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City of Fric�ey
Water Department
6431 University Avenue NE
Fridley MN 55432
(763) 572-3561
Uwe hereby authorize the City of Fridley and/or its
employees to do what is necessary to shut off the water at the curb stop box. I understand
that the property owner is liable for the water line from the main to the premise. (Per
City code 402.06) I also hold the Ciiy of Fridley and/or its employees harmless for any
damages that may occur while doing this operation. This to include,but not limited to,
sod, yard,landscaping,trees, shrubs, driveways, sidewalks or the curb stop box and
service line. I understand I am also required to obtain a permit prior to any work.
Name: Address: rc,JU `y - `?���r
Phone Number:� Date: �`l,�
Signature: -
Witness Signature:
FRIDLEY CITY CODE
CHA.PTER 402.WATER,STORM WATER AND SANITARY SEWER
ADNIINISTRA,TION
(Ref Ord No 1.13,464,565,566,629,638,662,922,988, 1144, 1156, 1191)
402.05. PERlVIIT FEE
Prior to constructing or repair of any water ar sewer line connecting the e�risting municipal system and any
house or building for which the application is made,the owner or contractor shall be required to obtam a
permit for such connection,and shall pay a permit fee as provided in Chapter 11 of 13iis Code. After such
connection has been made,the Water and Sewer Deparlment shall be notified. It sha.11 be unlawfiil to cover
any connecting line until an inspection has been made and such connection and the work incident thereto
has been apptoved by the City as a proper and stritable connection.
402.06. REPAIRS AND MAINTENANCE TO CONNECTIUN
Aftar the initial connection has been made to the water service curb stop box or the sewer lead at the
property line or a water service or sewer lead has been e�rtended to the property line for connection,the
applicaut,owner,or the occupaut or user of such premises shall be liable for all repairs rec�uired to�y
water line and any sewer lines necessary for connection of the premises from the main to the premises. If
the properiy owner requests maintenance services or repairs be performed by the City,the property owner
shall be charged for the costs of the maintenance and/or repairs,including any necessary street repairs,at a
rata set annually by an administraxive policy. It shall be the respansibility of the applicant,owner,occupant
or user to'perform standazd maintenance of the sewer service line fro.m the premises to the main including
debris clearing or root cutting and to maintain the water service curb stop bax for operability and at such
height as will ens�e that it remains above the fwished grade of the land or property: (Ref b38, 1156, 1191j
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Req uest N u m ber: 6424
Public Works Division
Senrice Request
Problem Address: 6874 7th St Requested By: Ramiro Salazar
Department: WATER Address: No address provided
Problemllssue: INSTALL METER(WATER) Phone Number: 763-571-2367
Scheduled D te: 2013-07-17 Scheduled Time: 08:30:00
�� �� ^��� ��3U
ACTION NEEDED: 2013 AMR Prgm
Created by: Wendy Hiatt Date Created: 2013-07-16
ACTION TAKEN:
...:.....................................................................................:................................................................................................................................................................................................................................................................................................._.._................._
_.......��..�n���........._-..-..........................�.._�.._�.-��'...._��..._�_��.........................................................__......_..............................:..._._..__...................._._
_.:.�..........��...o......�_�c�..-...............................�....:�..��..._��o...........................................................:...................:.........................................._.
................._._._._................ .
...._���...................:..--....��-._�:............... ._�,_`�.....�..�...`��_�c�.................................:.........:......�.......................:........................................._.__:..._...:...:................_
......._II���..���..._l............�..........................................................................................................
................................................................................................................._..............................................._
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�E�- ....................:...................................................-�.._+c�...'�.......... ................_................................................................:............................:.........................
.................._........_..........._�:_._.....:...:.............._:
_.................................................... ......................
Status: In Progress Resident Contacted . �
Date Completed: Completed by:
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Hiatt, Wendy
Subject: Ramiro Salazar, 763-571-2367, AMR @ 8:30 AM
Location: 6874 7th St NE
Start: Wed 7/17/2013 8:30 AM
End: Wed 7/17/2013 9:00 AM
Show Time As: Tentative
Recurrence: (none)
Meeting Status: Not yet responded
Organizer: White, Karen
Required Attendees: Hiatt, Wendy
�
i
,
- City of Fridley
Water Department
-
6431 University Avenue NE
Fridley,MN 55432
(763)572-3566
��We hereby authorize the City of Fridley and/or its
employees to do what is necessary to replace the water meter. I understand that the property owner
is{iable far the water line from the main to the premise and all interior plumbing. (Per City tode
402.06) I also hold the City of Fridley andJits empioyees harmless for any damages that may occur
while doing this operation. This to inciude,but not limited to;valves,piping,walls,floors or the curb
stop box and service line. I understand i am also required ta obtain a permit prior to any work,if
necessary.
Final meter reading(old meter)_ ��� `���
Name� Address•,
���� ` `�
Phone Number: Date: <�"' ��'" ' �
, ,�/' � �
Signature: � ��"�—��
Witness Signature:
FRIDLEY CITY CODE
CHAPTER 402.WATER,S70RM WATER,AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988, 1144, 1156, 1191)
402.05. PERMIT FEE
Prior to constructing or repair of any water or sewer line connecting the existing municipai system and any house
or building for which the application is made,the owner or contractor shall be required to obtain a permit for such
connection,and shall pay a permit fee as provided in Chapter 11 of this Cade. After such connection has been
made,the Water and Sewer Department shall be notified. It shall be unlawfui to cover any connecting line untii an
inspection has been made and such connection and the work incident thereto has been approved by the City as a
proper and suitable connection. �
402.06.REPAIRS AND MAINTENANCE TO CONNECTION
After the initial connection has been made to the water service curb stop box or the sewer lead at the property
Iine or a water service or sewer fead has been extended to the property line for connection,the applicant,awner,
or the occupant or user of such premises shail be liable far ail repairs required to any water line and sewer lines
necessary for connection of the premises ftom the main to the premises. if the property owner requests
maintenance service or repairs be performed by the City,the property owner shali be charged fnr the costs of the
maintenance and/or repairs, including any necessary street repairs,at a rate set annuafly by an administrative
policy. It shall be the responsibility of the applicant,owner,occupant or user to perform standard maintenance of
• the sewer service line from the premises to the main including debris clearing or root cutting and to maintain the
water service curh stop box for operability and at such height as will ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191}
�,
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,a�b;
Request Number: 7364
Public Works Division
Service Request
Problem Address: 6874 7th Street NE Requested By:
Department: WATER A�ddress: No address provided
Problemllssue: WATER MAIN BREAK(WATER) Phone Number:
Scheduled Date: 2014-01-05 Scheduled Time: 05:00:00
ACTION NEEDED:
Created by: Jeannie Benson Date Created: 2014-01-07
AC TAKEN:
...............:� ' �-1� ��
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_. .�..................... ..... ....��................ ......................_...__........._................_..................................................... ..:...............................................................__..............._.........................__.__. .........
..........................................................................................:........................................................................................_____..._..._..._................................................................:.:................................................................................_...._..............................__.._..._
_.................................................�....�._...........m...................................................................................................._................................._..............................................................................................................._................._..........._._..........____.................
_................................................................................................................................................................................................................................................................:.._.........__........._..........__..............._................_...................._............�....................._..___._
..............................................................................................................................................................................................._...................................................................................................................................._................._..............__............__..._...................
_............................................................................................................................._......................................_......................................................._....................................................._....__............._.....:........._..._........._.._.._........._..................._......................_..._.....
Status: In Progress Resident Contacted ❑
Date Completed: �J��l� � Completed by: