Meter Swap .
Request Number: 11613
Pubfic Works Division
Service Request
Problem Address: 4578 2 1/2 St Requested By:
Department: WATER Address: No address provided
Problem/Issue: INSTALL AMR METER Phone Number:
Schedaled Date: 2016-06-24 Scheduled'Iime:
ACTION NEEDED:
Created by: Wendy Hiatt Date Created: 2016-06-23
ACTION TAI�N:
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Status: In Progress 5ubmitter Has Been C,
Contacted
Date Completed: � / '2� I Z��� Completed by: n�� /^J�_^,.,�,`� ��l� ��7�"�I
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'� � Ciiy flf Fridiey
- . . _ VUai�r[9epartment _ _ __ _ �._
64�1 Universi#y Avenue N�
Fridley,MN 55432
{763)572-356fi
!/we hereby authQriae d��tY of fridiey anci/or its
employees#o da wh�t�s necessar�v to reptace the wa#er meter, !understand that the property owner
ic lia�l�for the water(ine from the maie�ta the�remise and all irderear plumb�ing. (Fer Gty cade
402.0�&� f.als+�hold the�C�ty of Fridtey�nd jits em�rloyees l�armMss oe ac�y amages a may� �
while doing tE�is a�perat�on. �'his t�o incfude,bu�not timited ta;vala�,P�ping,walis,flaors ar the cnrb
�tup 6ux and senrice Gne� t understtand t am also required to abtain a permit prior to any woric,if
necessary.
- qSC�3DC�
f�nai m�#er c�eading�old me�et)
Name: Address: � s� V d �a S T
P6aae Number: Date: �/ Z'?��ZO j6 �
S�gnatvre•
Witness 5egnature; `� ��%' `
�RIUt�Y GITY�ODE
�fi�Tf�R 4{l�<1NATER,5T�}Rlrl[WA7�R►AN�S+�NCfAitY 5EWER
AaM1N#STRATtClt�
(Ref ard�ta�.13,454,565;556,6��,638,Sb�,91�,988,1144,1156,1191J
4tJ�.05.P'E�M6T FEE �
Priar to canstrut�ing or repair af any water ar sevuer iina connectingtfie exi�ting municipaf sys�em a�d any f�nuse
ar 6uiiding for which tF�e application is made,the awner or c�rrtractor shall be requ+ie�to abtain a petmi�for suci�
coarrectian,and shafl pay a permif fQe�s Pfp��Qa in Chap�ter 11 afi�is CQde. Afiter such cannection bas heen
made,the Water and Sew�r Departrnent shail be notifted. lt shaii 6e vntawful�o cover any connecting fine unti!an
inspection has 6een tnade and such connection and the work incident thereto has heen approved by ttte City as a
properand suita6le connection.
40�.06.i�EPA1R5 AlVD M�tiNTE�YAIVCE TO�ONNEC�'iQN
-A�tk�.iaitia' '- `��� aa+^the water service curhstao 6sax nr the sewer lead at the prapert�
�rnnnar-�itlll li ril'n
line or a water service ar sewer lead has been e�tettded to ttie pro�rfyline#or cannection,#he appltcant,owner,
ar the occupant or user at such premises shal!be 1i�61e for al(�epair�required i�eny waker line and sewe�lines
ne�essary#or connection of the prernises firom the main ta the premises. ifitite propetty owner requesis
rnainte�►ance senrice flr repairs he perforr+�ed hY the Cii.y,the praperly owner shall be rharged far the�a�ts af the
. maintenance and(ar repaies, inc(uding anY necessary s�reet repairs,at a rate set annually by�n adminfstrative
po(i�r. It shati be the responsihility�fthe applicants owner,occupantor user to perfarm standard rnain#enance of
� the sewer service fine fram the premises to fi�e main incfuding de6ri�dearing ar raot cutting and to maintairi the
water s�rvice curl��op hox�tir 4peraGi!'�ty and at suth height as u�i ensure that it remains a6ave the finished
_„grac�e oft���tarrd vrpr�p��.y.�tR�►`63�,a.i.55,-�3:97:� __ ._ _ _.._ ._.: � _ .:.._ .-.� �. ..:_ .:. � .._��-