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� Request Number: 14436
Public Works Division
Service Request
Problem Address: 5201 Pierce St Requested By: Ron Bloch
Departmeut: WA'IER Address: No address p�ovided
ProblemRsswe: INSTALL AMR METER Phone Number: 763-571-5737
Seheduied Date: 2017-04-11 5c6ednle�'Iime: 09:00:00
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AC7ION NEEDED:
Created by: Beth Kon�ick Date Created: 2017-03-30 �
ACTiON TAI�N: �
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Contacted
Date Completed: Completed by:
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Water Department
6431 University Avenue NE
Fridley,MN 55432
763-572-3566
i/we hereby authorize the City of Fridley and/or its employees to do what is necessary to
repiace the water meter. 1 understand that the property owner is liable for the water line frcm the main to the premise and all interior
plumbing. (Per City code 402.06) 1 also hold the City of Fridley and/its employees harmless for any damages that may oaur while 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,if necessary.
FINAL METER READING(old meter)
Name• ��, �,:���/` \ Address��1 ` '��/r�, �
Phone Number ���_������,)� Date �� 4 1�� ` `
Signature Witness Signature
OLD METER# � d ��G C j/�
OLD READING 1 � � `G � � �
NEW METER �� Gl��� � ` � L�
NEW READING �
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FRIDLEY CfTY 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 oonstruding or repair of any water of sewer fine connecting the existing municipal system and arry house or buiiding for which the
application is made,the owner or�ritraictor shalf be required to obtain a permit for such connection,and shall pay a permit fee as provPded in
Chapter ii 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 uritii an inspection has been made and such connection and the work incident thereto has been approved br the City as a
proper and suitable wnnection.
402.06 REPAIRS AND MAINTENANCE TO CONNECTION
After the initial connedion has been made to the water servtce curb stop box or the sewer lead at the properly 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 tine and sewer lines necessary for connection of the premises from the main to the premises. If the property owner
requests maintenance service or repairs be performed by the City,the property owner shall be charged for the costs of the maintenance and/or
repairs,including necessary street repairs at a rete set annually by an administrative poliry. It shall be the responsibility of the applicaM,
owner,occupant or user to perform standard maintenance of the sewer service line from the premises to the main including 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)
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Request Number: 7404
Pubiic Works Division
Service Request
Problem Address: 5201 Pierce St Requested By: Terry Bloch
Department: WA1ER A�ddress: Pb address provided
Problem/Issue: OTHER(WATER) Phone Number: 571-5737
Schedukd Date: 201401-14 Scheduled Time:
ACTfON NEEDED: Trace depth of water service line.
Created by: Wendy Hiatt Date Created: 201401-15
ACTION TAKEN:
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, Status: In Progress Resident Contacted �
Date Completed: Completed by:
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