Meter Swap � Request Number: 14206
Public Works Division
Service Request
Problem Address: 1651 61st Ave Requested By: Margo Tech
Ikpartmtnt: WATER Address: No address provided
Problem/Issue: ;�;:��'�L�R�R Phene Nomber: 571-6542
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Sc del d Date: 201'7-03-29 � Sc6edaled 13e�e: 09:00:00
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�. _�a�'°�bor-�r va�'V�ra�r.S�it��kM�t for i�t�llaticu�:�ra�nir is made.
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Created by: We�y Hiatt Date Created: 2017-03-20
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Contacted
Date Completed: Completed by:
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4o2.s PERitff!'�'FEE
Prior to r.onstr:uctirtg or�epair of atr�waCe+r esE se►ver iiiae connectir►g the eRrstis�g rnttnicipat system and arr��ouse os buiidhig fo�w(�ich tf
�pplicaiavn is rnade,the ownes or co�rtra+ctflr shatl be required tfl osstain a pesms�for suci�corsriectio�,arid siaall pay a�rermr�fee as provt
Cha�ter 3.�of th�s Cade. Ai`�er sucfi connection has beer�made,�te�U'ater and Sewe�Departmex�t�hal[�e+aotafied. i�shat!be un{aarfui t
ar�y cvns�eefiing iine unfiif an irtspection�as been anade and such connection ancf the war�c in+cidert thereto has�teen aPpr'oved f�y ghe C�ty
pro�er and surtab�e conn,�ctian.
4f32.96 �EFAlR��1N��iAlS1tTE4i(ARtCE TO C011t�tECf�Olet
After the initiat connectivn Itas been made to the water service curb stop i�c ar t�e sewer lead at the properey iine or a wa�ter senrice lea�
been extended tv fif►e pro�aerty line for cannectian,the appiicarrt,odvner,or occupartt ar user of such nrernises sEtati be i'taMe�t���
�^ec{u�red to arry rva#er tine�nd sewer iines necessar+�for connectian aF the�rem�ses fi,om tt�e main to the pierraises, iF the pnoperty owne�
�equesfis+nair�#enanc�senrice vr regairs be perfomsed by the C'ity �tae properfiyr oarner shail be cF�arged for�te�s uf i�e mairrtenance a
repairs,indudirag necessary�treet a�epairs at a rate set annual(y 6y an administra�ixe poSicy. �C sfiai!be tiae respor�sibii"rty of the appiicarrt,
o�vner,occrapa��mr user ta perF�rm standard mairrt�riance af the seuver seraice line from tfae premises to the rnain iadud�rig debris d$arir
rovfi ctatting artd fio cnairr�ain the water service r.ur���p�x for operafoili�tyy and�t such�eigFre as,�riil ensure that it rernains above#re fini:
gra�e of the land or pro�erty_ �FEef 638,1156,i341�
City of Fridley
�Tater Departm.ent
6431 University Avenue NE
� Fridley MN 55432
' ' (763� 572-3561
Uwe hereby authoxize the City of Fridley and/or its
employees to do what is necessaiy tv shut off the water at the c�b stop box. I tm.derstand
tha:t the property owner is]iable for the water line from the main to the premise. (Per
City cvde 402.Q� I also hold t�.e City of Fridley and/c�r its employees�ess for anp
damages that may occur while doing thi.s operation. 'Thi.s to include,�ut not limited ta,
sod,3rard,landscaping,lrees, shrubs,driveways,sidewalks or the curb stag box and
service line. �understand I am also r�quired to obtain a pennit prior to a�y work.
Nam.e: Ad.dress:
Phane I�Tumber: Date:
Sigt�ature:
Witness Signature: _ �
F�LID►�I,�Y CITY C�DE
C�APT�R 402.'WATER,STflRM WATER AND 5ANTrARY 3EWER
ADM�IISTRA.'ITON
(Ref OrdNo 1 i3,464,555,566,b29,638,662,922,988,1144,1156,1191}
�LOZ.05. Pi�R.MIT FT+�E
Prior to cnnslrnctin.�or repair of any water�sewer line co�neci.ing the exisi�o.g municipal system.and any
honse or b'�'ic�mg for which the application is made,the owner ar com.tractor shall be reqna'ed to obtam a
. pemut for sunc�oimectian,sud shall gay a.pe�iit fee as pravided m Chap#er 11 of this Cod�. After such
connection has been.made,the Water and S�wer Depaztm.eat st�all be noiified. Tt shall be on.tawful to cover
any c�nnecting line umtil an inspecti.on has been made aud such com�ection.xad i�e wark mcide.,nt thereto
has been agpxo�ved by the Cily as a propes an.�s�utahle carineotion..
402.d6. RL�PAIRS AND NlA1NTlC1�TANCE TO CONNECTION
Af�ar the ini.iia.l conn.ection has be�a m.ade ta the water service c�b st4p�x ar the sewar lead at i�e
pmperty 1'me or a water servi�e o�r sewer lead.has been extend�ed.to the proPestY l'me for commeclion,the
applicaont,owner,or the occupant or user of such prewises shall be liable for all,repairs re�ed tfl any
water line aad any sewer lines necessatiy for cannectian of the premises from the m��bo the premises. If
the proper�y awner requests mait�tenance services ar rzpairs 1ae pe:r�cnmed bq�e City,the praperty ownes
sllall.be ch�xged for tb.e costs of the maintena�r►ce aud/or repairs,in.ciuding any nec�sgary stre�t repa'trs,at a
rate set aamually by a,n.�ve policy. It shaIl be i�e respons b�l.y of the applic�Qwner,occapant
or user ta perfoxm standard m�,...�ance of the sewer servi.ce 1'me�the pa emises to ii�e ma3n inclu�ing
debris clearnag or root cutking�.d to main.i�.in the water s�rvice cm�b stop box for ogerability mad at sach
height as wr'11 e�sure i�at it zemains abave the fmished grade oftlxe iaad ar prapearl.y: (R.ef 538,1156,I191j