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Request Number: 6767
Public Works Division
Service Request
Problem A�ddress: 860 Pandora Dr Requested By: Debbie D
Department: WATER Address: No address provided
Problemllssue: INSTALL METER Phone Nurr�ber: 572-9108
Scheduled Date: 2013-09-20 Scheduled Tirne: 02:30:00
ACTION NEEDED: 2013 AMR
Created by: Wendy Hiatt Date Created: 2013-0&20
ACTION TAKEN:
�: Standpipe will not shut off water. Needed Chris Carv�eAe(plumber)to repair vaMe. CXd meber#17504186 Oid read+ng:
► 947�70 New meter#44922400 ERT#35159 6 t • 1
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Status: Completed Resident Contaated ❑
Date Completed: 2013-09-23 Completed by: Pete Gunderson
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Request Number: 6766
Public Works Division
Service Request
Problem Address: 860 Pandora Dr Requested By: Debbie D
Department: WATER Address: No address provided
Problem/Issue: INSTALL METER(WATER) Phone Number. 572-9108
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Scheduled Date: 2013-09-20 Scheduled Time: 02:30:00
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ACTION NEEDED: 2013 AMR
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Created by: Wendy Hiatt Date Created: 2013-08-20
ACTION TAKEN:
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Status: In Progress Resident Contacted ❑ 1 `
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Date Completed: Compieted by: �
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City of Frrdley
Water Department
i.,,, 6431 University Avenue NE
'`� <,,.• Fridley,MN 55432
� (763)572-3566
I/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
�F` is liable for the water line ftom the main to the premise and all interior plumbing. (Per City code
402.06) t also hold the City of Fridley and/its employees harmless for any damages that may occur
while doing this operation. This to include,but not limited to;valves,piping,walls,floors or the curb
�� stop box and service line. i understand I am also required to obtain a permit prior to any work,if
necessary.
Final meter reading(old meter) ���,� � `�
Name• Address• �� ����
Phone Number• � Date: L����t l
Signature� !�'���'�-L llYi.1-C�(.aG�4N'✓(�-1 -
Witness Signature: � i e�
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FRIDLEY CITY CODE „''`�� �`~�
CHAPTER 402.WATER,STORM 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 municipal system and any hous.e
or building for which the application is made,the owner or contractor shait be required to obtain a permit for such
connection,and shail pay a permit fee as provided in Chapter 11 of this Code. After such connection fias been
made,the Water and Sewer Department shall be notified. It shall be unlawful to cover any connecting line until 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 sewe�lead at the property
line or a water sen+ice or sewer lead has been extended to the property line for connection,the applicant,owner,
or the occupant or user of such premises shall be liable for ail repairs required to any water line and sewer lines
necessary for connection of the premises from the main to the premises. If the property owner requests
maintenance seroice 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 rate set annually by an administrative
poticy. 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 curb 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)
.
BILL TO:
CITY OF FRIDLEY PUBLIC WORKS
ACCOUNTS PAYABLE ' '
�1����'i��e� 6431 University Ave NE • •
Fridley,MN 55432-4303
PURCHASE ORDER 601 00543
DATE: 9/23/2013 VENDOR: CARVELLI DRAIN SERVICE
ADDRESS: 2361 CARVER AVE
DIV/REQ BY: Water Ct�rYSTz�P: MAPLEWOOD MN 55112
VENDOR INVOICE#: PHONE: 651-675-4334 VENDOR# 3310
ACCT NUMBER QTY DESCRIPTION UNIT PRICE SUB TOTAL AMOUNT
601-7000-415-4340 1 Repair shut off valve for AMR $150.00 $150.00 $150.00
meter installed @ 860 Pandora Dr.
PROJ CODE: 601007 v►x x:
TAX:
LINE CODE: S&H:
PROJ CODE: rnx%:
TA7(:
LINE CODE: S&H:
PROJ CODE: rax%:
TAX:
LINE CODE: 5&H:
PROJ CODE: Tax%:
TAX:
UNE CODE: S&H:
STATUS: TOTAL: $150.00
NOTES:
ey my signature/do hereby authorize payment for the above indicated goods or services and attest thot all City guidelines have been
followed in ifie procurement of the listed Aoods or services.
PURCHASER/SUPERVISOR DIRECTOR OR DESIGNEE/DATE
PINK COPY TO ACCOUNTS PAYABLE FOR PAYMENT
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CUSTOMER
APPROVAL SIGNpTURE T� --�—��
AUTHORIZED SIGNATURE GRAND TOTAL ��+� ��
A-2817-3817/T-3866 10-11