Meter Swap _ � Request Number: 14749
Public Works Division
Service Request
Problem Address: 1612 Berne Q�j Requested By: Cheryl Stinski
Department: WA'IER Address: No address provided
Problem/Issue: INSTALL AMR METER Phone Number: 612-518-5207
Scheduled Date: �017-04-21 5chednled 1lme: 11:00:00
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ACTION NEEDED:
Created by: Beth Kondrick Date Created: 2017-04-18
ACTIQN TAI�N:
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Status: In Progress Submitter Has Been r
Contacted
Date Completed: Completed by:
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City of Fridley
Water Department
6431 University Avenue NE
Fridiey,MN 55432
763-572-3566
�/M+e hereby authorize the City of Fridley and/or its employees to do what is necessary to
replace the water meter. 1 understand that the property owner is liable for the water line from the main to the premise and all iMerior
plumbing. (Per City code 402.06) I also hald the City of Fridley aod/its emp{oyees harm{ess for any damages that may occur whiie doing this
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,ff necessary.
FINAL METER READING(old meter) �� ���
Name:�LI�,rU' `�f � ��1 1f���1 Address_�Y� `� �'Ur�K./ l�►Y�'
Phone Number���l �1���� 1Date_.� ��� t 1
Signature_ Witness Signature
OLD METER# �� � (�" �X�� I
OLD READING r 1 � 4 �� '-'� S nd���T �l a��e r ��C �PS'� .
NEW METER# T�Z�� . � '
NEW READING�
ERT# I v��6�` ` �q
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191)
402.5 PERMIT FEE
Prior to construding or repair of any water of sewer line connecting the existing municipal system and any house or twilding for which the
application is made,the owner or contractor shall be required to obtain a permit for wch 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 DepartmeM shall be notified. lt shall be unlawful to wver
any conneding line until an inspection has been made and such conoection and the work incident thereto has been approved by the City as a
proper and suitable connection.
A02.06 REPAIRS AND MAiNTEP1ANCE TO CONNECTION
After the initial connection has been made to the water service curb stop box or the sewe�lead at the property line or a water setvice 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
requi�ed to any water line and sewer lines necessary for connection af the premises from the main to the premises. If the properly owner
requests maintenance service or repairs be performed by the City,the property owner shail be charged for the costs of the maiMenance and/or
repairs,inciuding necessary street repairs at a rate set annuaily by an administrative poliry. It shali be the responsibility of the applicant,
owner,occupant or user to perform standard maintenance of the sewer service tine from the premises to the main including debris c{earing 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 flnished
grade of the land or property. (Ref 638,1156,1191)
Request far Service Report
, �ity of Fridley
R eference hJ o: 6�1-11-3308 Date: 08/11111
Request Type: Turn water afFlon Entered By: Wendy Hiatk
Department: Water Citizen Name: Cheryl Stinksi
Address: 1612 BERNE CIR NE Callback Phone: 612-518-5207
Scheduled Date: O�f1511) �lO,J�.�°";� ` Property�wner. 763-571-9(149
Location Details: Permit#2011•01526 Request Details: Shut water off}leave keg �`
""""BILL""`
Action Taken:
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Responsible Person: _
Approver:
Completion Date: t itizen Notified
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City of Fridley
�Vater Department
6431 University Avenue NE
Fridley MN 55432
(763) 572-3561
Uwe hereby authorize the City of Fridley and/or its
employees to do whatis necessary to shut offthe water at the curb stop box. I unders�and
that the properiy owner is liable for the water line from the main to the premise. (Per
City 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, yazd,landscapi.ng, trees, shrubs, driveways, sidewalks or the curb stop box and
service line. I understand I am also required ta obtain a permit prior to any work. -
Name: Address:
Phone Number: Date:
5ignature:
Witness Signature:
FItIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SAlvPTARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988, 1144,1156, 1191)
402.05. PERMTT FEE
Prior to constructing or repair of any water or 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 obtam a
peimit for such connection;and sha11 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 shall 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 proper and stritable connection.
402.06. REPAIRS AND MAINTENANCE TO CON�TECTI�N
After the initial connection has been made to the water service curb stop b+�x or the sewer lead at the
property line or a water service or sewer lead has been extended to the property line for connection,the
applicant,owner,or the occupant or user of such premises shall be liable for all repaits required to any
water line and any seveer lines necessazy for connection of the premises from the main to the premises. If
the properiy owner requests maintenance services or repairs be performed by tlie City,the property owner
shall be charged for the costs of the maintenance andlor repairs,including any necessary street repaas,at a
rate set annually by an administra#ive policy. It shall be the responsibility of the applicant,owner,occupant
or user to'perform standard maintenance of the sewer service line fram the premises to the main includ'mg
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�e finished grade ofthe land or property (Ref 638, 1156, 1191j
Req uest N u m ber: 7548
Public Works Division
Service Request
Problem Address: 1612 Berne Circle Requested By: Dave Sheely-(House sitting for
owner)
Department: WATER Address: No address provided �
Problemllssue: FROZFN WATER SERVICE Phone Number: 612-685-9358
Scheduled Date: 2014-02-20 Scheduled Time: '
AC710N NEEDED: Frozen water service
Created by: Wendy Hiatt Date Created: 201402-20
ACTION TAKEN:
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S"tatus: In Progress Resident Contacted ❑
Date Completed: Completed by:
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3-��-�y :
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