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Meter Swap � Request Number: 12607 Public Works Division Seivice Request Prol�em Address: 7564 Jaekson St Requested By: Mary Kay Iord�n Dep�rtmeM: WA'IER Address: 7564 Jackson St Fridley,MN 55433 Problem/Issne: INSTALL AMR ME'IER Pho�Number: 763-670-3471 3eheduisdDate: 2U17-01-04 Sc`ed�ladl]�e: U3:OO:QO b � �- ,�; AC"1TON NEF.UED:Install AMR ' Cresited by: Beth Kondrick DAte Crested: 2016-12-28 ACIION TAI�.N• I� `�� ,t,e�- ��..�, ____r��____ r St�na: In Progcess 5obeiltter Hu Hee� � Coitacted Date Co�eted: �� - l Coimpleted by: , � .��' 1 City of Fridiey �'� �'' �/� �� v��" Water Department . - 6431 University Avenue NE � � ` Fridiey,MN 55432 � (�� 763-572-3566 �`� i/we hereby authorize the City of Fridley andjor its employees to do what is necessary to replace the water meter. 1 understand that tfie property owner is liable for the water line from the main to the premis�and aN interior plumbing. (Per City code 402.06) 1 also hold the City of Frid4ey and/its empioyees harmless for any damages that may occur while doing this operatio�. This to inctude,but not limited to vatves,piping,walis,floors or the curb stop boz and service line. 1n understand 1 am also required to obtain a permit prior to any work,if necessary. FINAL METER READING(old meter) � �� `-'a `� " Name• ��/ i�l �Slii��"'� Addrexs_ __ !_� ��C��1,n �. Phone Number �t�3 '.3 / Date �_'� � ( Signa Wiiness Signature �� OLD METER#__� � � �lD V =J � , OLD READING �� ` ��G IVEW METER# �� I Olo CJ� NEW READING v Ear# � � S� � d �7 7 � FRIDtEY CITY CODE CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER ADMINfSTRATIOAi (Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191j 402.5 PERMIT FEE Prior to constructing or repafr of any water of sewer line connecting the existing municipai system and ariy house or buitdi�fo�afiich the application is made,the owner or contractor sball be required to obtain a permit fw sucM connection,and shaN pay a permn fiee as prov�ed irr Chapter 31 of this Code. After such connection has been made,the Water and Sewer Department shatl be notified. tt sha{I be unlawFul to c�rer any connecting line untii an inspedion has been made and suth wnnection and the work incident thereto has been approved by the City as a proper and suitable connection. 402.86 REPAIRS AND MAINTENANCE TO CONNECTION After the initial connectioa has been made to the water senrice curb stop box or the sewer lead at the property 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 shali be liable for ail repairs required to any water line and sewer lines necessary for connectian of the p�emises from the main to the premises. If the pro�rty a�rner requests maintenance service or repairs be perfiormed by the City,the property owner shall be charged for the costs of the mal�rtenaece a�d/or repairs,including necessary street repairs at a rate set a�nuaily by an administrative policy, ft sfiai{be the responsibility of the applicaM, ow�er,occupant or user to perform standard maintenance of the sewer service line from the premises to the main includir�g debris clearing or root cutting and to maintain the water service curb stop box for operabifity and at such height as wili ensure that it remai�above the fl�ished grade of the land or property. (Ref 638,1156,1191� � �t�q�t f�r�e � R�� ' +�i�r a�# Fric#�y � �: ��-�2-�a t��: �r-��r�o�2 �T�ea T�wat�a�lan E3�r. YYa� . Wat�s . Add�s: 7�i+1.�Oil S I`NE C:aEu�c�: �x3-38A�36 tlaE+e: frl'i?�1�'7�ll#i �� t�w�r: . �70 fieque�t D�: 5hut�x a�-ie+aMe lar�r � p A�n T�� -��,,�� ti'� J�tc,� S� O�� ; "'�'��`� �S `gCZm�s�J f�� v'�.�� 1�itJ� tT. l.�e�,� c�K� w � �.L t�e�� t�� O ►.SOT �l LL � t � � � �... ____ _ �_ _ __�_�n____�� .._.�_._� �� i � ��. _..._...____._�__.� .._-.��______.._,_.._____ _ � � �.__�._ __..�__._____.___�__ _.._. �_�____�_.__ __�_� ��: � �___�� _��-.� __ __ ______� . • City of Fridley Water Department 6431 Univexsity Avenue NE Fridley MN 55432 (763) 572-3561 Uwe /�-Vi/ � hereby authorize the City of Fridley and/ar its employees to do what is necessary to shut aff the water at the curb stop box. I understarid t.hat the property owner is liable far 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 wlule doi.ng 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 germit prior to any work. , � Name:��-/�-/�-r ' ' �1�'.,' •.` � Address: ��-t JAC..I�� Phone Number: 7�3'��y "��Jh Date: � ��'� � Signatur • � Witness Signature: FRIDLEY CITY CODE CHAPTER 402.WATER,BTORM WATER AND SANITARY SEWER ADMiPTISTRATION (Ref Ord No'113,464,565,566,629,638,662,922,988, 1144, I 156, I 191} 402.05. PERMIT F`�E Prior to consttuctm�or repair of any water ar sewer Iine connecting the existing municipal system and any house or building for which the application is made,the ou�ner or contractor shall be required to obtam a pex•mit for such connection,and shall pay a perniit fee as provided in Chapter 11 of ti�is Code. After snch connection has been made,the Water and Sewer Deparbnent shall be notified. It shall be unlawful to caver 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 aud scdtable connection. 402.06. REPAIltS AND MAINTENANCE TO CONNECTIUN Aftez 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 or sewer lead has been extended to the properry line for com�ection,the applicant,owner,or the occupant or user of such premises shall be Iiable for a]1 repairs required to any water line and any sewer lines necessary for connection of the premises from the main to the premises. If the property owner requests maintenance services or repairs be performed by the City,the prop�rrty owner shall be charged for the costs of the maintenance and/or repairs,in.cluding any necessary street repairs,at a rate set annually by an administrative poIicy. It sha11 be the responsibility of the applicant,owner,occupant or user to"perform standard maincenance of the sewer service Iine from the premises to the main including debris clearing or roat cutting and to ma.intain the water service ct�rb stop box for operability and a#such height as will ensure that it remains above the f�ished grade ofthe land or properiy. (Ref 638,1156, 1191j