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Request Number: 12205
Public Works Division
Service Req►�est
Problem Address: 5421 W Brenner Pass Requested By: Andy M�ciacciaro
Dep�rtment: WATER Address: No address pzovided
Problem/Isaue: INSTALL AMR METER Phone Number: 763-567-8620
Schedul ed Date: 2016-11-15 SchedW ed 13me: 02:00:00
� c�e � �, C�
ACTION NEEDED:AMR
Created by: Wec�y Hiatt Date Created: 2016-11-09
ACITON TAI�N:
__. _�__.._._....�.._.___..______�_I�...�'� _.
Status: In Progress Sabmitter Has Been r
Contacted
Dxte Completed: Completed by:
1 � � � 5- �
.
` � 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. l understand that the property owner is{iable for the water line from the main to the premise and all interior
plumbing. (Per City code 402.06) t also hold the City of Fridley and/its empioyees harmless for any damages that may occur while doing this
operation. This to include,but not limited to vaives,piping,walls,floors or the curb stop box and service line. In understand I am aiso required
to obta'sn a permit prior to any work,if necessary.
FINAL METER READING(old meter� �� ���
Name: Address � y� l, "v ti��'�- �_�,�
Phone Number Date ` �'`��J����
Signature ~ ' Witness Signatur� r�
OLD METER#��� � 1��
v
OLD READING ��� ` �lJ
NEW METER# �`�� ( l ����
NEW READING �
ERT# 1� v� �`-�w
FRlDLEY ClTY 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)
402.5 PERMIT FEE
Prior to constructing or repair of any water of sewer line conneding the exisCing municipal system and any house or buildi�for whicfi the
application is made,the owner or contractor shall be required to obtain a permit for suth connection,and shall pay a permit fee as provided in
Chapter 11 of this Code. Afte�such connection has been made,the Water and Sewer Department shaii be notified. It shall be unlawful to cover
any connecting line until an i�spection 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 tine for connedion,the applicant,owner,or occupant or user af such premises shali be liabie 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 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 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 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�nished
grade of the land or property. (Ref 638,1156,1191)