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Request Number: 8480
Public Works Division
Service Request
Problem Address: 40-63rd Way Requested By: Mary Jo Smith
Department: WATER Address: No address provided
Problemfissue: INSTALL AMR ME1ER Phone Number: H-763-571-3192
Scheduled Date: 2014-07-29 Scheduled Time: 10:00:00
ACTION NEEDED:AMR Install
Created by: Cheryl Pellegrin Date Created: 2014-07-16
ACTION TAKEN:
Old meter 3 14403365 Old reading 40 60 Newmeter#44922064 ERT#35159417
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Status: Completed Resident Contacted f`
Date Completed: 2014-01-29 Completed by: Ryan Johnson
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City of Fridley
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
Ciiy 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 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:
Phone Number: Date:
Signature: 1 -.1�� G� _ �` � ' .�,
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Witness Signature:
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SAIVITARY SEWER
ADMIl�iISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988, 1144, 1156, 1191)
402.05. PERM[T FEE �
Prior to conslructing or repair of any water or sewer line connecting the existing municipat 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 this Code. After such
connection has been made,the Water and Sewer Department shall be notified. It sha11 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 pmper and siritable connection.
402.06. REPAIRS AND MAINTENANCE TO CONNECTI�N
After the initial connection has been made to the water service curb stop box or the sewer lead at the
properiy line or a water service or sewer lead has been extended to the property line for conneckion,t�►e
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 connection of the premises from the main to the premises. If
the property owner requests maintenance services or repairs be performed by the City,the properiy 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 policy. It shall be the responsibility of the applicant,owner,occupant
or user to'perform standard maintenance of the sewer service line fram tUe premises to the main including
debris cleariug or root cutting and to maintain the water service c�rb stop box for operability and at sueh
height as will ensure that it remains above the finished grade of the land or property: (Ref 638,1156, 1191j
,
Request Number: 8480
Pubfic Works Division
Service Request
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Problem Address: 40-63rd Way Requested By: Mary Jo Smith
Department: WATER Address: No address provided
Problem/Issue: INSTALL AMR METER Phone Number: H-763-571-3192
Scheduled Date: 2014-07-29 c� Scheduled'15me: 10:00:00
C '_` � �
ACTION NEEDED:AMR Install
Created by: Cheryl Pellegrin Date Created: 2014-07-16
ACTION TAI�N:
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5tatus: In Progress Resident Contacted p �
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Date Completed: Complete b :
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_ - City of Fridley
� � --- Water Department .. :.. . .
6431 University Avenue NE�
Fridley,MN 55432
___ ___ _ __ . (763)572:35b6 _
i/we hereby authorize the Gty of Fridley and/or it5
employees ta do what is necessary to replace the water meter. I understand that the property owner
is liabie for the water line fram the main to the premise and ali i�rte�iar plumbing. (Per City code
40�.�) I also hold the Gty of Fridiey and/its emplayees harmless for am►damages that may occur
while doing this operation. This to include,but not limited to;valves,pipin�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. , r��� � �
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Final meter reading(old meter)
Name• Address• � �� ,
•--�
Phone Number: Date: •��2'a���
Signature• � , �
_ _ _ / . _ _ ___ _.
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Witness Signature:
FRIDLEY CITY CaDE
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.PERMR FEE �
Prior to constructing or repair of any water ar sewer line connecting the existing municipal 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
wnnection,and shall pay a permR fee as provided in Chapter ii of this Cade. After such cannection has 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 wark inddent thereto has been approved by the City as a
proper and suitable connection.
402.06,REPAIRS AND MAINTENANCE TO CONNECfION
After the initial connection has been made ta the water service curb stop box or the sewer lead at the praperty
lioe or a water service or sewer lead has been extended to the property line for connection,the applicant,awner,
or the occupant or user of such premises shall be liable for ail repai�z required to any water line and sewer lines
necessary for connection af the premises from the main ta the premises. If the prop�tty owner requests
maintenance service or repairs be perFormed by the City,the property uwner shall be charged far the casts of the
maintenance and/or repairs, induding any necessary street repairs,at a rate set annually by.an administra�ve
palicy. It shail be the responsibil'dy of the applicant,owner,occupant or user to perform standard mainte�ance of
' the sewer senrice line from the premises tn the main including debris clearing or root wtting and to maintain the
,.�+o��o.,,:�o M,�h�+�.,ti�Y F����p�h���t�r and at such hei¢ht as wlil ensure that it remains above the frnished