerely, James Thomas Fire Inspector Ref. # 114078 i , .����`��;�`:�.`�t`� Contrac# 1 µ - , � nvo�ce r�� . � tf�3���-� , Invoic�: 1385 t:���`�'--.r�' �: � ,�J '��� �•�. �. �� Datie; 04J17/2U12 ��Y':;y�.F.� ��� ..e� :� .+:'_� Billed To: ICraut, Steven Project: Kraut, Steven 2817 Anthorry Lane 874 Burr Street Suite 207 St. Paul MN 55130 St Anthony MN 55418 Due Date: 05/17/2012 Terms: Due on Reoeipt pbg� Descrlptfon Taxablo Amount Cartent Removal and Sewage Cleaning Y 3,71725 Sales Tax 283.44 Nates: A servrce charge�00% per annum wi!!be charged on aN amounts ov�er�iue on regularstatement dat�es. � Please make checks a are to: � Amount Due $4 000.69 P Y8 Clean Response, Inc. # � 480 Prior Ave.North � St Pau�, MN 5b104 65?�46-3408 phone 651 417 2506 fax .�-- - Restoradon Contractors,Inc. dira Cle�n Response _:� .;- _ _ A� - ��"� 480 N.Prior Ave. _ -�' ST.Pau1,MN.551i)4 Yhone:651-64Cr3408 Fax:651-917-25(f6 Qient: Steven Kraut Home: (612)799-4412 Pmperty: 874 Bnrr Strett St.Paul,MN 55130 Operator I�►ta: Uperator: 7AKE Estimator: Jake Mendt Business: (651}646-3408 Company: Clean Responae Busi�ss� 480 N,Prior Ave. St Pani,NIN SS I04 Type of Bstimate: Backup of Sewer or Drain Dare Eutet+ed: M17R012 Dau Aasigned: Price List MNI�+IIV7X�APR12 Labac F.fficiency: ResOOaation/SetviceJRemodel 8stimate: 874B[TRR-STREET MTIZ t`��-.--��- Restoration Contractor�,Inc. dba Clean Response -�,�.��=�;:`` ='=='`= 480 N.Prior Ave. - _-_ _ ; ST.Paul,MN.SSiO4 Phone:651fi4(r3408 Fax:651-917-2506 874-BURR�TREET-NIITI Basement - -�-- Stor�ge Ae+ea/R�oo�m ��6�y�� �'" � 549.28 SF Walls 317.?5 SF Ceiling - �,,,r,�:..,,,,�,w,:; 8b7.03 SF Walls dt Ceiling 317.75 SF F'loor - 3531 SY Flooring 81.33 LP F�loo�Perimeter - _ 84.67 LF Ceil.Perimexu Mi�ng Wall: 1- 3'4"R 6'8" Qpens into UTII.ITY Gces to Floor DESCRIPTIUN QNTY RCMOVE REPLACE TOTAL 1. Teat out wet p�neling,bag for disposal- 205.98 SF U.66 0_OQ 135.95 Cat 3 2. Tear om wet drywall,cleanup,beg,per 6.00 LF 5.66 0.(� 33.96 I,F-to4'-Cat3 3. Clean stud wall 205.98 SF O.flO OS8 t 19.47 4, L(ean with pressure%hemical spray- 798.37 SF O.flO 039 311.36 Heavy Totals: Storage Atea/Roan 600.74 :'8` CI.os�t He�i�t:7,1•� �2i� �� . i52.29 SF wans 19.64 SF Cciling ; i; � � m i' � ; �, '- ;; 171.93 SF Walis&Ceiling 19.64 SF Floar `� €� '' 218 SY Flooring 21.50 LF Floor Pcrimetcr ; !; +� 'I i i ; " "� 21.50 LF Ce�.Perimeter ���� F� ;! � ;i DE5CRIPTION Q1VTY REMOYL REPLACE TOTAL 5. Tear oat wet paneling>hag foc diaposal- 15229 SF 0.66 O.t10 10(}.S I Cat 3 6. Clean stud wall 152.29 SF O.i10 0.58 88.33 7, Ciean with prossureJchemical spray- 19.64 SF 0.00 0.39 7.66 He�vY Totals: Aoset 196.50 874BURR-STREET-MTIT 4i172012 Page:2 T�� fr°. Rest�rat�an Contractors,Inc. dba Clean Response �.-.: �Y� 480 N.Priar Ave. _ - -�'- ST.Panl,MN.SS104 Phone:651-64b-34f18 Fax:�51-917-2506 - Utitity Room Hefght:7'1„ -. b53.12 SF Walls 299.39 SF Ceiling ,;;�._ �; 952.51 SF Walls dt CeiHng 299.39 SF Floa� 33.27 SY Flooring 92.01 LF Ploor Perimeter - 95.34 LF Ctil.Perimeter .��. Missing W�: 1- 3'4"%6'8" Opeas lnto 81'ORAGE Goa to Fioor DF�CAIPTION QNl'Y REM�VE REPT.�ACS TOTAL 8. Ckan with pneasucrlcleemical spray- b25.95 SF O.W 039 244.12 Heavy Totals: Utility Roam 244.12 Tatai:Basement 1,441.36 Up�tairs g� H�ght:Sloped = 175.00 SF Walls 48.09 SF Ceiling 223.U9 SF Walls&Ceiling 66.90 SF Floor 7.43 SY Flooring 29.15 LF Ploor Pcrimctcr 3U.3'l LF Cet�.Perimeoer Mi4sing Wafl: �- 3'2"X 6'9" Opens Into EYterior Goes to I7oor/Ceilimg �ng w�v: �- s�z��x a�4�* o����r c�te�ic�u� DESCRIPTI4N QNTY REMOVE REPLACE TOTAL 9. Clesn hard surfacad ateps 13.00 EA U.QO 4.28 55.64 Totals: Stairs 55.64 Totai:Upstairs SS.b4 General �IESCRIPTION QNTY REMOYE REPLACE TOTAL 874$URR-SI'REET-MTIT M17/?Ai2 Page:3 ` � : Restoration Contractors,IaG dba Ckan Response a� , ;_ -- -�a.���.>.- __ _ _ - °�``'' 480 N.Prior Avo_ _ - -_.. -- ST.Pavl,MN.55104 Phone:651-646-34{)8 Faa:b51-917-2506 CONTINiJID-General DESCRIPTION Q1VTY REMOVE REPLACE TOTAL 10. Dumpster load-Appiox.2U yards,4 2.00 EA 3�F2.54 0.00 685.08 taos of debris 11_ G`lesn ductwork-Exoerior(per LF} 68.U0 LF 0.00 3.1U 210.80 12. Clean ductwock-Interior(PER 14.00 EA 0.00 30A 1 420.14 REGIS'TER) 13. Famace-check,tuavy clean,replace 1.Ob EA 0.00 220.34 22(f.39 filters and service 14. Cleaning Remediation Technician-2 24.00 HR Q.OQ 45.16 1„0�3.84 tcchnician9 far 12 honrs I.abor to removo ail of nc�conterns fnom the basea�nt and discard in the damp,eta. Totals: Gendal 2,620.25 Line Iteffi TotaLs:874BURR-5TREET-NIITI 3,717.Z5 Grand Total Areas: 1,529.69 SF Walls 684.87 SF Ceiling 2,214.56 SF Walls and Ceiling 703.67 SF Flvor 78.19 SY Plooring 224.00 I.P Flooi'Perimeter d.00 SF Loag Wa11 0.00 SF Short Wall 231.88 LF Ceil.Periaieter 7Q3.67 Floor Area 736.78 Total Area 1,456.28 Interiat Wall Area 867.69 Ekterior Wall Area 109.6? Ext�ior Perimetcr of Walls o.�o s�� o.�o x,��sq,� o.oa T�P�r��n 0.00 Total Ridge Length O.OQ Total Ii'ip Length 874BUiZR-STREET-MITI Mi?/Z012 Pagt:4 �'���,�;�:,,. Restoration Cantractons,Inc. �ba Clean Response 480 N.Priar Avc. - -, �'^` ST.Paul,MN.SSt04 �:ssi-�-�ws F�:�si-si�-zso6 Sommary Li�e Item Total 3,71T.25 Cleaning 5ales Tax � 7.b2596 x 3,717.25 2$3.44 Replacem�t Cost Valae $4,400.69 Net Ciaim $4,000.69 Jei�e A� 874-SURR-STREET-MITI 4/172fl12 Page:S ,� ��-,�,,- Restoration Contractors,Inc. dba Cleaa Response �� 480 N.Prior Ave. - ' �';- ST.Paul,MN.55104 Phone:651-646-3408 Fax:651-917-2506 � �''"�t.. ..._ � .�. � �. _ .. _ . -�� ��r-_.. .�c="...,.�g;��..��'� �...,.�,�.,�+`� �� . :ax� ,: � ,:,�t3 .<-.,, � _ .. . _ . .; . .., . . .,��.�ei � a -:� , - .. ;- — . , _ � �s.,.�,. ....c� ,, ,o. -� . . -...:.� y,�.ra:,.:.., �,_ .A.V ,,r,�� .;.:.. � . ,qg�' .::. ... '*�' .- .. ._.,.:�.. ,� � ��� � , �r � _� . _ . . _ .-,y , . ... ... _ ._;M : .. �i����..:, .,.�..�?~�,� _:: r �� I �, aj ..��.. $���� _ y 1 �� . .. ... . " s'�+:$a. . . '' � :.vt'M�K4�-+T - ��,�#�� R�.y+. .'-gh�`i Tt, i.v ;n, � , • �.�1� :�.. ,�;. � , , .. ,: , e � . a 51�� f. .�., ���� .-.��� .., �� � . S �' . ..3zakJ " '� %��: .. �.i:J.4.'R.... .« . .. . .... .._ ... .I. . , te . . .Y+++.' .. .,. . . 5 L ,.874 Bwr Street 005 Date Tek�en:i�AM�9�4 Taken By:Jake Araidt �����'t� 874-BURR-STREET-MITI M17R012 Pago: 10 y��� -�� n,°�,>. Restoration Contractors,Inc. dba Clean Respon�e � ,�, ..y __ __ _ �'```s 480 N.Prior Ave. - _- ,.. ST.Panl,MN.55iO4 Phone:b51-64b-340$ Fax:b51-917-2506 ;v� :��Y .F...�.«,.�,�a.�����` ' '� ���.�;,�- % ��: . ':�<`- ��.�� � � f � ^�e'tn-� �.::a �� .k� . t:,.. .. �� � �:'. -�� �� `�' . . '4 �;� :� s�4.'�.�5�� . F.« .��,t�, _ .. . " , ,. ,; �.. � c , � : •�� � vi��Y� �I II I II�I '°. ' � �� s, t �I :� $ , �. � � � � a�z,� I��� �� < ---fr .. �I � .� y. �. � a; � � �F �.' �} � 'r� ,� �� : � � ri �: > � �- ,�.;.�. + , ��� _. � ,_ . __ ,.'�. 9 874 Burr Sh�eet 004 Date Tsken: Taken By:Jake Arendt �'�a f�.G'r��L- 874-BURR-STitEEf-M177 MI7/2d12 Page:24 g�F�,���,.P �StO[�t1Q11�:O��I'SC'�OI'S�TIIG 1��A �CAn�O� �,�- - �q�"�`��~' 480 N_Prior Ave. ` ` '`,' °"`'� ST.Paul,MN.55104 P6ona:651-64b-34{18 Fau:b51-917-2506 «� ��:. �=E�°i ��. — � �: ` , �, : � , �� . ,�.. � �- ... 3. .a s.r�' ," "' . . ... .. _. . _a �. ,.- „.... �._.:'. . .. : ...C.,. ...-...,.:.. .. .� . ._ . .. � �. . G� ��� " �-.:�-, � . � ,�� � `0 , � ��" .,�� � � z � � . � � , ., d ,�.. . ,p��. , n. ...e � _.'. ��..,' . . . , ..,,, . . - � '.. ' ' �.-.. .t,�s+zs.r ' ��,.�... 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F.Fr�"f� �ys�:�Y'3��,t+,� .� ,'a at ,$'�C -�y ."� � '` .`� n� c .� 3�'°"rs�`ti..�+.�.ief"" �{�_ � t ' .0 .rp # .� >.�^l'�„*.+.#i � ,�y y�'}. - d + �o' '�,�r �, � '� t a, 4 r� .�},�,.;� �,s � • �.R;. -t.> c ?' � _� *�� r� r ,.�� �rt, i., � 1 ,. . , _ . _, , : ., : - . : .. _ �.:� . �.� . � . . ; . , y 4 . .- q . _ - � R:�� - •-a. �y�� � � ��tr 1. �� `:�?&. yx��. �� �'e� �. .��PUU �_R � x �`�� ..`�.�' f'�'� �4'' :; , • _ _ �:�'' , . _ ���,� �'a 14 874 Bu�r Street 014 Date Taken:�0 Takcn By:Jate Arendt �Jy�b(:;l�'f l 874BURR-STREET MTTI 4J17CL012 Page: 19 "� x �`' Restoration Coniractors,Inc. dba Clean Response :,.�f�:� - r �`.'.� 484 N.Prior Ave. � � � �''�" ST.Paul,MN.55144 Phane:fi6l-64G-340� Fax:651-91�-2506 �: ".�,�:��„�..,,.,H x � t � L �+ry � 4 .� � � .;..� , �i �I�. v il �' ��r'i��� � �� �� � � � _ :{�^��� �_ ,� Y �. � ,). 'w#e'^ p. t G�3 F✓��, �'��.y l4�t� �t����r �'yµµ�e+E �@ 4 ��� L.. 9. �f.v l , �'+`'��Yb'ti"� '£,riE 3`laf,v V � '�`.,�. ' � �� � f . � �'�i " F' k 3�'�^� �4 ,. - ;;.$"4i �`"�.x, . .. _ _.. .. "'�`..�. � .. � ��� .. . �� �":t . . r � ��t ns � � . . w��. � . ' � ��zr��s ��s�'"^r..�'�. ��•- ,�,. � „"� � t e��.f _ T: z: .�.:t .. . � . � .. ... ..... .... . . .,,..,.._� ... ."'�2 16 874 BuQ Street 016 Dau Taloen:4/6J2012 Taken By:Jake Arendt 874BURR-STRE�T-MITT 4/17RA12 Page:21 �''' ResRor$tion C�tractors,Inc. dba Cles�u R ,�-�-��-. � - � _ ;,'�'�'� 480 N.Prior Ave. _ - - -_. _-° ST.Paul,MN.55104 Phone:651-646-3408 Fax:651-91?-2506 z�` � � `�' � �, �:. > n; �: �� � . � � � � � ti ; ;� ���. e �-" � a:d • �.:: � 5 aS"i ' «I X-f. � , � �y�.,.:'.� � .q< ,y;` - �,, - �'�'v . ;�:.; ��.. - `�,.���4y`:�'. a %�' :y. @',�•.� ,; _i+"� ' .'.�'�� .''��"}- ti`�" r .'a,.��.. �s:��' 6� l I��, �, � � � ���� � :. �i., ` � 4"'��e"` � �,: 4�; �:'� ����• 3-: '� ��1W _ ��. �� -; � h. �:�'� �.. r, yw R�. .+Ji' A~ei.. ... idY'j .n�' + `( ���. .'��.. . . . . . s �a. � _ . .�._ ... �.j...�. . . F : .. , ' . :.. ' � .. N F a �; �'� � tn� � . . . � �-.�_ .. . . 17 874 B�ur SMeet 017 Daoo Tsken:4/6/2012 Tsken By:Ialae Arendt 874BURR-STREET-MITI Ml'IJ2012 Page:22 ::�,�--w j�;, Restorat3on Con6ractors,Inc. dba Clean Response �.����n�,f N�� _'�` '�'' 480 N.Prior Ave. _ _ -` ST.Paul,MN.55144 Phone:651-b46-3408 Fax:651-917-2506 � �'. �� �x� �' ��: �;� � �: �':,> .�: - ��`•:. ,� � yk,�,,,, =...pe( .p,�.�, %v�;Aa �'�"'Zi`- . .. . �� _� 3'.. � � }�,..H c: ) Z 1 874 Burr Street 021 Date Takea:4J6J2012 Taken By:Jate Arendt 874BURR-STREET-MPl'I 4JI72012 Page:26 ��„����a. Restaration Contradors,Inc. dba Aean Response �=.�' �� =�� 480 N.PriQr Ave. °� 5'I'.Pa�l,MN.55104 Phone:b51-64b-34U8 Fax:651-917-ZSU6 .:�` - �,= ry:: � - :Fs��°� � �� � � - i� [. ~ �, ��,r . i � _ ss��� q; d�i ly��'G�;I�knr�� i' �� � � I _ ,. ;� I � ,r'f k; �, �.a�� `� �, r�. . . :,�:3 'r� ��:,-�: � -�� � :. �.-., . s• . 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''���" 484 N.Priar Ave. - -- � ST.Paul,MN.SSZ44 Phonc:651-646-3408 Fax:651-917-2i06 �r ,#, <; �'+:� .. � ti� ..,t - - � � � ,��f �� — � �j � �;f: � � �,�;;; ��� �,� — X.: ��a �° ;� ,. � .. � � � � �� ��� �t ..��:� .�� � ��w. � � � ;x �}��� � �yr ��� � �. i � f 4 il °�n �" � .r � t" �� � IP';� . ;;;� , ,, �.. � R i t _ � � +fe�s V>'. _ � ��,� .F��w. ... $�'. �� . ;,,� d� A � M1c�! � �V � ���� �� j 1I �`'t a�., a��m�"yc'�x9 �d�l � .. � e"�x�.:.'. `� ''"'. ,� v .T,,;:`>' . ZS 874 Bmr S�ect 0'25 Date Taloea:M612012 Taken By:Jake Arendt 874BURR-STREET-MTTI M172012 Page:30 ��`r,�,��.:. Restoration Contractors,Inc. dba Aemn Response ,_� h�.�., °`��. ^�°`fr 480 N_Prior Ave. � - �T' ST.Paui,MN.55 t04 Phone:651-G4b-34�8 Paa=651-917-250b � �� �� ^a �ga,F !��1 � . ,��� � �,�.. ;.��-� � ." �� �. ��� y�t y ' v. � ,��"s � . . Jy� . � �,§F�i _ .. � . p 9�,� Y'.. 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'S/^ t x`F,. µ� i,' `t, .,: 4' �, �� 2 . � , � l� . .. �:� ,. r �;".� r,.�a. ,�h�: ��.� K r�' .. . 3_ " '.� y, � � � �' � # � .+ y�arSM}a. „ � �' ,4', . . f-. d;. :'�6 f . .�_ �. ��`r; .3 . ,f�.�,���?^��'�s��§��� T �„ a,� �;" _ �r* ,`. . � t�""�<�n'��t,r . • � � S � m �pr h-.. <- . t '�- -�'j"`, . lY :a.'� " � . � x .%a.- � "°�n, , y '�.� �-s" . 28 874 Ban Street 028 Dabe Taken:4/6/2012 Taken By:Jal�e Ar�dt 874BURR-STREET-MTl'I M172012 Page:33 �-���Y::: Restoration Cantractors,InG d6e Clean Response �.;<-� a.. 48Q N.Ptior Ave. - - -: '' ST.Pau1,1VIN.55104 Phone:6S1-64b-3408 Fax:651-917-2506 �:.,, .' q : .�:� '.�?M1y = . .. .. � �, �:. �} �' �� r� ;� F� �� � �� `� � � � `M �.t � _� � ;� � . � �� � �,�'a� ,:. . �,� �<°` �� - , k s-._ �,s ��� . . � � � �` *±�' "� :;..,,.: ,�;, ,�i�� r i$ �9 �'t�`' .."�:�° �:,. ���:?s .�"'i' .,a`:r" s,c �4'� 1� t z�.,��r �'t-F"' 4� d � ��� 5� � � ��; , " �� 4 �'� : �''. o�. d' _ � �'1:rr �;y�n Y�i `:i .6 �t' it 4 " ��� : . 1� �� . ._. � ��. � 3p' 1 g E�"�W�. 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'� _ �`+7_m - � _ � � +V • w . � yi,, fi , �,� F ��_:._ , i ���'��' . _ � -���'��,� �.,, �. � �- �..�� - �� �, , . , ,..fi�.? f���,� � - .. � � . ._.. � '�, � Z 874 Burr Srnet IX?2 Date Taken:�9 Taloea By:lske Aret►dt �`T����IFL g��{-SURR�STREET-IVIITI �I/��/Z�12 PAgC:7 NO: 3� � ^, � .� , ��� !, � f ���T Date: � '� ��-- _ � � / : . , � � • . � , , . �.ssa���� � 1 ����N��Y�4cP[h,r -" �''�siCe� 89��� �ene�s,g�:ncyr ' !RrE2kF„"FfF 7.Ria7�°��i1w3� ` Sk'PYPS� / .� � i�.._��.i`= , _ -� �� TECH :�i✓�-�!�� _. :� .=,.r, -. ���� ��d S��►�r Ciea��i�g ,.> . , ; , SERVICES REQUIRED � __� �,. ` 3 `�` ` �, ❑ Name '�- .�� ��, �,,�' �.,� Main ;• _ �' -� f�"", �,;f ��— ` ❑ Floor Address: �' � x` ��.� _ `.��.. _�-�..., .� _,, ,�� ,f ❑ Bath Tu b City/ State���-�'�``� 'F f Zip Code: ❑ Kitchen Sink : , �' -- - '` �` ` �' ❑ Laundry Tub Phone # 1� ;'� � _ ��,. ` ,.�1�' .���l� ������ :��` rii - � � � - � ° ❑ Bathroo�n Sink �- � � ,;,_,f �,,��7 l �� !;�;j�,� ����� Cell /Work #: ,:Ff�-�' �:.��_ .; `,% ` '� _fx . � ; ❑ Other� � � -� � . __% .-� «,ti� , , DESCRIPTION OF SERVICE� " � �. . . - ��? ���� �. _ � �� '� � . ._ �t ,, -{.. _ 1 _ _ � _ , � � � � �#�� ,`� �' �-.r��� �^� d ,� ��f —��--�� �'•ry �,� �. �.�s,. � � � ;-�;' �,. � � _ _ _ � �. , .� � , -..,�;;.�'�;. �-. � ,,, �,_� zf" � ,�j R �-� /. t_ : , . • _ . - r . � � f �' �' .� �4 f f�C ns �� �" �. .l �� �C3 �' C�f � �iE 'OL �'^. � C� �T�_ �� �� : �...� � ..�- �� �� ff 1 � �„ � � °'' " ` WARRANTY Our warranty is 6 months for residential property. 30 days for commercial and rental properties. Drain Busters reserves the right to alter or decline any warranty due to defect or neglect. DAMAGE RELEASE I (we) agree and authorize the work listed above and understand that"Drain Busters," and their technicians are not responsible for any damages occurred while servicing my property.This includes all pipes, water damage, porcelain chips or breakage, scratches, dents, holes in wa�ls, or marks on floors / carpets. ti r � t - , `' f ;`' , ,_., � /, �..��.. 4 r I � .� . .r.... j f �.% � /� .\ CUSTOMER SIGNATUR�: �/.�" '��',`�,- ;, ; ,���.f ; � ,,, DATE'��.-�-� • ���;-�' � � - ( NO: ,. � .. .: ,.; _ fi..� -.� � �.-'s ",* �� ���� Date:�..�' --, "_ :, .---: � � � � R , l ;;�aa L�c��s� ��� 2�F�wu� F�eKe2s ('���j �ereeegerey? e�,r�u�� ��.�i"���� 5er�ric� . — - � ��i �1�1lI� .�'i���l" �°�C�1111�� TECH: �--=��.-�= SERVICES REQUIRED �� Name: � -- _ ' ,� „ - �`:._. � :`,�� �; � Main , � > � - f ,, U.. - �s�. =❑ Floor j Address: �`;z ° 4A°'' ' ❑ Bath Tub ' � ` Zi Code: ��������� Kitchen Sink City/ State: � ��,• :� '{ p ��.r .�t ,� ❑ i � _._., , , � E � .-�� ❑ Laundry Tub � Phone # ��4 �` ��' �.� � ,�--.� _ ❑ Bathroom Sink ! Cell /Work #: ❑ Other �, , � � �� �^—� � , o DESCRIPTION OF SERVICE: �:: �EJ, ;�,; ;�-'�. ��.,-�f ��:T" � #�,�;���w. ; 'z�4_ ..� >_�- _ _._, . � • r ,� � � �v s �. ,, , � , � � �— .�.s--�,, °"'r'` F"�2 P a ��1���� �� p'� � Y ��{'�; L..�� ��. , ,r ,-- j . £ 1 L z r Y- t�r' � `1IF R �`+„J;� € + i�'s i i, ,"3 � § — '' �i � '� �� � ,I f �-%r � .;�,��y�jf �' � � .. � � / �"� �F�� � , � k.'� ....r�' i ��° y . � '��.. ?� j� �� ��, � �f � � l � � � rc�; �. '�`' .-, . ..F^� o `". , t . �,� ! ��.. '� f �.�a •-,r,, L.,.-.' � d� g d�-' A r'� � : ����..Y. k f� 2.,,-,.�' � . � � i—,.i" ; � ^. « ' r �.S � 'rt �`� ! ! . �y `f.. _ � � , . � .. — 1 pr � ` ~} �'��� % � � Is WARRANTY ---- :`;' :�,�`.` � '�--�� " Our warranty is 6 months for residential property. 30 days for commercial and rental properties. Drain Busters reserves the right to alter or decline any warranty due to defect or neglect. DAMAGE RELEASE ! (we) agree and authorize the work listed above and understand that"Drain Busters," and their technicians are not responsible for any damages occurred while servicing my property.This includes all pipes, water damage, porcelain chips or breakage, scratches, dents, holes in walls, or marks on floors / carpets. CUSTOMER SIGNATURE: DATE: NO: ; �.> , ; , _.. ;, � � �� ;'" .�� _ . � - �� �� Date:- � ;:>. -. � � - � � � . , ,� . 'r ,, �c�¢nae�� 1�.�,r��4 t�QCes _ ._ 4 ' s.�W�e� ��5e�� Eenerates��yr _ - t-� Aroa€:zcf �wZs�is��8� �e:€re�e ��� �� �"i��1��` C����! � TECH - ., _. '`, SERVICES REQUIRED .. � - _ �.. . :. ,�._ p . . Name: �, {.__ k .� � 1 � . m t , '. , '� '.�,Ma. . � , ,. . __�. ,. (, �;'� . - ❑ Floor Address: � . ' ' �F � ` `� �` ❑ Bath Tub _ A,,�, , City/ State: �,� ;�' Zip Code: :F `' _ ❑ Kitchen Sink , - � r �: . ❑ Laundry Tub Phone #: _ . _� - ; ; � ': ❑ Bathroom Sink Cell /Work #: ❑ Other DESCRIPTION OF SERVICE: �-,., - , ; , � n, �. r� : `'� ..� ° � ��_,� ��`�� ` � J� i .� �_ F ' � �. �.�` W . J� � 4_ T� 1� k � fi l�'�...�� i �;'l 1^1 S 1� 1_ _ .` r R .. �, �� \.J,,,! . ... ., : �;,..—.,....... � � �,,., ., . i � '� � �r �{��, � - �{ sa,, . . \j _ � ^ .i . — — � � .: - .' 4 � f .-_^._ . :��. . �. .' � . F F i _- t .} .�"' �, � , t s R . r'�..�'� � .�" �� f ` ' 1f `i t 6 � '`�. t - .- �" �� " �� ' � , � .�''�... . , ; - "J� '� ( "'i.7 f � ' `:'� `�. '''.._ _ _ _ F r fF ; / i ,_ -� _ _v i --i—. , �' .1' �'h 3 `..._.._ __ j� ,i _ � ' . /� F 1` ,r� � � � . �� i z t � �7b'� � .ri"t'.. / �� 1'-^_ai� ._ � . ''�.'� J� l . R r - V\�. / . .' _ �.-. � S,� ,. .. WARRANTY .____ ,:� �; _ {�, ,��., :: -.:.: E :. ,._ i. . �t .:" -," �t � , ,. Our warranty is 6 months for resi�f"ential property. 30 days for comme�c�a�and�renta� properties. �rain Busters reserves the right to alter or decline any warranty due to defect or neglect. DAMAGE RELEASE f (we) agree and authorize the work listed above and understand that"Drain Busters," and their technicians are not responsible for any damages occurred while servicing my property.This includes all pipes, water damage, porcelain chips or breakage, scratches, dents, holes in walls, or marks on floors /carpets. CUSTOMER SIGNATURE: DATE: