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Request Number: 11617
Public Works Division
Service Request
Problem Address: 4526 2 112 St Reqnested By:
Department: WA1ER Address: No address provided
Problem/Issue: INSTALL AMR METER Phone Num6er:
Scheduled Date: 2016-06-24 SchedWed Time:
ACTION NEEDED:
Created by: Wendy Hiatt Date Created: 201 b-06-23
ACTION TAKEN:
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C�-� ����k ,�Za�{7ZZl .,
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C'�-� �.�o lt�(� �.���a
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Status• In Progress Submitter Has Been �
' Coatacted
Date Completed: Completed by:
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. ' � � �iiy�ff Fridley
„ - . _ tnJat�r[9�p��ttmment _ _ : �. _
64�1 Univ�rsiiy Avenue NE
�ridley,MN 55432
[763�572-3566
tJwe hereby auth�rixe t����91 af fridiey and/or its
Qmpioye+es#�do w6�t�s necessary�to�p9ace the wat�er meter, (underr.�ttand that the praperty awner
i�liabie f�r the water tine from the main to the pr�mise and a�ir�t�f�°r P��mbing. {Fer City code
402.0�6) t.ais�hoid the City of Fridley and jits ennploy�es harmi�ssfor a�y amages a may . �-
rrdhhile doing this operat��n. Tfris tv inr�udef bu�not fimi#ed to;uah�e�►R�P�n�,'�s,fiuors or fihe curb
sta�6mc and�eevice(➢nea t understaad t am alsa required to ahtain a perrnit prior ta�any work,if
nec�ssery.
, �inal m�ter reading(old meterj `l./V ` `D .
Name: Address: ��a 6 O"�a s�
Ph�ne Num6er� Dat •
�-zy- z�fG �
Signature•
UU'rtness 5ignature; _���
. . �RdDlEY ClTY CODE
��dAP�"ER 4iIZ�WATEFt,STORM W�TER,AND sAANNiTARY SEWEf�
A[��MIN(S'�'RAl'4U�t
�Ref CJrd�lo i13,�-54,565;556,6Z9,638,562,922,988,5�.�4,1155,119i}
4U�.05.PERM1�"FEE �
Frinr t�canstructing or repair of any water or sewer t9ne cflnn�ctingthe exis�ing muni�ipal sy�em and any house
or huilding f�r wt�icl}the apprca�ion is made,the awner°r cac�tract°r shall be reqairesi ta abtair�a permi�#o�such
conrrectianr and shal)pay a permi�fee as Prauided in Chapter 7.1 of this CAde. After such connection bas been
made,the 1iVater and Sewer Department shal)be noti#ied. It shalt he unlawful to cover any connecting Sine until an
inspection has 6een[nade and sucb cannection and the work inade�thereto has 6een approved by the C'�ty as a
properar�d s�►table connectian.
402.06.REPAIRS A1�tD MAll�1'E'�fATJCE T97+C�}NN�Ci'tQN
-A�tt�-iRi�i�� A�{nn has hP�n ma_da�to the water service curhskaa hnx ar the sewer iead at the prapert'
line or a water service ar sewer lead has been extended to fhe propertyline#or cannectian,the appltcant,t�wner,
ae the occupant or user af sueh presn9ses shalt be liahle f�r all repaks required i�arry water line and sewer hne�
necessary for cannectian of the premises�rom the main tcr the premises. if the prope�,y flwner cequests
rnaintenance service�r repairs 6e perfnrmed by the City,the pr�perty owner shalf be rharged i�rr the ca�ts of tk+e
maintenance and/or repairs, inciuding any necessary s�reet repairs,at a rate set annuallyby.an administraidve
pa(icy, it sha(1 be the responsi6ility�oftE�e appli�ent,°wner,occupantor user to perf8rnt standard maintenance af
• the sewer servic�e 4ine iram the premises�#he main including del�clearing flr raat cutting and to maintain the
water servic�cqr6 stop hox far aperab9tity and at such height as wiH ensure that it remains abave the f+r�ished
, . . . _
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