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Pr��leidl�we: INST�tLi.AA�E Ni�ETEFC P�Number: 61Z-666-3232
3�Asd�i Ua�s: 17-11-20 ._,� Sche�loled'F�s: 10:00
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City of Fridley �a��D ����,
Water Department
6431 University Avenue NE S�� �J� � a..
Fridley,MN 55432
763-572-3566
1/we hereby authorize the City of Fridley and/or its employees to do what is necessary to
replate the water meter. 1 understand that the property owner is liable for the water line fcom the main to tfie premise and afl imerior
plumbing. (Per City code 402.06) 1 also hold the City of Fridley andJ'Ks empfoyees harmless for any damages that may occur while doing thn
operation. This to include,but not limited to valves,piping,walls,floors or the curb stop box and service line. In understand 1 am also required
to obtain a permit prior to any work,if necessary.
FINAL METER READING(old meter�
Name• Address (D�✓J �~* 5 t'/ V+I��j'� ��n�i�,�x
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Phone Number Date � '"L� � /
Signature Witness Signature l.�-- ��
OLD METER# � � �4 S�U 1 SIZE & STYLE(Circlel
OLD READING S�-r1 ���I CX� 5/8" HEX
NEW METER# 49y� Ya s� �" HEX
NEW READMG O " ELIPTICA►L or �� �
ERT# 7oZ(�v �7 3 S('j'� 2" ELIPTICAL or HEX
FRIDLEY CITY CODE j
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,S65,566,629,638,662,922,988,1144,1156,1191) �
402.5 PERMIT FEE
Prior to constructing or repair of any water of sewer line connecting the existing municipai system and any house or building for which the
appiication is made,the owner or wntractor shall be required to obtain a permit for such connection,and shalf 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 not�ed. k shali be uniawfui to cover
any connecting line until an inspection has been made and wch connection and the work incident thereto has been approved by the City as a
proper and suitable connection.
�02.06 REPAIRS AND MAINTENANCE TO CONNEtTION
After 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 lead has
been extended to the property line for connection,the applicant,owner,or occupant or user of such premises shall be liable for all repairs
required to any water line and sewer lines necessary for connection of the premises from the main to the premises. ff the property owne�
requests mairrtenance service or repairs be performed by the City,the property owner shali be charged for the costs of the maintenance and/or
repairs,including necessary street repairs at a rate set annually by an administrative poliry. ft shall be the responsibility of the applicant,
owner,occupant or user to perform standard mairrtenance 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 fnished
grade of the land or property. (Ref 638,1156,1191)
Request Number: 10240
Public Works Division
Service Request
Problem Address: 6455 Sth St Requested By: Andrea w!J Hawke Mechanical
Department: WATER Address: No address provided
Problem/Issue: TURN WATER ON/OFF Phone Number: 612-522-3499
Scheduled Date: 2015-07-07 Scheduled'I�me: 09:00:00
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AC'ITON NEEDED:'lhrn off water for repair.Permit#2015-01205'This is an apartxnent complex.Notices will be
issued to tenants that water will be off for a short period of time.****BILL****
Created by: Wendy Hiatt Date Created: 2015-06-30
ACTION TAI�N:
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_...................._..,............................................................................................:............................................................................_...._.__.......................___.__...................................__......_.._......................................_.__............__.....__............_....__............
Status: In Progress Resident Contacted ❑
Date Completed: Completed by:
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A �
�� City of Fridley
Request for Billing Invoice date:
Invoice number:
Due date:
Date: 7/10/2015
Department: Public Works
Contact Person: Wendy Hiatt
Customer: Hawke Mechanical Req Cust#:
Address: Apartment Building Bill Type: PW
6455 5th Street NE
Fridley, MN 55432
Phone Number:
Descriqtion of Charaes: Amount
Turn water off and left key for plumber. 25.00
Picked up at 11:30
Total 25:00
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PW-Check One Finance-Check 'One Box'from UT or AR
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� �'�Public Works Repairs (Pks,Streets) �. "? I��A : 101-0000-345-0431
� ' � � � �:Water Damage/Repairs i�..�.,,I W� ' - 601-0000-371-8000
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°� '���,-,�'Sanitary Sewer Repairs ,.:°u ' �M ' �� , � 602-0000-372-7000
� � ��` Water Flow Test 1�lA: ' �� f.� � ;: 601-0000-371-8000
� ` "WaterTurn Off/On Fee u . TQ , ` s � �� � 601-0000-371-5000
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� _�.. . � � ��� � °'Meter Reading ❑ MR � �,�..�.; „r.� -� , ;,,,._ ,... 601-0000-371-8000