Meter Swap .�'
� Request Number: 13819
Public works Division
Service Req�st
ProWem Address: 6481 Arthur St Requested By: Ma�gie Kendall
Departme�: WA'IER Addres:: No address provided
Problem/Iaa�: INSTALL AMR METER Pbo�Nami�r: 763-571-8764
Scheduled Date: 2017-03-14 5c�edolei 1lme: 01:00:04
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ACTION NEEDED:
Cre�ed by: Beth Kondrick Date Cre�ed: 2017-03-03
AC'II N TAI�N:
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Stah�: In Progress 5ubmitter Has Be�a �.
Co�uted
Date Completed: Complet�d by:
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(��a� hersby atr�ho�ize ttae L' �o#�r�cile ared oe-its ean 7
�egs9ace the�rater�saeger. �a��derstanc�ttaat�he ro e '�° � � !���es�do w�at ds necess
, taar a�sira �► P �flwner is diai�le f�r��►e�ater lin�from the anais�to�ee premise and ail aareerio�
�S g• (Pea'�C"s�ij�ode��2.�6� �adso�aoid the�"s�j+�f�Bc6ley and�Sfis em�Olaqees hasmless#or any�lamages't�aC�raay�ccur atrhile s�oir:
�' n�er,a�taora. �'teis�o�nctucEe,6axrt reca�t�isa�'stect�o wralves,�Iping avadls,fl9ors as�ee�narEa stog��ox arad seavece line_ Irn undersfiand i am also
t�o8staira a�era�nit gar�or to�aaay rrnr�,��ecessary.
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Signature '
Witness SignaGur+E
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402.5 PE€ttk�dT 6EE
Prior to,constn.rcting or�-epair o�F afry eivaCer oF sexrer 9irae connecting fihe eKistir�g�rrunicipal system and arry nvuse or 6uiidirig#or arhich the
�PP�i�'a�+�s rnade,the owner or corri�actor shatl be required to obtain a�ermifi for such connectian,a»d slaalt pay a permit fee as providE
Cha�rCer 3.1 of tfiis Code_ �,fter such connection has�een inac(e,the Water and Sewer Departmerrt shali i�e noi�fied. it shall be unlaurful to
aray�coranecting Gne urrCil an;nspection has 6een anade and sucfi connedaon and the war�c inciderrt thereto has i�eert approved by the City a
proper and suitab�e connection.
402A6 �iEPA1R�fii1t��itA14�TENANCE TO CO11tN�CT1091(
All�er the iniCial sonnectivn has been made to the water service curb stop box or ihhe sewer fead at tne propert�tine ar a�ater�nrice Iead
been extended#o�the proper[y line foc con�ection,the appiicartt,owner,nr occu�rarrt ar user of such premises shali be ttwbfe fo�a!1 repairs
require�{�lo arry water J�ne and sewer lines necessary for connection af the premises from the main to the�remises. 1f the property awner
requests ma�rr#enance senrice ar repairs be performed 6y the fa"tY.the properfiy onvner shali be char�ed for#he costs trF the mairrterrance anr
repairs,iraclud€ng necessary sfireet repairs at a rate set annua�ly�an administ��ative policy. it s6afl be the respons�biiity af the applicarrt,
o�vner,occu�►arrt or user to perform standard mairrtenance af the sewer serarice�ine from i�ae premises to ifie main ar�ctud'ir�g detxis dearing
roofi�ufiCing ar�d to mairrtain#he water seruice curb stQp box for operafaslity and at such height as will ensure that it rerr�ains aboue the fPnish
grade of the�and or property. (i�ef 638,1156,1192�
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��� Request Number. 9886
Public Works Division
Service Request
Problem Address: 6481 Arthur Street NE Requested By: Mazk resident for Mazgaret Kindall
owner
Department: WA'iER Address: No address provided
Problem/Issue: 1TJRN WATER ON/OFF Phone Number: 763-571-8764
Scheduled Date: 2015-03-23 Scheduled TTime: 12:00:00
ACTION NEEDED:Please shut water off at street today by 12:OQ noon.Homeowner has her plumber coming today at
12:00.Jason W.Advised.
Created by: Cheryl Pellegrin Date Created: 2015-03-23
ACTION TAI�N:
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Status: Tn Progress Resident Contacted ❑
Date Completed: Completed by:
����' I � �
Permit No. :
CITY OF FRIDLEY * z ID 1 5 — 0 0 4 6 2 *
DATE ISSUED: 03/23/2015
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
763 572-3604 FAX: 763 502-4977
ADDRESS : 6481 ARTHiJR ST NE
pI1V : 343024430013
LEGAL DESC : UNAVAILABLE
: LOT 38 BLOCK 0
PERMIT TYPE : PLUMBING-FIXTURE BASED
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : VALVE REPLACEMENT
NOTE: CAT.L 763-572-3566 TO SCHEDULE SHUT OFF.
CALL FOR FINAI,INSPECTION WITHIN!0 WORKING DAYS.
CHANGB METER SHUT OFF VALVE
APPLICANT VALVE REPL FEE,RESI 35.00
STATE SURCHARGE,PLBG FLAT 5.00
TERRY OVERACKER PLUMBING INC TOTAL 40.00
502 E MAIN ST Payment(s)
ANOKA,MN 55303 CREDIT CARD 2236 00462 40.00
(763)572-8880
Minnesota State License#:PLBG-MB3102
OWNER
KENDALL MAGGIE .
6481.ARTHLJR ST
FRIDLEY,MN 55432-
AGREEMENT AND SWORN STATEMENT
This permit becomcs nutt and void if work or construction
suthoriud is not commenced witin 180 days or if consWction
or work is suspcnded or abandoned for a period of 180 days at
any time after work is commenced.
I hereby certify that I have read and examin�this
application and know the same to be true and corrcct. All
provisions of Iaws and ordinances governing this type of work
will be complied with whether specified berein or not� 1'he
granting of a permit does not presume to give au�ority to
violate or cancel the provisions of any ather state or local law
regulating constructioa or the perforrnance of construction.
APPlicant Date
Bld$Insp D�
F�am:763 572 8889 Page:2!2 Date:3/23/201510:18:45 AM �� r.�
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$uilding PLUM.�ING ��it xo.•_
Inspections RESIDENTIAL APPLICATIUN Rcceived By:_
�63�s72-3b04 CITX OF F�DLEY o�c�x��a:
7b3-S02-4977 FAX �c�vEi_i-zoia
DATB �w "" YOUR E�MAIL ADDRESS
STTB ADDRESS
TH1S APPIdCANC 1S: Cl OWNER �CfOR
PRorERTY vptics: � sr��r,�.�! s��2
T NANT annx�ss: �
PHQME• �,�/��"'" ��.'��iL----
Corrct�CTOR N,�: Terr�,r�Plumbing.Znc
SUBMIT A COPY QF STA'B LiC�TiSE#PM PMOb�,94� ���n'rH 1 Z13 Ul5
YOUR STATE
LICEN3�,BOND ANQ CONTRACTORi�(FC OR PS) PC�1247 �nn� �zr�ins
GERTTF[CATEOF pppg�g; 502 E M�11 St Ct7'Y_ ArIa�B STA'i8 M1�T �P-�3�3--
INSIJRANCE PH�g 763-323-$8$$ PAX 763 5724q��0 —
PER1�II'C7'YPE �SINGi.EFAMTGY ❑TWQFAMiLY L7'fOWt�C1i0USE
TYPE OF WORK: ��' ���M�'r
DETAQ.ED DBSt:RIPTTON OF WORK
FEES ARE f3ASED O'N Sl Q.04 PER FIX7'U�S.EXCE.4T WH&RB NaTED. FDC[UKES: (1NDICATB TQYAL MJMBflt OF'BAC�i BELOYY),
BATH SR�K/LAV F[.OQR DRAINS SHOWHtt WATIs1t PIMNQ
�BATHTUB _....OAS P[PTNG(NEED QTY LiC) �SWIMMiNG YO�I. �WA18R SOFTNLR(i.l'S)
CLOTHES WASHFR Kl'l'CHP.N SINK WATCIt C�J05ET _BACKF't.OW PI�tEV.(SIS)
�DISHWaSHER �LAUVDR�'TRAY WATEtt HEATER(�33) FOR[RRIdA'1'fON
""` WATER M�I'&R OTFiER
Nnmber of ifictures��1 Q.00 x�1 Q.�_$ • ' .
Nu»ibor of t'ixtures�S15.OU ' a�1 S.�?_$,,,�..�,,,_ • � ' .
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Nusnbcr of�ixturw�(�535,04�x S3S.00�S� •
Stacv Surchar� �--�� ' � ' � .
s3s �b �`�m s �'' •
'f'4TIS 7$A.Y APPLICATION FOR A PERMIT I�I4T VAUA UN14.MtOCESSS�
1 hereby apply for a piumbing pe�mit I knowled$ that the informstion sbove is complota and accurate:tl�at tba work arill be ia
condFormance witb ihc a�dinances and the Citv F ay and wi�fi the Mira+e�ta Cansaucttan Codes:tLat[�dersta�i�ia is
not a penmit but anly an application a It sad not to s�art witho�rt s parmit on aitc;�at the wcuk wip be in e�ordancc
wich che approved plao in the c ` o ���P�P� f P
SI�TiAT[3RE OF APPLTCANi' dA �
APPRQVAL IIYSP6Ci'ORi4 SIGPi DATB
�PLEASE NO'IE: S�PARATE P FOR BUILDINC3 LEC7RICAL AN�. C�'�O�
Ctitty of Fr�dley
Ba�7ding In�pections Departrn.ent
b431 Uaiversity Avenue NE,Fridlcy,MN 55432
763-572-3604
FAX: 763-50�-4977
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