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Meter Swap , , � - .: Cily of Fridley Request Number: 17900 P�Iic worka Dlv�ion � Sen�lce Recpieat Probtem A�esa: S 1 Talm�dge Way Req�sted By: Department: WATER Addr�:: No acldress provided Problem/Isane: INSTALL AMR METER P�oae Nnmber: 651-500-�009 Sc�eduled Date: , 018'-03-09 Sc6�d�led 11me: 08:00:00 ;� �� r � ��v ACIION NEEDED: t CYented by: Beth Kondrick I�te Cre�ed: 2018-03-08 .Ai(,'IION'�'�i: ,- __._ ._a���...��� ��.� _._._.._.. StAtas: In Progress Sabmitter Haa Been r Co�ted :; Date Completed: CQmpleted by: � Honrs n �,(p 3- � ��, ,.,, �. � r � ., ��; -��:� � �;�:� , � � ��, � � .� �. .. � � . � S'o �i-� City of Fridley Water Department � (��"�71?�v� 6431 University Avenue NE Fridley,MN 55432 763-572-3566 �/We hereby authorize the C'�ty of Fridley and/w�ts employees to do what is necessary to replace the water meter. I understand that the property owner is liable for the water(ine from the main to the premise and all interior plumbing. (Per City code 402.06) I also hold the City of Fridiey and/'�ts employees harmless for arry damages that may oaur while doing this operation. This to inctude,but not limited to vahres,piping,walls,floors or the wrb stop box and servi�line. In understand 1 am also required to obtain a permit prior to any work,if necessary. FINAL METER READING(old meter) � ly �(/►' / v t/ Name: Address �I I � �1��!/��'1� ��lG Phone Number��� � :J� �' /�� ` p�e ��9 ` � (j �/ Signa�ure /' �/�.� WitnessSignature s �j !_ \ OLD METER#_ , � I -1 � �V�(7 SIZE & STYLE(Circlel OLD READING � lY � / �� 5/8" HEX �� � NEW METER# 1 �� � � � � lS/ 1" HEX NEW READING v I�" ELIPTICA� or HEX ERT# �'a 3� �� � 2" ELIPTICAL or HEX FRIDLEY CITY CODE CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER ADMINIS'TRATION (Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191) 402.5 PERMIT FEE Prior to construding or repair of arry water of sewer line connecting the existing municipal system and any house or building for which the application Ys made,the owner or contractor shali be required to obtain a permii 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 Departmerrt shall be notifred. It shall be unlawful to cover any connecting line until an inspection has been made and such connection and the work incider�t thereto has been approved by the C'ity as a proper and suitabie connection. 402.06 REPAIRS AND MAINTENANCE TO CONNECTION After the initial connection has been made to the wate�senrice curb stop box or the sewer lead at the pro�rty line or a water service tead has been extended to the property line for connection,the applicant,owner,or occupant or user of such premises shall be IiaWe for all 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 mainte�ance service or repairs be performed by the Ctty,the property owner shall be charged for the costs of the mair�tenance and/or repairs,inciuding necessary street repairs at a rate set annually by an administrative policy. it shall be the responsibtllty of the applicant, owner,occupant or user to perform standard mairrtenance of the sewer service line from the premises to the main induding debrts clearing or root cutting and to maintain the water senrice curb stop box for operability and at such height as will ensure that it remains above the finished grade of the land or property. 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Please retum this portion wkh your paymeM. When paying in pe►son,please brinp both portions of thls bill. MAN HUYNH REMIT AND MAKE CHECKS PAYABLE T0: 51 TALMADGE WAY NE CITY OF FRIDLEY FRIDLEY,MN 55432 6431 University Avenue N.E. Fridley,MN 55432-4303 315520770030000000146420000000161061 CUSTOMER ACCOUNT INFORMATION -RETAIN FOR YOUR RECORDS Name Service Address Account Number MAN HUYNH 51 TALMADGE WAY NE 315-520770.�3 Status From e^��ce ate o #Da s Bill Date Pena{ty Date Due Date Active 10/31/2017 1l31l2018 92 2i28/2018 3/30/2018 3/30/2018 PREVIOUS BALANCE 5583.43 PAYMENTS �0.00 ADJUSTMENTS 5583.43- PENALTIES 50.00 CURRENT PREVIOUS PAST DUE AMOUNT S0.00 METER# DATE READING DATE READING USAGE FIXED WATER CONS 18.00 STAT'E SERV CONN 1.54 SEWER BASE CHARGE 50.00 SEWER USAGE 59.39 STORM WATER 9.24 RECYCLING 8.20 Tax 50.00 ADJUSTED BILL $146.42 AMOUNT DUE 5146.42 AMOIJNT DUE AFTER 03/30/2018 S161.06 _ �� _Iv o��,t,u'v� ��.��. '�Ol� �l�f�� � �����'�" �� _ ,�y�� � � 6M �� �w� FR�M :CITY QF FRIDLEY FAx �4. :7635711287 Jan. 02 2013 �1:00PM P2 R�Ll�"55� ��1" �E�(�6C� ��t�C� Clf�f C�� '�fbtlE�]I p ��(t� fie�f�*ar�ce Na: f�l-f3-561� D�ta� 1r'2r�13 -� R�q��t Type: lib.� 5,��i!8y; �Be�rson (�!e[t!: �' C,�taen PJ�ne: Aw1d�: 5A TlIL.M�R�GE iA►AY NE Ca�c.�f�hhons: 763»571� Sct�edufec�[?ate_ 1�13 it�4�AM Ptope�iy t3wrr�x A+�Fiuyrdt Lo�aliat�'�A�: {V�w8ter snGe ye�tar�y Heqr�st Ddai�: Sess wh�►na waR�er_ �T�: : �m� 4u��. '��'� A '�t-v���'�►C� �'�PA`� � � 1,��-��, W�"t� ��� �� CA�c � �� "� �� L �,,?� -'� k��S C�w I•� �uS� . �O?N �lll.v�`S l� ► �.'�` "T�c-� M �-r,� w�,� �,.,� �,�-�c2 �s o N `7�4�+oc�Ca�1 —�'�-4�..- n(��['�,, I� N��:�'� �''Da ��S ���M�,��(�, �-������ ...�.........�,........._............_.....�...___.._......__.___._.._ __.__...._... .._. . ___._ . .. Responsible Person: ��C�:�� � V�rM�- �+PP'�'� C [1�e; !" a`�I� �t�en Nd�d