Meter Swap :
2 Request Number: 15613
Public Works Division
Service Request
Problem Addrsa:: 4550 2 1/2 St Requested By: Mark Isaacson
Department: WA1ER A�ddreas: No address Ixovided
Problem/Isaue: INSTALL AMR ME1ER Pbo�Nwnber: 763-781-0074
Scheduled Dnte: 2017-0b-06 � Schedale�1lme: 08:OU:00 .��,
--�----
A�CIION NEEDED:
Created by: Wendy Hi�t Date Created: 2017-OS-30
ACIION TAi�N�'
__....:.._ � v�-:�_.___........_ � __ ��-'�� _._._____
Status: In Progress ����r Ha�Been r
Cont�ted
Date Comgleted: Completed by:
�-�- �� � ��
�
�ity o�Fridley ��
yvater�e�artr�se�� ��i� _ ���'�b D "
'` 6431 l�niversity Avenue NE J'1
' Ft�di�ey,MN 55432 s�� �iG�
7fi3-572-3566
��We heref�authorize tfie Gty of Fridley and/or its employees to do wfiat is necessary to
replace the water meter. (understand that the pro�erty owner is liable for the water line from the enain to i�e premise and alf irtte�eor
piumbing. (Pe�Zitoty code 402.06j t also hold tFee Crty of Fridiey and�its employees harmless for any damages that may occur while doing this
operation. This to indude,but not limited to valves,piping,wails,floors or the curb stop box and seroice line. In under,�tand!am also requie�
to obtain a permit prior to arry work,if necessary.
FIPIAL METER READI G(ald meter) � "'�� � �
Name: '�� `��� JVn Add �t� ��
. �� �-I S�'� 2
Phone 9Yumber��V,"��`� f�'!' ��� pate�� ! ��
�ignature�/�1 ��`�'� /r -��_� Witrress Sigrtature �
OLD METER# ��`�V �� � `�1
OLD READING U��V ��v
NEW METER# —T- {�i-2�� `l �
NE1M1/READlRtG O
E�#4`i 222-�l 2°��
FRIDLEY CITY CODE
CHAPTER 402.WATER,S'rORM WATER AND SANRARY SEWER
ADMINDSTRATION �
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191j
402.5 PERMI7 FEE
Prior to constructing or repair of arry water of sewer line connecting the existing municipa!system and arry house ar building for which the
apptication is made,the owner or cor�tractor shatt be required to obtain a permit for such con�ection,and sha(t pay a penmit fee as provided in
Chapter 11 of this�ode. After such connection has been made,the Water and Sewer Departmer�t shall be notified. It sha)1 be anlawfu!to cover
any connecting line urrtil an inspection has been made and such connection and the work incident thereto has l�en approved by the City as a
proper and witable connection.
402.06 REPAIRS AIYD MAIMfERfARlCE TO CONNECTtON
After the initiat connectiort has been made to the water seroice curb stop box or the sewer iead at the properiy line or a water se�iead has
been extended Lo the property line for connection,the applicarrt,owner,or occuparifi or user of such premises shall be Itabie for a0 repairs
required to any water line and sewer lines necessary for connection of the premises from the main to the premises. If the properiy owner
requests maintenance service or repairs be perFormed by the City,the property owner shall be charged for the c�ts of the mairrtenance and/ar
repairs,including necessary stree#repairs afi a rate set artnualiy by an administrative poticy. It shatt be tt�e resportsibitity of the applicarrt,
owner,occupant or user Yo perform standard mairrtenance of the sewer service line frvm the premises to the m�in including debris dearing or
root cutting end�o mairrtain the water service curb stop box for operability and at such height as will ensure that it remains above the finished
grade af the land or property. (Ref 638,1156,1191j
� F ���
f� ;
?� t� l�s�da „s��,� st � a r � q �'�; � 1
1 �i� .Y Y -;4�'
� "'
.��� L
� . . M 5����'���. �
i � City of Fridley
, �Pater Department
Address �'��b �'�'2 ��
Name �Q ��f!L C _.i. ��q.C.���
Date � "'���� �+
Old Meter Number w ��
Old Meter Reading G��� ��
Replacement No. Q 6 ` �
Replacement Reading �
Replacement Make � 0.Q. i'
Remarks: `��,/�p� ly/�.� �'
..'"
Si�ned ��
� � Request Number: 11615
Public Works Division
Service Request
Problem Address: 4550 2 1J2 St Requested By:
Department: WATER Address: No address provided
Problem/Issue: INSTALL AMR METER Phone Number:
Scheduled Date: 2016-06-24 Scheduled Time:
ACTION NEEDED:
,
Created by: Wendy Hiatt Date Created: 2016-06-23
ACTTON TAI�N:
.................................................................................................................._.....�.�,�,,1` . ��
....................... ............................. ..................................................................._..................._._..............................._._..........._._._..............._._...............
_............���.._(Y1����-.......-............_
_...................................................._............................_........................................_.._....................................................._...__......._______....._.........._........__...........
��� l��-���(��- _
...................................................................................................................................................................................................._............................................................_................................._..................-�-----................_.._.._...........�......._____._.__.
N� Id���'7�—��-
...........................................................:......................................................................................................................................................................................................................................__..............._........_...................._.....................__..__............._.._
� 2� ��C�-- �
....................... .. ......(...,....�............................................................................................................
..._............................................_...................................................................................................__._........_........................................_.___................._.._....
......:.:..::..:................................�.:�......._�......................................__.........................................................................................................._..........................._......__....._.._...........:.........................._...............__.....................................
Status: In Progress Submitter Has Been r;
Contacted
Date Completed: Completed by:
�-a��� �
�:�.
` . �iiy of Eridfey
. - . - � �lat�r Depa�tanent _ - -- .�.-
64�1 Universi$y Avenue NE
Fridley,ME� �5432
�753�5723566
t/we hereby autharize the Lifiy�a#Fridley andjor ii�
employees#o do wt�at u necess��to r�place the water meter.(un�ler�tand that i�te property awner
is liabls for the water lir�fram the main ta the premise and a�in�rior plambing. (P8r Gty code
4U2,+Q6) 1 als+�fi+nid fihe City nf fridley ar�dJits empioyees�arm(ess or aary amages - may —�
while doing ii�is operadon. Tf►is ta indude,but not Pmited to;ua#u�s,PiPing,watls,flanrs or the curb
stop 6ou and servi�line. t ttnder�stand 1 am also cequ�ced to ahtain a perrnit prior tv any work,if
necessary,
Final m�ter a�eading�old meteri .
Name• Address• � �� t� ��a ��
Phnne Numbar• Date:
Signaivre:
Witness 5ignature:
�RIDL�(C1TY�C�1DE
4i7MT 1�[i Ft�L:NYH C L�A���1[��YYli 1 i-i�i H1`�u 3rifl�di�i I J�WCR
���tNtsr�aToon�
{Ref Drd No�.13,454,555;556,6�.9,638,662,92�,4&8,1144,1156,1191�
4UZ.OS.PfRMii'�E� �
Priar to canstructing ar repair�f any water ar sewer line cc�nnectingthe existing municipat sys�em and any E�ouse
ar buiiding for which the application is made,the owner°r t���0r shal)be reqaired to obtain a permi�for such
conrrecctianr and shall pay a perm�fee as prflvided in Cfiaptec 11 of th"ss tbd�. After such cannectian f�as heen
made,the 1Alater and�eruer Department shall be natified. 1t shal!he untawful to caver any connecting fine until an
inspection has�een made and su�h canne�tion and the work incidertt thereto has 6een approved by the C'dy as a
, prnperand suitab[e connectian.
�02.86.REPl�►lit5 AI��MAINTE�tANCE 7Q CONNE1fifQf�1
�g����jpj�i rnnnar-�inq�Id.S�P��.IIl'r+i da�"tM�water service cur6 ston bQx nr the sewer tead at the prapert'
line or e water service or sewer lead has heen extended to the propertyline#or cannectinnj the appizcant,owner,
or the occupant ar user af such premises shal!be li�bte far all repaks required ta arry water line and sewer fines
n��es�ary for connection of the prernises from the tnain#a ttte�premises. tF the pr�petky nwner requests
rnaintenance service�r repairs he performed by the��yr the praperty awner sha11 be charged for the costs of ttre
. maintenance and/or repairs, inciading�ny necessary s�reet repairs,at a rate set annually by.an admin9strat3ve
policy. It shail be the responsihility ofthe aPPi��a�tj 4wher,occupa�tor usgrta perform 5tandacd maint�nanc�Qf
• the sewer service Gne from the premises ta the rnain including d�h�5 clearing nr raot cutting and to main�airi the
uuater$ervice curh�tnp hox#ar operabi{ity and at such height as w�ensure that it remains abave the finished .
-„gracPe oft����tard ar-pr�p�tiy.�t�t�6;�,3.��5,t.��l� _. .� . . . .. . . � --