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Meter Swap . Request Number: 12460 Public Works Division Service Request Problem Address: 7398 Concerto Cun+� Requested By: C�rol Glidden Department: WATER Addres:: No sddress provided Problem/Iasne: 1NSTALL AMR METER Phone Number: 763-786-6836 Scbeduled Date: 20 -1 -20 5c6edaled 11me: 01:30:00 � [ '�� ACliON NEEDED: Created b3: Wendy Hiatt Dste Created: 2016-12-1 S AC1iON TAI�N: � s�. �e � ��Z st�ua: In Progress sabmitter Hu seen C, Conhcted Drte Completed: '�� — �v.� '� Com�eted by: � �' . __......__ � ' � City of Fridley �-�/'� _ Water Department 5�T �. ' 6431 University Avenue NE Fridley,MN 55432 '3v(,1 ��p �7�U l�l 763-572-3566 �/We �"'r'� r � '��% �'�1 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 hold the City of Fridley and/its employees harmless for any damages thai may occur while doing this operation. This to inctude,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. FlNAL METER READIPIG(oid meter) �� ` v�� Name: �f1��U 1 �(r C�d'� � Address �� 1� l.�V�GB•r�-G �.u•+^'�'� Phone Number ��'7 �V.� �� Date 1ry'ZV i`� �Signature L . �tness5ignature �''1(l� OLD METER# I � " l �� I OLD READIf11G �� NEW METER# �� I I � / �� NEW READING U ERT# "' "� �� v � � FRIDLEY CITY CODE CHAP'TER 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 constructing or repair of any water of sewer line connecting the existing municipal system and arry house or buildir�for which the appllcation is made,the owner or co�ractor shall be required to obtain a permit for such connection,and shali pay a permtt fee�pro�rided in Chapter 11 of this Code. After such connection has been made,the Water and Sewer Department shall be notif'ied. It shall be uolawful to cover any connecting line until an inspection has been made and such connection and the work incident thereto has been approved by the C�ty as a proper and suitable connection. 402.06 REPAIRS AND MAINTENANCE TO CONNECTION After the initial connection has been made to the water service curb stop box or the sewer lead at the property line or a water service iead has been extended to the property line for wnnection,the applicaM,owner,or acwpar�t or user of such premises shali be liable for a!I repairs required to any water line and sewer lines necessary for connection of the premises from the main to the premises. If the property owoer requests mairrtenance service or repairs be performed by the C'ity,the property owner shali be charged for the�of the maintenance and/or repairs,including necessary street repairs at a rate set annuaily by ao administrative poliry. R shall be the responsibility of the applicarrt, owner,occupant or user to perform standard mairrtenance of the sewer service line from the premises to i�e 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 the land or property. (Ref 638,1156,1191) R�u�st f�r '�e� R�rt . �i�t ca# Fricfl� � �€ �: ��-�2-� ��: ��r�o�2 T�� T�+��f� �. . �rr�� - . � �: ��ao�c:�c��rv�E �� -�-z��a �: �.��a�:��w�-- c�: ��: ; �� T.�,�� e�.��, �� i.7�+�� (�� 's�.� .�'t�-�S� �� ; �p lL�-� �-� to�3 d � t�� i � � � � 1 �3, � t� 3 � I � � . i � ! t � � � j t......v__..._ ...� ....._.. ......., e........... ...............__ _...._........_......._.._...._..........�........_......__......._..........n...._........_..,.r . � � � i ...._......_.....> ......_....... �.._�..� ._ ....�.._....._ . ..............r._...._. „.........P......._....._._._..._..� ` �. 1 1(^', � _ .._.....�...�-..e�.�l. `.��-V ...........__«_-..... ......d � �� ' City of Fridley ` Water Department 6431 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 offthe water at the curb stop box. I uuderstand 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, shiubs,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: Address: ��LJ ��\�J� Phone Number� ��3"7�` ��.�� Date: A � ��d� Signature: l� � Witness Signature: F`RIDLEY CITY CODE CHAPTER 402.WATER,STORM WATER AND SAIVITARY SEWER ADMIlVISTRATION (Ref Ord No 113,464,565,566,629,638,662,922,988, 1144,1 I56, I 191) 402.05. PERMTT FEE Prior to constructing or repair of any water or sawer line connecting the existing municipal system and any house or building for which thc application is made,the owner or contractor shall be required to obtam a pernut for such connection,and shall pay a permit fee as provided in Chapter 11 of t�is Code. ARer such connection has been made,the Water an.d Sewer Department shall be notified. It sha11 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 smfisble connection. 402.06. REPAIl25 AND MAINTENANCE TO CONNECTIUN After the initial connect'ron has been made to the water service curb stop box or the sewez lead at the property Iine 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 sha11 be liable for all repairs req�tired to any water line and any sewer lines necessary for connection of the premises from the maiu ta 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 ra.te set annually by an administraxive policy. It shall be the responsibility of the applicant,owner,occupant or user to perform standard maintenauce of the sewer service line from the premises to the main including debris clearing or root cuiting 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 tand or properiy: (Itef 638, 1156, 1191j