Meter Swap . ' Request Number: 13095
Public works Division
Service Request
Problem Address: 1331 Meadowmoor Dr Requested By: Jerome Banick
Dep�rtme�: WA'IER Address: 1331 Meadov�wor Ih
Fridley,MN 55432
Problem/Issue: INSTALL AMR ME1ER Phone Number: 763-784-0009
Scheduled Dnte: 2017-02-03 Sc�ed�led 11me: 10:30:00
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ACIION NEEDED:AMR
Crexted by: Beth Kondrick Date Created: 2017-01-26
ACTION T
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Status: In Progress �bmitter Aaa Been r,
Contacted
Dnte Completed: Com�leted by:
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iNater�epartrnent
6431 i�niversity Aversue NE � � a a,� I
Fridley, MN 55432
• ` 753-572-3566 3 �a � S'1 S � �71 `_� 1
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�/We her�by authorize xhe C'rty a#Fridley and/or its empioyees to do what is necessary to
replace the water sneter. �understand that the property owner u liable for the water line from the main to the premise and all interior
plumbing. (Per City code 402.06; i also hold the C'rty af Fridiey and/'rts employees harmless#or arry slamages that may occur while doing this
operation. This to include.bufi not lim'rted to valves,piping,walis,floors or the turb skop box and service line. in understand i am also require�
#o obtain a permit prior to any�rork,if necessary.
FIlVAL METER READING(olc!mefier) ��� �`�`�
Name•�CJ` "�� ��� Address � �l�� `� `C���W1�� �'
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Phone Number � p � �
Signature�^ iN'rtness Signateire
OLD METER# �,��� ����
OLD READ[NG i�� �v �O�.J ,
NEW METER# ��L�'Ir��Z��
NE1N READfNG �
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FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord Wo 113,464,565,566,629,638,652,922,9$8,1144,1156,1191j
4Q2S PERMt't'FEE
Prior to constructing or repair of any water oF sewer line connecting the existing municipal sysfiem and arty house or buildir�for which the
application is made,the owner or corrtractor shalt be required to obtain a permit for such connection,aod shall pay a permit fee as pruyided irr
Chapter 11 of this Code. After such connection i�as been made,the Water and Sewer Departme�rt shall be notified. R shail be unlawful to cover
any connecting line urrtil an irispection has been made and such connedion and the work inaderrt thereto has been approred by the City as a
proper and suitable connection.
402.06 REPAIRS AND MAI{11TENARICE TO CONNEC17aN
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 servi�lead has
been extended#o the pro�erty IFne for connection,the appf iprrt,owner,or accuparrt or user of wch premises shali be IFaWe for a8 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
reqaests maintenance senrice or repairs F�e performed by the City,the property owner shail be d�arged for the costs of tf�e mairrtenance and/or
repairs,including necessary street repairs at a rate set annuaily by an administrative policy. It shall be the responsbility of the applipnt,
owner,occuparrt vr user to perform standard mairrtenance of the sewer service line from the premises to the mai�i�du�ng debris deariag or
root cutting and to mairrtain the water service curb stop box for operability and at such heigtrt as wili ensure that it remains above the finished
grade of#he land or property. (Ref 638,1156,1191)
Request for Service Report
City of Fridley
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R eference N o: 601-11-3077 D ate: 06/01111
Requesk Type: Turn water oFFlon Entered By: Wendy Hiatt
Department: Water Citizen Mame: Jerome Banick
Address: 1331 MEAD04ti(MOOR DR NE Callback Phone: 763-784-0009
Scheduled Dake= 061011ll 1=U0 PM -- � Property0wner.
Location Details: "xx`BILLx"x' Request Details: Shut waker offlleave key
Permit#2011-00771
Action Taken:
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��Responsible Person:
Approver:
Completion Date: Q Citizen Notified
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