Meter Swap Request Number: 12874
Public works Division
Service Request
Problem Address: 7517 4th St Requested By: Megan
Department: WA'IER Address: 7517 4th St
Fridley,MN 55432
Problem/Issue: INSTALL AMR METER Phone Number: 763-464-9640
Scheduled Date: 2017-01-24 Scheduled Time: 10:00:00
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ACTION NEEDED:Install AMR
Created by: Beth Kondrick Date Created: 2017-01-13
ACTI N TAI�N: �
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Status: In Progress Submitter Has Been r
Contacted
Date Completed: Completed by:
1 ' �� � l � ��, �-�
�o�/or rr�aoey
Water De�sartment ) � �C� �
6431 Universiiry�Avenue N�E /
� Fridley, MN 55432 �J� , ��'SL�"�
� 763-572-3566
1/we ~ hereby authorize the City of Fridley and/or its empioyees to slo what is necessary to
replace#he water meter. 9 understand that the property owner is liabie for the water line#rom the main to the premise and all interior
pluenbietg. (Per C"rty code 402.06) i also hold the City�of Fridley and/its employees harmless for any damages that may occur while doing this
operation. This to include,bufi not limited to valves,piping,walls,floors or the curb stop hox and service line. In understand!am also required
tn obtain a permit prior to any worlc,if necessary.
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FINAL METER READIPIG(old meterj
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Name: _ l t � � Address �, ���
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Phone Number �A'n�� Lr�v` � C,��Cgate � � ` ��' `�
Signature �—'��----- Witness Signature `��
OLD METER# ��-� � � � ����
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OLD 12EADING �� ���
NEW METER# �� ` �\ �_ `��
NEW READI{VG l/
ERT#_���C� t I S Z .
FRIDLEY CITY CODE
CHAPTER d02.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATIOIV
(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 any house or building for which the
application is made,the owner or contractor shall be required to obtain a permit for such connedion,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 shall be notified. It shall be unlawful to cover
any connecting line until an inspedion has been rnade and such connection and the wortc incident thereto has been approved by the City as a
proper and suitable connection.
402.06 REPAIRS AND fNAINTENANCE TO CONNECTION
A�fter the initial connection has been made to the water service curb stop box or the sewer lead at the property iine or a water service lead has
been extended to the property line for connection,the applicant,owner,or accupant or user of such premises shall be liable for ail repairs
required to any water line and sewer lines necessary for connection of the premises from the main to the premises. If the property owner
requests maintenanee service or repairs be performed by the City,the property owner shatl be charged for the costs of the maintenance and/or
repairs,including�ecessary street repairs at a rate set annuaily by an administraxive po�icy. it shall be the responsibility of the applicant,
owner,occupant or user to perform standard maintenance of the sewer service line from the premises to the main including 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 the finished
grade of#he land or property. (Ref 638,1155,1191)
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Request for Service Repork
� City of Fridley
Reference N o: 601-11-3014 Date: 04/28111
Request Type: Turn waker aFFlon Entered By: Wendy Hiatt
Department: Water Citizen Name: Natasha-Mgmt Company
Address: 7517 4TH ST NE Callback Phone: 952-829-1576
Scheduled Date_ 04129111 9=00 AM -�'yl�'�t.� Property Owner:
Locakion Details: Turn water on Request Details: Turn waker on
Reconnect meter � Reconnect meter
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Action Taken:
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Responsible Person: �„����'�.----�_��� �
Approver: �
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Completion Date: � � _�`� _ 3 �
�Citizen Notified
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City of Frialey
Water Department
6�31 University Avenue NE
Fridley MN 55432
(763) 572-3561
Uwe hereby authorize the City of Fridley and/or its
employees to do what is necessary to shut off the water at the curb stop box. I understaad
that the property 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, yard, landscaping, trees, shrubs, driveways, sidewalks or the curb stop box and
service line. I understand I am also required to obtain a permit prior to any work.
Name: Adclress:
Phone Number: Date:
�,� s
Signature: f������
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Witness Signature: _c��-�.,,;--�___��--�-�--'�---.
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM R'ATER AND SAIVITARY SEWER
ADMIlVISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988, 1144, 1156, 1191)
402.05. PERMIT FEE '
Prior to constructing or repair of any water or sewer line connecting the existing municipal system and any
house or btulding for which the application is made,the owner or contractor shall be required to obtam a
permit for such 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 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 siritable connection.
402.06. REPAIRS AND MAINTENANCE TO CONNECTION
Af�er th�initial connection has been made to the water service curb stop bax 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 repairs required to any
water line and any sewer lines necessary for connecdon of the premises from the main to the premises. If
the property owner requests maintenance services or repairs be performed by the City,the property owner
shall be charged for the costs of the maintenance and/or repairs,including any necessary street repairs,at a
rate set annually by an administrative 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 including
debris clearing or root cutting and to maintain the water service curb stop box for operability and at such
height as will ens�e that it remains above the finished grade ofthe land or property. (Ref b38, 1156, 1191)
L�ty of�'rid.lz�r
�Taie�De�a��e�t
S�;31 L?�v�rsi-ty_�v znue 1�a%
Frialey 1v�i�T 5���2 =
(763) �72-���1 �
Uwe he�ei�� authoi��e thv Ci�� o�r�.�ley a�dlor its
employetis�fl ua �hat i�Ile��,ssary tll�r;,p1a���.he�aiUr me�er_ _T_undE�stand 'rliai�e
prope�iy o��er i� 1 able ior ihe�aater line f�-o�ihe maiu to t�e prer�ise an�.all inz�ror
plu�bi�a- (�er�i�y c�de?42_0� I�?sfl '�old i�e �ity�i Fridley ancv'or lI� ZIl7DIO�T�tis
�a�nlPss ior any damages t�aL tt�13Y OC�l3i w�1t�I.� �p171�t�is op���rifl�. Tbis �o iucla��_bu't
�ai Li�niterl.to; �ialves,P1F�.n� walls, foors or t;�e c�'� sto�bon and s���ice ltae_ 1
Lnderst�nc� i am �ls� requ;r���o n'at� a��-�i-c pro�-�c any�io-�?�, :r��e:,�ssary.
�`�ame: A��ess_
t none l�um'oer: Date: .
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il�fl'lla.��. � ���T�' .
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�`nTit�ess �i�ature_ '�-�--�.
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:r��L��,���'��1����'� -
- ��.���'��=��3a.3?J�,1��,���°�T�v����'�'�d�i� 5.�1�1�'3:��'��;���
1����������r
(kei Ord itiT-o 1li,4b�,�o�, �o'o, 0'29, b�o, 0'02, 92_,980, 1111, l l�o, I191)
�a?.fl�. �-'�'�I'r�'�+�� �
Pror to consiruc�ng or repair oz any�,vate;or sewer line co�eciing the el�stin�mu�icipa,i system and any
house or�uil���or whicn t�e a�pl�cation is made,the o�er or cantractor shal�be ze:�uired io ob'rain a
pemit for such conne�ticn, a�d shzll pa�a per_nit fee as provide�.i�Cna�icr 11 oi-ihis Code. _�ffrer�such
cannz�an has btien made,�he Watzr��Sz�.ve��epa.�-tmeni�all be no�ed. it shall�e urlawn.ti iL covex
any ccnnec�ng.iine until aa inspecrion has bean�ade and suLh conne��ori and the�ork i��ideni t�cre#a
has been appreved by�e Ci�T as a�orooer�ct s�itable canne�ion_
=!OZ.a�. � i���.��31���1°�'�'��T a��T�:v��3 i.�?Il'd�;��'I�1�T
��er t:he iniu�l:cona�c��n has been�ads t��e�x3rer servic� �.�-� s�op bon or��e�ewer�ead�,�u�e
oroper��li�e�or a watz:ser�rc�3r seu�er'•ead�as b�Un z<���ea�fl ihe pr�nei-ty linz f�r can�ec�o�,;�e
�pplican�, o�rner, orthe o�cupan�or�se�oi suc�premises shall'�e Iiable tar a.i'trep�rs iequirzdto an;�
�vater line and any sew�]i�.es netiessaE�fer c��nec�on Qr�a nremises�om�e main tn �.he prem�ses. Lf -
the nropert;r o��r�er re�uests m�inizr�ce se;vices or re�,aLrs�e perrorme�.by?he �iiy,�e propezTy ow�e<
shall be c�arged ior u'�e costs oi 1�L mainte�anc�a�d/or��a�s, �nc��:din�'c3Ily ne�ess��sue�t IeF)21TS,3I 3
rate set�ually ov an aami�is-�aiiva policy. ?_s�a3��e the r�spc�sib�i1i�r of the a�pi�c�r, otiv�er, oc�up:nT
or use;to peai�rm sta�dard mainze�anc�QI he se�ver service�e aflm th.,p�nises io t3�e sain iucluding
de'�i-�� cle��ng or r�ot cui�g�d t4 maiata�n i�e�at�r ser�ric� curb st�p b�ti i�r o-nerab�lit;�anj�su��
hei�t us will en:�are��at;t rem�s abn�ihe fi�.s�e:��ade o�u�e laud or�ro�Priv_ ��i 534, 11�o, lly!j
Request for Service Report
City of Fridley
R eFerence N o: 601-11-2762 Date: Ol 110111
Request Type= Turn waker oFflon Entered By: Wendy Hiatt
Department: Water Citizen Name: NatashalDetloff Mgmt
Address: 7517 4T H S T N E Callback Phone: 952-829-1576
Scheduled Date_ Property Owner.
Location Details: Lockbox ID:2609 Request Detailx= Turn water oFf_ Get meter reading
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Action Taken:
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Responsible Person: � � )
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Approver: �
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Completion Date: ��� 1^✓�, Q Citizen Nokified
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Request Number: 10609
Public Works Division
Service Request
Problem Address: 7517 4th St Requested By: Tim De-Haan
Department: WATER Address: No address provided
Problem/lssue: T[JRN WA'TER ON/OFF Phone Number: 763-568-4714
�
Scheduled Date: 2015-10-07 Scheduled Time: 09:00:00
ACTION NEEDED:Turn off water for repair.Permit#2015-04080****BILL****
Created by: Wendy Hiatt Date Created: 2015-10-07
ACTION TAI�N:
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Status: In Progress Resident Contacted �
Date Completed:� � � � I � Completed by:
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Request Number: 10582
Public Works Division
Service Request
Problem Address: 7517 4th St Requested By: Tim De-Haan
Department: WATER Address: No address provided
Problem/Issue: 1URN WATER ON/OFF Phone Number: 763-568-4714
SchedWed Date: 2015-09-29 5cheduled Time: 0930:00
ACTION NEEDED:Turn off water for repair.****BILL***
Created by: Wendy Hiatt Date Created: 2015-09-29
ACTION TAKEN:
Tc,�.rn r� w�►.{-d-Q�.
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......................................................................................_............_............................._..................._.........._........._................_....................._.._......_._.............................................____...._..............._..............._......................._._._.._...................__................
Status: InProgress ResidentContacted ❑
Date Completed: �/Z��/�; Completed by: �a�
REQUEST FOR SERVICE REPORT
CITY OF FRlDLEY
Reference No. /' _ �� � Date: �--`--1 `r�,
C�� � � `
Request Typ�: Entered By:
Department: Citizen Name: ��
t�. -�I --- - 6
Address: �� � � � � Phone Number: � 3—�'j6�'j —
Scheduled Date: Property Owner: ����
Location Details: Re.quest Details:
Action Taken: _ �
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CPrI_L_ � �t ��-►��Z -'c�J l�`��4C� T� ��A�.��
ResponsibLe Person:
Approver:
Compietion Date: Citizen Notified:
5-�-�5