Meter Swap �
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Citp ot Fridiey
Water Department
Address ��0� � .����'��a`�
Name S�'sCE.y ,� �A��—
Date S"���V( �
Old Meter Number � � ��
Old Meter Reading �� �T
Replacement No. J��U f]��
Replacement Reading_�
Replacement Make ��t7C��--
Remarks• '"���OQP� ,�' � t�-
Signed � _
' Request Number: 12220
Public Works Division
Service Request
Problem Address: 5407 E Brenner Pass Requested By: Brittney J�kson
Department: WA1ER Address: No address provided
Problem/Issue: INSTALL AMR METER Phone Number: 1-320-496-3529
Schednled Date: 2016-1 -17 � Schednled TYme: 07:00:00
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ACTION NEEDED:AMIt
Created by: Wendy Hiatt Date Crexted: 2016-11-14
ACIION T.AI�N:
i�5�... .
Status: In Progress Sabmitter Has Been r
Contacted
Date Completed: Completed by:
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City of Fridley
, Water Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3566
i/we hereby authorize the City of Fridley and/or its employees to do what is necessary to
replace the water meter. I understand that the property owner is liable for the water line from the main to the premise and all interior
plumbing. (Per City code 402.06) l also hold the City of Fridley and/its employees harmiess for any damages that may occur while doing this
uperation. This to include,but not limited to valves,piping,walis,fioon or the curb stop box and service line. in understand I am also required
to obtain a permit prior to any work,if necessary.
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FINAI METER READING(old meter)
Name� Address ��L� `� << `���� ��
Phone Number Date � � � t�'" �1!J
Signature I'��7/1.�1 Witness Signature
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OLD METER# ��� �d�35
OLD READING � l _ ` �- � ��
NEW METER# ��� �� l��C��
NEW READfNG l`�'
ERT# LV (.7 V I �.'�j��
FRIDLEY CITY CODE
CHAPTER 4U2.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191)
402.5 PERMIT FEE
Prior to constructing or repair of any water of sewer line connecting the existing municipal`s e,ln and any house or building for which the
application is made,the owner or contractor shall be required to obtain a permit for such con d shall pay a permit fee as provided in
Chapter 11 of this Code. After such connedion has been made,the Water and Sewer Department s al(�be noti�ed. It shall be unlawfuf to cover
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 and suitable connection.
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 appiicant,owner,or occupant or user of such premises sha�l be liabie for ali repairs
required to any water line and sewer iines necessary for connection of the premises from the main to the premises. If the property owner
requests maintenance service or repairs be performed by the City,the property owner shall be charged for the costs of the maintenance and/or
repairs,including necessary street repairs at a rate set annually by an administrative policy. It shall be the responsibility of the appficaM,
owner,occupant or user to perform standard maintenance of the sewer service fine from the premises to the main including debris cleartng 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)
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