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Meter Swap s v Request Number: 14377 Pubiic Works Division Service Request Probiem Address: 1522 Berne Rd Req�sted By: Todd Department: WA1ER Address: No ad�ess provickd Problem/Issue��,, , INSTALL.AMR ME1ER Phom Nmnber: 612-618-2916 .��,� ��•+� Sc6eduled Date: 2017-04-04 Scheduled'Iime: 07:00:00 ` `-jC' ;�,. "�:=�`vin�brt so�a�er c�c�sln►t off val�e.Install,A�R. Crented by: Wendy Hi�t Dxte Crented: 201?-03-29 ACTION TAI�N: ..__._._..._...�.�___.�____(��'�i 4�� l S �J �t= �-��,��T �C�12 4�-S � f►t��c5w�t�2 � �� lUv� C�-I�r��E � /� L-�D� ��T ��i,s `�'�r�� , l ��'�� `{ Statua: 1n Progress ��er H�s Been r Cont�ted Date Completed: Com�eted by: �� H� �� Gity of Fridley Water Department , 5431 University Avenae N.E � Fridley NIlV 55432 ' (763) 572-3561 I/we hereby a.uthorize the City of Friclley and/or its emgloyees to do wha.t is necessary to shut offthe water at the curb stop box. I understa�e.d that the praperiy own.er is liable for the water line from the main to the premise. (Per Cit�cod$402.Ob} I also hold the City of Fridley andlvr its employees hatmless for any damages tbat may occur while doing this operatzon. 'This#o include,�ut not limited to, sod,Yard,laudscaping,trees, shruhs,driveways,sidewallts or the curb stop box and service line, i understan.d I am alsa requixed to abtain.a pezmit prior to anp wor� Name: Address: Phozae Number: Date: Signature: Wiin.ess Signature: - IRI�LEY CITY C(fD� C��AP'TER 402.'@vATER,STORM WAT�R AND SANT�'ARY SE�VER ADNIINISTRATION (RefflrdNo 113,454,5b5,566,629,638,6b2,922,I&S,I144,.1156,1191) 4U2.ti5. PERiVIlT FT.�E Friflz tti canstractia.�or repair of any water ar sewex line connecting the exisl�ag znunicipal system and any house or bu�ding for which tT�.e appIicatioxe is made,the owner ar comd�'actrn.'shall be reqa�ed.to oMain a . pexmit for such com�.ect�ion,and shall pay a.pe�mit fee as provided in Cha�rter i 1 of this Cod�. .�er snch conneclion has been made,the'Waker and Sewer Degarhm.ent shall be n4iified. Tt slaall be unlawfi�ta caver azry eonnecting line u�ntit an�nspection has bee�n made and snch co�ectian aaid the worls incide�st thereto has�een approved by the Citp as a proper an.�s�nitable cnnueGtion. 402.06. REPA7RS AND MAil.YTEI�3tiNCE T+a CONNECTI�N A�ex the initiai connection has been made to the water serv'ice c�s s�ap box or i�.e sevqer lead st t3�.e ProP�nY line or a water service or sewer lea.d has been ext�nded to the property line for coamnectian,tha applicant,owner,or the occupant or user af s�nch pre.misas shall.be jiable for a11 repaits requ�ecl io say water line and anp sewer lines necessazy for co�tn.ection of the pr�mi.ses frvm the mam tn tf�.e premises. If the ln'oP�rty awner requests maiutenan.ce services or repairs be gerformed by t�e City,the pmperiy owner shall be ch�ged for f�.e costs af the main.tenance aud/or repaixs,including anY necessazY s�et re�?�rsy at a rate set au�t.ually by an admmistrative policy. It shall.be#he responsb�ity of t�.e applica�Qwn�r,occap�at or user ta`perform standard maartenance of the sewer service line�rom t�te premises to the mx¢t includiug debrls clearing c�r rocst cuttsag and to maintain.the water servi.ce curb stap bo�far aperabi`t�"p and at snch hei.ght as wr1i.ensrne that ik xem��i._m.s above tb�.e finisi�ted gra�.e ofthe land ar propexl.y: (Ref 638,1 i56,1191j . , City of Fridley �� U�� Water Department � �� 6431 University Avenue NE �ridley,MN 55432 763-572-3566 �/we hereby authorize tfie City of Fridiey andjor its employees to do what is necessary to replace the water meter. I understand that the property owner is liable for the water li�e from the main to the premise and all iMerior piumbing. (Per City code 402.06) I also hold the City of Fridley and/'rts employees barmfess for anY damages that may occur while doirq�this oqeration. This to include,but not limited to val�es,piping,walls,floors or the curb stop box a�d service line. In understand 1 am also required to obtain a permit prior to any work,if necessary. FINAL METER READlIVG old meter �� j Name: Address I�� L��r'v � � Phone Number Date L�� Signature � � Witness Signature OLD METE # ` � �� 1 OLD READING � �^�'� G''ov NEW METER# {� `�� i . NEW READ{NG � ERT# ��`� FRIDLEY CITY CODE CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER ADMlNISTRATION (Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191) 402.5 PERMIT FEE Prior to constructing or repair of any water of sewer line connecting the existing municipal system and arry haase or buiiding for which the appliption is made,the owner or contractor shall be required to obtain a permit for such wnnectio�,and shall pay a permit fee as provided in Chapter 11 of this Code. After such connection has been made,the Water and Sewer Department shali be notified. It shall be unlawful to cover any connecting line until an inspection has been made and such connection and the work i�c�de�t thereto has been approved by the City as a proper and suitable connection. 402.06 REPAIRS AND MAINTENANCE T�0 CONNfCTION After the initial connedlon has been made to the water service a,�rb stop box or the sewer lead at the property line or a water servke 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 tepatrs required to any water line and sewer lines necessary for connection of the premises from the main to the premises. ff the property owner requests maintenance service or repairs be performed by the City,the property owner shall be charged for the costs of the mairrtenance andJor repairs,including necessary street repairs at a rate set annually by an administrative poliry. It shail be the responsibility of the applicaM, owner,occupant or user to perform standard maintenance of the sewer service li�e from the premises to the main induding debris dearing 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 finished grade of the land or property. (Ref 638,1156,1191)