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City of Fridley _
^ Water Department
' 6431 University Avenue NE
Fridley MN 55432
(763) 572-35b1
Uwe hereby authorize the City of Fridley and/ar 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 City of Fridley and/or its employees harmless for any
damages that may occur while doing this operation. 'This to include,but not lim.ited to,
sod, yard,landscapiiig,trees, shrubs, driveways, sidewalks or the curb stop box and
service li.ne. I understand I am also required to obtai.n a permit prior to any wark.
�,, �n6�-�-
, , ticl O�me"ca `����f CPU�`` ��-e�
Name:���'�� ��.t�10� rn, Address: �-C�
PhoneNumber: (�p5)-��-�J�'� Date: )a - I��' ��,
Signature:
Witness Signature:
FRIDLEY CTTY CODE
CHAPTER 402.WATER,STORM WATER AND 5AIVITARY SEWER
ADM�TISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,98$, 1144, 1156,1191)
402.05. PERNIlT FEE
Prior to constructing or repair of any water ar sewer line connecting the existing mwaicipal system and any
house or building far which the application is anade,the owner ar contractor shall be required to ohbin a
permit for such connection,and shall pay a permit fee as provided in Chapter 11 of i�is Code. After such
connection has been made,the Water and S�wer Department shall be notified. It shalt be unlawfi�l to cover
N any connecting line uniil an inspection has been made and such conneetion aud the work incident thereto
has been agptoved by the City as a proper and svitable connection
402.06. REPAIRS AND MAINTENANCE T4 CONNECTIUN
Af�er 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�ended to the property line for connection,the
applicant,owner,or the occupant or user of such premises shall be liable for all repairs required to anY
water line and any sewer lines necessary for cannection of the premises from the main to the premises. If
the property owner requests maintenance services ox repairs be performed by the City,the properiy owner
shall be charged for the costs of th�maintenance andior repairs,including any necessary street xepairs,at a
rate set annually by an administra.titve policy. It shall be the respons bility of the applicant,owner,occnpant
or user to'perform standard maintenauce of the sewer service line from t]�e premiises to the m�ain inciuding
debris clearing or roat cuxting and to maintain the water service curb stop box for operability and at such
height as will ensure that it remains above the finished grade oft�e land or property: (Ref b38, 1156, 1191j
-�.—
Request Number: 7105
Public Works Division
Service Request
Problem Address: 1426 64th Ave Requested By: Alex-new ovmer
Department: WATER Address: No address provided
Problemllssue: TURN WATER OWOFF(WATER) Phone Number: 612-597-1699
Scheduled Date: 2013-10-08 Scheduled Time: , 10:00:00
..--�—'
,�_-�-��.
ACTION NEEDED: New owner. Tum on water. Reconnect meter.
'� `'�'
Created by: Wendy Hiatt Date Created: 2013-10-07
ACTION TAKEN:
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................................................................................................_................................................................................................._.............��...�..............................................._........_..................................._..........................................._.................................
Status: In Progress Resident Contacted ❑
Date Completed: Completed y:
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_ City of Fridley
Water Department
6431 lJniversity A�enue NE
Fridley,MN 55432
(763)572-3566
��We hereby authorize the City of Fridiey and/or its aWn�r
employees to do what is necessary to replace the water meter. n�e do�t�mbing.t(Per�CitY code
is liable for the water line from the main to the premise and all i p
402.06) I aiso hold the Gty of Fridley and/its empioyees harmless for any`d�ama�g"s'�Qors or he curb
while doing this operation. This to include,but not limited to;valves,pip' g.
stop box and service line. I understand I am also required to o6tain a permit prior to any wurk,if
necessary. � �� �
� � 3r-%
Final meter reading(old meter� ' ��
Name: Address•
1 `"1� '
�� " � .. ��
Phone Number: Date:
,.�
Signature�
Witness Signature: �
FRIDLEY CITY CODE
CHAPTER 402•WATER,STORM WATER,AND SANITARY SEWER
' ADMINISTRATtON
(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 cunnetting th n��ben equiired to b ain a permit for such
or building for which the application is made,the owner or contrador s
connection,and shall pay a permit fee as Phall'be not'fed.tlt sha(i be unlawfut to cover any conneicti g lineeuntil an
made,the Water and Sewer Department s
inspection has been made and such connection and the work incident thereto has been approved by the City as a
propec and suitable connection.
402.06.REPAIRS AND MAINTENANCE TO CONNECTION
After the initial connection has been made to the water service�o e�Op��e forrconnection'the ppl'icant owner,
line or a water service or sewer lead has been extended to the p R �Y
or the occupant or user of such premises shail be��maen to the pre'misesulf he p operty owner requ sts r��nes
necessary for connection of the premises from the
maintenance service 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 s�reet repairan���u er to perfo m rtanda d m intena'nce af
policy. It shall be the responsibitity of the applicant,owner,occup
• the sewer service line from the premises to the main inhe d�aa W�I ensure t at i ema ns above the fin shed he
water service cur6 stop box for operability and at such g
grade of the land or property. (Ref 638,1156,1191)