Meter Swap �� l�-U I�5-Y�ivy��
� ��"`��1 INSTALLATION
G.n� AUTOMATIC METER READER
FRIDLEY
Address 1(� 2�`�1� ��.
��
Name ���� ����'�
Date � l �'�-V '� �
Old Meter Number .� � �
Old Meter Reading � �
Replacement No. �a
Replacement Reading �
Replacement Make �
ERT# � �{C3�
� �
Replacement ERT#
Remarks:
Q.�3�] Signed:
Requ+est fQr �rv�ce Report
. �ity of Frid�
f�F�renc�fi�: �1-Z 1-3'�07 i}�e: 11'I28J2'�1�
R� Tppe� T�n water afflon Erd�eci By: W�dy l��#
Qe�a . Water t:�iz�N�e: F�k w/7{�'s
Adckess� 482 RICE CREEMM�TER NE C�adc Ptro�+e: 763-493-�D
s��a �c�: �j�rzo» �:����--� ��S , P�c�: pc��� �7G�'� ��� �� �l�
Loca�icx,��s: ""B��.L"" � neta�s: shut ,rr�teF off-le�►e ke�r
Pexrr�T##2011-02'fi�4
���� ��.1��Cv�
,�T��,:
; ��
v� w��� a �F �-�� 1�� i
I , -(� �J� K�-� � �G�N �
�<<� �
N`����,--� ���Z ������ ���= . ;
l !
� �
�
E �
G ,
; �- � - 33��73�� ;
���� � ;
i
� � �c� �-���(� - `�D �c7 '
i �}._ c.{ !
� ��� ��� �s�la�g ;
' �� ����� � ;
,
� �
� �-�� ��a�6�o �
�
4 _ _ _ _ . _ __ . ___ _ �
�,�P�:
��:
_ _ _
c���: � _ �, 1 � I�c�;��r�a
� _ __ ,
� (�
,. ' City of Fridley
Water Department
6431 University Avenue NE
Fridley MN 55432
(763) 572-3561
I/we hereby authorize the City of Fridley and/or its
employees to do what is necessary to shut off the water at the curb stop box. I understarid
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 hannless for any
damages that may occur while doing 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 permit prior to any work.
Name: Address: �'�,�. ��CE �N� � E�2
Phone Number: Date:
� , � ,
Signature:� t � i `-., ��, 1 l�� j '� ��
Witness Signature: �-
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988, 1144, 1156, 1191)
402.05. PERMIT FEE
Prior to constructing or repair of any water or sewer line connecting the e�cisting municipal system and any
house or building for which the application is made,the owner or contractor shall be required to obtam a
permit 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 Department shall be notified. It shall be unlawful to cover
any connecting line until an inspection has been made and such connection and the work incident thereto
has been agproved by the City as a proper and suitable connection.
402.06. REPAIRS AND MAINTENANCE TO CONNECTION
Af�er 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 or sewer lead has been extended to the property line for connection,the
applicant,owner,or the occupant or user of such premises shall be liable for all 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 property owner
shall be charged for the costs of the maintenance and/or repairs,including any necessary street repairs,at a
rate set annually by an administrative policy. 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 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)
� Request for Service Report
City of Fridley
Reference No: 601-11-3906 Date: 11/28/11
Request Type: Turn water aPFlon Enkered By: Wendy Hiatt
Deparkment: Water Citizen Name: Rick w!Kal's Plumbing
Address: 482 RICE CREEK TER NE Callback Phone: 763-493-2060
Scheduled Date: �� ��,11 f� ,� '�j(j'"'r�Qs , Property Owner:
Location Details: Permit#2011-02664 Request Details= Shut oFF water - learre key
"'"B I LL""x`
Action Taken:
Responsible Person:
. F2�quest f+�r Serv�e R�p�or#
�ity of Fridley
t��ce t�a: �-12-�4�'Oa t?ace: 1l1ot2�d12
Request T�e� TY seirer�fir�e Errt�reci�j. W�uly k�t
�artme�: 5ern� t�ixe�►V�e: Jaao�Kanop�
Ad�� 482 RICE GFtEEK 7ER NE Ca�ad�c�e: fi12-7t�9-6d�3
S�duled Date_ 1/11/2t►1�"2:#i�FIYI ,�L'�' P�()wn�:
L.�ca#ic�n t��s: � D�eta�s: 7�Sewer Ser��cx
Ac�icm T�:
° l--� -S i,
i ����u=z_ �.--�t�rz ����t�5�� � ��o o�'`��LT' i
? ' � � �-�' av� ��&- � ��"'_
i �p�� � �,�(���.��v �
I
�
I
I
i
�
�
� �
,
r
�����,: ���_� �� � . " _ .
_ ...___ �-,
,���: � -J ._ _ _
�
c� - ��: ���r��a
\ � � t _ �c�2�
!��{�t for�noic.�; Repr�rr�
��y caf Fridi�:y
�.�.. : �. -�2-:� �: ���orzt��2
T�e� T�t�s�+�� �r:
I�ar�e.nf: S�r ��e: Ja�s iSa�p�
Ad�: �FilCE C�C TER� �P�ar�� �12-7�73
[)at+e= 7171J�1��!Q F�1 _
t�[}�a�s: :i�rrrat tleia�s: 71�i Scw�r Secvi�e
,m_ .. �. __ __ _ _. � _ ��_ � ._.� . �_�._ m__ �.. �_� ___�_ � �. ..___.__. __..____ _ _� _ . ..___�..� _.__.. ���� __�. .,�__
�t Ta�:
' �trr"d f�ar�'dt��
�� �
�
�
I
I
�
� �
f
�
�
�
�
� _ i
� 'Car�g�
�
��..._.______ _._- —w____. � ._._.... _ ._....____� __ _._�._.___ �
��e: 114f�tI��7:'14,�1 ��
I �
� .....___ ... �._ _.m_..�. _ .�...�