Meter Swap ,
� Request Number: 12523
Public works Division
Service Request
Problem Address: 7301 Memory Ln Requested By: Ron Panasuk
. Dep�rtmlut: WATER Address: No address pcovided
ProMem/Issue: TURN WA1ER ON/OFF Phone Number. 612-860-7711
Scheduled Date: 2 -12-21 5cheduled 1lme: 08:30:00
2G� S� g` �O '
ACIION NEEDED:Turn off water so valve c�be replaced Tnstatl AMR as well.He is on the list.
Greated by: Wendy Hiatt Date Createds 2016-12-20
ACTION TAI�N:
���:'�,� 0�-'1�--�(�.L� �
�1�S ��u-� Pr�C�
____ ��.�v� ��� �?'r 3o t a-a�
�tl.f
St�tus: In Progress Submitter Hn�Been r,
Co�xcted
Dxte Com�eted: Gompleted by:
la����� �
City of Fridley
�ater Deparf�nent
Y 6431 University Avenue I�TE
� Fridley MN 55432
• (763) 572-3561
Uwe hereby authorize the City of Fridley and/or its
employees to do wha.t is necessary to shut off the water at the curb stop box. I un.dersfiarj.d
that�the progerty owner is liable for the water line from the main to the premise. (Per
City cod.e 402.Ob) I also hold the City of Fridley and/or its employees ham�less for any
dam.age�that may occur while doing this operati.on. This to in.cl.ude,but not limited to,
sod,yard,landscaping,trees, shYubs,driveways,sidewalks or the curb stop box and
service line. i understand I am also required to obtain a pemzit prior to any work.
Name: Address:
Phone Number: Date:
Signat�e:
�itaess Signature:
FRID�LEY CITY CODE
C�A,PTER 402.WATER,STORM WATER AND SANiTARY SEWER
AD14�IINLSTRATION
(R.ef OrdNo 113,464,565,566,629,638,662,922,9$8,1144,1156,1191)
4U2.05. PERikIlT FEE
Prior tfl constractin.�or repair of any water or sewer line cannecting the existing munici�al system and any
house or build'ung for which the application is made,the owner or com�ractor shall be reqaired to obtaui a
. peanit for such co�meciion,and shalt pay a.permit fee as provided in Chaptsr 11 oft7�is Code. After such
connection has heen made,the Water an.d Sewer Depazlment shall be notified. It sha11 be nnlaw.ful to cover
auy cannecting line until au inspection has been made and such connection.and i�.e work incide�t thereto
has been agproved by the Ciiy as a proper aact saitable connection.
402Afi. REPAIlt5 AND MAIlVTL+'N.ANCE T+0 CONNECTION
A:ftar the initial connection�.as been made ta the water service curb stop bnx ar the sewer lead at the
properiy line or a water service or sewer lead has been extend,ed to the PraPem'line for c�neclion,i�e
applicamt,owner,or the occrgrant or user af such premises sball be liable for all repairs requ�ed to saY
water lin:e and anp sewer lin.es necessary for conneciion of the premises from the m�n to ttie premises- If
the pmperty owner requests maintenance services or repairs he performed by the City,the prope�ty owner
shall be charged for the costs of the mai�tenance andlor repairs,ineluclmg any necessary street repairs,at a
rate set anunally by�.A�Imm;sn�ative policy. It shall be the responsibility of ttie applic�owner,occapant
or user to'perform staudard mamtenance of the sewer service 1'me fram the preqnises to ti�e main includ'mg
debris clearing ar roat cut#ing and to maintain the water service c�b stop bog for operab�ty snd at such
height as wr11 ensute t�iat it zemains above the finished g�rade of the land or propert,y: (Ref 638,1156,1191j
City of Fridley �� � '1 � �
Water Department - �
6431 University Avenue NE � l� S-�S�jU—v�
Fridley, MN 55432
' 763-572-3566
�/We hereby authorize the City of Fridley and/or its emp�oyees 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 alw hold the City of Fridley and/its employees harmless for any damages that may occur while doing this
operatton. This to include,but not limited to valves,piping,walis,floors or the curb stop box and service line. In understand I am also required
to obtain a permit prior to any work,if necessary.
.. FlNAL METER READING(old meter)
� � � � O
Name: �c� ��t��v� Address � �jd� .i � l C`,/�(�+�-7 t�N
Phone Number_���� (a�o� �� � � D� ^ ` K./
Signature `� � ��,W" Witness Signature
OLD METER# ��^,�) S C�v(� �.l
OLD READtNG l� 1 �/ I �� �v
NEW METER# ( �` I �� �U
NEW READING �
ERT# ���� O S � [
�- .
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANlTAtiY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191)
s�
.�� �:S PERMIT FEE
,.j , �.
we
Prior to constructing or repair of any water of sewe�tine connecting the existing munidpal system and any house or building for which the
��,,application is made,the owner or coMractor shall be required to obtain a permit for such connection,and shall pay a permit fee as provided in�
Chapter 11 of this Code. After wch connection has been made,the Water and Sewer DepartmeM shall be notif'ied. It shall be unlawful to cover
any connecting line untii an inspection has been made and such connection and the work inadent thereto has been approved by the City as a
proper and suitable connedion.
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 lead has
been extended to the property line for connection,the applicaM,owner,or occupant or user af such premises shall be liabie for all repairs
required�to any water fine and sewer iines necessary for connection of the premises from the main to the premises. if tl�e property owner
request"s maintenance servke or repairs be performed by the City,the property owner shali be charged fo�the costs of the maintenanc�and/or
repairs,including necessary street repairs at a rate set annually by an administrative poliry. 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 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)
t f_
��,
�� r
_ ''�